[Question #5337] Follow up #5211 (Testing question - PeP required)

23 months ago
Dear Doctor,
This is a follow up for the question 5211. My risk was, fondling with the breasts of female massage therapist using my hands. I was not sure if the breast milk or blood from the therapist made contact with the cuts near my fingernails. This incident is about 5 weeks old. I was following your advice of not bothering much about it. However, lately I've developed symptoms which kind of resemble ARS. This got me worried again, although I'm trying my best to not think much about it. 
I'm having a inflammation on my lip area (unsure if it's a boil or ulcer), along with this I'm having a sore throat. I did not kiss the therapist, and don't have oral herpes, as I test regularly. I also get pain in joints just after I wake up in the morning. This had led me to believe that Hiv could be a possibility.
I'm extremely worried thinking about the timing of all these symptoms, which is about 2-4 weeks from the incident. 
Kindly advice what should I do next? 
Edward W. Hook M.D.
Edward W. Hook M.D.
23 months ago
Welcome back to the Forum.  My assessment is unchanged.  All of the activities that we discussed during your prior post were no risk events, even if you did get breast milk or other bodily fluids on your hands during your interaction. The ARS is a group of symptoms occur as persons begin to make antibodies to HIV and is characterized by high fevers, severe sore throat, muscle and joint aches.  Some people call it the worst flu they have ever had.  When persons at risk for HIV (I do not consider you to be in that group) experience ARS/flu-like symptoms, 99% of them do not have HIV but instead have another flu-like illness of the sort that most people get from time to time.  In your case, I am confident that his is what is going on.

There is no medical need for testing.  If your anxiety requires you to test, 4th generation, combination HIV antigen/antibody tests are typically positive at the time of ARS symptoms and a negative test at this time would prove that you are not experiencing the ARS.

I hope this information is helpful.  I am confident that you did not get HIV from the events you describe and that your current symptoms are not the ARS.  EWH
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23 months ago
Thank you Doctor. Looking at my current nature of symptoms, I've decided to test at 6 weeks from the incident. This is purely from the perspective of relieving my anxiety, as you have stated that I've no risk from the exposure. I trust your advice, but the symptoms are alleviating my worry. Today I'm experiencing Swollen eyelid with repeated irritation. With the already inflamed lower lip (I realised its a pimple, red bump with single white tip and not a cold sore) and now the swollen eyelid, I can't concentrate on anything and keep thinking that it's due to STD or Hiv. I also had a canker sore below my tongue few days back which subsided in two days.
I request you to not close my discussion, as I would like to share my test results of the Hiv test that I'm going to take next week. If there are any other STD tests which I should take, then please let me know.
Edward W. Hook M.D.
Edward W. Hook M.D.
23 months ago
Thanks for the followup.  I understand that you may wish to have a test result to prove to yourself that you were not infected.  Your symptoms sound like an upper respiratory tract infection.  If they continue to progress you may want to see your doctor to get some symptomatic relief.   I'll do my best to keep,the thread open while awaiting your test results.  EWH---
23 months ago
Dear Doctor,
Thank you for waiting for my results. I've tested at 6 weeks with Hiv Duo test (4th gen) and the results have come out negative! It is quite relieving to know that despite all the symptoms the results are negative.
I stay in a country which has conservative guidelines on window periods, thus I will test again at 3 months. I've read your comments on Hiv testing, that it is conclusive at 6 weeks with 4th gen test, so I know what result to expect during my 3 months test. 
I was thinking about the risk i took 6 weeks back and would like you to share your perspective on below two questions.  My Risk: I'd touched breasts of female therapist for sometime and thought that blood or breastmilk must have contacted some of the cuts near my finger tips. 
1. Isn't this completely a no risk event, equivalent to me touching any surface which would not lead to transfer of virus of any kind? I think I've overreacted to the situation and given meaning to the fear. If this was a common day event, i would not have noticed it or remembered the day it happened.
2. If this event was even minutely risky, it would have been reported by agencies and Hiv would have been much more contagious than what it is. Like for example, something like a handjob or touching breasts would have been explicitly mentioned as risky events and people would take utmost caution like wearing gloves before engaging in these events. Massage therapists all over the world would be wearing gloves during every session to protect themselves and the people taking massages would also take caution. 

Sorry for asking these questions. I'm trying to rationalize and tell myself that my fears are indeed false and I did not put myself at any risk in the first place.
Edward W. Hook M.D.
Edward W. Hook M.D.
23 months ago
Thanks for sharing your result.  Given the nature of your exposure, there was really no medical or scientific need for testing but I can understand that your negative test will be reasssuring.  Getting breast milk or even genital secretions on your hands/fingers is a no risk event for which there is really no need for testing.    Thus, as the final answers to your questions:
1.  You are correct.  You could have chosen to not test as the event you describe is not associated with risk for HIV.
2.  Correct, no one has ever been proven to have acquired HIV from the sort of exposure you have described.  This was not even a minutely risky event.

Take care.  As per Forum Guidelines this thread will be closed in a few minutes.  EWH
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