[Question #5118] What should I do?

23 months ago
I scratched my arms badly in sleep which bled. Skin was healing and scab formed in 2 days.Went for a massage 2 days later but during massage the scabs were removed by nails of the masseus and started to bleed. Did not know then but found while showering later.She offered me extra services which i refused and she got annoyed.I remember that she inserted one of her hands in her pants inside her undergarments for about 10 seconds and resumed massaging me directly over the area where I had blood.I am worried that while she put her fingers in her pants vaginal/anal fluid or menstural blood came to contact with her fingers and then she landed it directly on the cut on my arms. I think she did it on purpose. My wound was not bleeding much but had drops of blood at two locations. I tested on day 25,40,55 and 69 days with a 4Th GEN combo test (non reactive).Dont know her HIV status.Since then I am avoiding sexual contact with my wife We are looking to start our family.
1.Is this like a needle stick injury or like occupational exposure where infected fluid may have entered my bloodstream? 2.How long to test to 100% rule out HIV. 3.Is window period different for this exposure (6 m instead of 6 w)? 4.Do I need to test for other STD?5.Do I retest at 3 & 6 Month mark.Was pretty relaxed till now until I read that such kind of exposures may require longer period of testing as per CDC guidelines.
http://nccc.ucsf.edu/wp-content/uploads/2014/03/CCC_PEP_Quick_Guide_for_Occupational_Exposures.pdf

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
23 months ago
Welcome to the forum. Thanks for your question.

You really needn't worry. You are way over-analyzing the situation. There has never been a reported case of HIV transmitted during a massage, assuming there was no actual sex (intercourse) -- not even "happy endings" by oral sex or masturbation have ever resulted in HIV. And if you think about it, there must have been millions if not billions of massage events in which minor nicks or cuts were present on the skin -- and still no known infections. Equally important, your test results proove conclusively you did not catch HIV. it is impossible to have HIV and have negative HIV antigen-antibody (4th generation) blood test results more than 6 weeks after the event. So even if you had had a truly high risk exposure, your negative tests at 40, 55, and 60 days all were 100% conclusive proof you did not catch HIV.

Those comments pretty well answer your specific questions, but to be sure there is no misunderstanding:

1. No, this was not at all like a needle stick exposure.

2,3,5. The antigen-antibody (4th generation) HIV blood tests are 100% conclusive any time 6 weeks or more after the last possible exposure. Your 25 day result was over 90% reliable, and the other ones were 100%. With this kind of test, the window period is the same for all types of exposure. You do not need any more HIV tests at any time.

4. There is also no risk for any other STD from this kind of exposure. I do not recommend any other STD tests on account of the situation described.

You are over-interpreting the CDC guidelines, which are highly conservative and also are based largely on pre-4th generation HIV testing. There is no possibility you have HIV. Please do your best to move on without further worry!

HHH, MD
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23 months ago
Thank You Doctor for your comprehensive reply.  Just to be sure so then even if infected fluid came in contact with my cut it would not be concerning as there was no direct contact as the fluid would have been exposed to environment before it touched my cut, would have been in a very small quantity if any on the fingers, also the cut must have been superficial and not too deep, and most importantly my test results taken sufficiently after six weeks would conclusively rule out an already highly unlikely scenario. Test results taken sufficiently after 6 weeks would rule out any possibility of infection irrespective of the kind of exposure and symptoms.  
Also why has CDC not revised its  guidelines. Is it because it considers that in such a scenario the exposed person may have taken PEP and because of which seroconversion may be delayed and also they would not have factored in the sensitivity and specificity of 4th generation tests.
I am sorry for being repetitive, its just that I am asking this for the peace of my mind. Lastly thank you once again doctor for your wonderful services, specially when there is lot of misinformation and confusion regarding this subject. May god bless you and your team always.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
23 months ago
I cannot say the risk is zero if infected fluid came into contact with your cut. But this has never been known to happen, so if there is a risk, it is low enough to be disregarded.

The CDC guidelines were not designed to address events like yours and are not a legitimate source of guidance for such events. I have no idea why they have not chnaged recntly.

Thanks very much for the thanks. Sorry I can't completely answer all your concerns.
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23 months ago
thank you doctor for your reply. So basically i am in the clear and can resume my normal family life 
23 months ago
sorry for writing again. I understand that risk may not be zero but the tests have ruled out any such possibility. This is my last post for this situation . Thanks
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
23 months ago
Yes, your test results are conclusive. Even if you had a truly risky exposure, they prove you did not catch HIV.

That completes the two follow-up comments and replies included with each question and so ends this thread. I hope the disucssion has been helpful.


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