[Question #5532] Household transmission - DCD

20 months ago
Dear Drs,

I read on here sometime ago from another poster that living with a roommate or family member (so no sexual relations) and sharing razors/toothbrush/towel/other household objects over a 2-3 month period, would have <1% chance of transmission of HIV/Hep B/Hep C and any other STDs/bloodborne disease. This was assuming the person is high-risk/infected with the bloodborne disease/STDs.

I’m in a similar situation to another poster where his gf lived with him and his family for 2-3 months, from a high-risk country. None of the family are vaccinated against HBV or any STDs.

At first your advice gave me reassurance. However myself and my parents suffer from DCD (Developmental Coordination Disorder), also known as dyspraxia. So my questions are:

1. I think I also read in your advice that having medical conditions would not mean a person is more suspectible to catching the above-mentioned bloodborne/STDs - ie HIV/HBV/HCV/HSV/oral herpes, and any STDs - but would this also apply if we had DCD/dyspraxia? My worry is that DCD makes you more clumsy, so more prone to cutting yourself shaving etc. But would I be right this would not be a material increase in risk, if any, and so should not be worried about?

2. So I am right that no medical conditions me or my family haven would change your previous advice on this in other posts?

Thank you so much Drs


20 months ago
And sorry I think I saw HTLV referenced in a previous question too. Could I check that none of the above responses would change for HTLV too?
Many thanks Drs again
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
20 months ago
Welcome to the forum. Thanks for your confidence in our services.

An enjoyable aspect of moderating the forum is that I learn things. As an adult-oriented internist and ID specialist, I had not heard of DCD. In response to your question, I did some quick reading about it.

My first reaction is that I am confident impaired fine motor skills, problems with hand-eye coordination, or "clumsiness" would not increase risk of HIV or other blood borne infections. The absnece of reported HIV infections in household contacts is because HIV doesn't survive in the environment more than a brief period before blood or genital fluids dry. It's not only households:  there also are no reported cases of HIV in workers in environments where infected co-workers might have bleeding from work-related injuries (e.g., construction, certain kinds of assembly line work, and so on).

Second, if you think about it, in the millions of households or shared apartments of HIV infected people, there must have been hundreds of thousands of household members with impaired coordination, undoubtedly including some with DCD. Also think of households with people with cerebral palsy, previous strokes, or many other disorders. And still no reported cases of household transmission of the virus. I don't try to keep up with these sorts of details for other blood-borne infections like hepatitis B and C, HTLV, etc -- but I am confident that poor coordination or other movelment disorders are unlitkly to elevate an otherwise zero risk, for all practical purposes.

So even if you or an affected famliy member were to share housing with a person with HIV or other blood-borne infection, or at risk for such inections, I am confident there would be no risk at all of being infected other than by sexual or overt blood-sharing exposures (e.g. shared needles).

I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD
---
---
20 months ago
Hi Dr Handsfield,

Thank you that’s so very helpful, so very much appreciate it. 

However I’m a bit worried by you saying that you don’t keep up to date with literature on Hep B/Hep C and other bloodborne viruses. In previous posts I’ve read on here, I believe both yourself and Dr Hook have said although not your primary focus, given the fact Hep B/Hep C/HTLV and other bloodborne diseases can be sexually transmitted and also your general expertise as an infectious disease specialist, your responses to questions on this forum can be considered expert advice?

And so I can be confident in your response as being expert advice on Hep B/Hep C etc, given your expertise as an infectious disease specialist?

Thank you so much again Dr.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
20 months ago
Other than HIV, the viruses you mention are sexually transmitted infrequently. Better terminology would be that they are sexually transmissible but not often sexually transmitted. This is especially true for hepatitis C virus, which is now proved to not be heteroexually transmitted at all:  the frequency of HCV is no higher in the sex partners of infected people than in anyone else (even after years of unprotected intercourse), unless they also share drug injection risks. HCV is only documented to be sexually transmitted among men having sex with men -- and even there, almost all transmissions are limited to HIV infected MSM.  HTLV is a very rare infection in general; the proportion sexually transmitted probably is near zero. Only HBV is sexually transmitted (heterosexually) with any appreciable frequency, and even here, the large majority of infections occur via blood contact, not sex. And probably not at all through environmental contamination.

So as STD experts, there really is little point, and it isn't worth our time and effort, to keep up on case reports of their transmission by nonsexual routes, if there are any. But I remain very confident there is no significant risk. If these viruses could be transmitted with any significant frequency through environmental contamination, it would be widely known and publicized in infectious diseases professional communities and resources. I guess it's up to you to decide whether our comments in these areas can be considered expert advice. 
---
---
20 months ago
Thank you Dr that’s a very detailed and helpful explanation. Sorry just a final couple questions, to be helpful I’ll put them as separate points:

1. One of Dr Hook’s previous posts here said the risk of transmission of HIV/Hep B/Hep C/HTLV/any  other bloodborne disease was <1% overall when sharing razors/toothbrush/towels/other household objects and living with an infected non-sexual partner. So I’m correct this would not change even if I or another uninflected family member had DCD?

2. The above answer to Q1 also applies for any other STDs, eg syphillis/HPV, and also HSV 1&2? I.e. DCD would not increase materially risks for these?

3. When you say “you will have to judge if we are experts in these areas” - this is a bit confusing/worrying to me (sorry if I’m not understanding). But am I right in that effectively this response and also your and Dr Hook’s previous responses on this forum (whether about HIV or Hep B or any other bloodborne disease) can for all practical purposes be considered expert/reliable? I.e.  I can relax and have confidence in them?

Thank you again so much Dr. Thank you for your patience - if you could so kindly take the time to reply on these, I will be a very less worried person!


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
20 months ago
1) I think Dr. Hook was being conservative -- both he and I often use different wording depending on the context of individual questions.  I'm sure the transmission risk is far under 1%. Both he and I are unaware of any such cases at all.

2) Yes, my replies are applicable to all STDs. I emphasized the blood borne viruses because those are what you asked about.

3) This is a nit-picking issue and I have no comment. I think my statement is clear and you can indeed relax about this.

That completes the two follow-up comments and replies includecd with each question and so ends this thread. I hope the discussion has been helpful. Best wishes and stay safe.
---