[Question #5773] HIV Concern

19 months ago
Good day Doctors, 

I hope both of you are doing quite well. yesterday I had an exposure that had me really worried. I am a 27 male who engaged in a sexual interaction with a mid thirties woman. The only thing I did was to finger her (with my index and middle fingers) probably for 5 minutes. After a while (between 15 seconds and minutes) I started masturbating myself. I am afraid that one of these fingers briefly touched my urethera, and therefore HIV transmission occurred. I read on many forms that this is zero risk but I wanted to get your reassurance. So here are my questions: 
1) According to what I read, fingering  a vagina does not allow for enough bacteria or virus on the fingers for transmission, therefore the risk is zero. Is it also true in my case?
2) If I merely touched my urethra with the fingers (maybe for a second or two) after I fingered the girl, without massaging the urethera, would that be considered an exposure or zero risk?
3) if I were to take the pcr RNA test after two weeks, what will the accuracy be? (I don't want to wait 6 weeks for 4th generation).

19 months ago
And, one last thing, is the accuracy for PCR RNA Different at 2 week, 3 weeks, and 4 weeks after exposure? 
thank you!!
Edward W. Hook M.D.
Edward W. Hook M.D.
19 months ago
Welcome to the Forum.  I'll be glad to comment.  Let me start however with the most important message.  The event you describe was a no risk event for all STIs, including HIV.  Statistically the odds that a woman in her mid-30s has any STI including HIV is low so unless she told you that she was infected, the chance that she was infected was quite low.  This is true even if she was a CSW.  More importantly however is that even relatively conservative agencies such as the U.S. CDC classify mutual masturbation, which typically involves partners getting each others' genital secretions on one another, as no risk events.  I see no reason for concern and no reason whatsoever for testing.  Now, on to your specific questions:

1) According to what I read, fingering  a vagina does not allow for enough bacteria or virus on the fingers for transmission, therefore the risk is zero. Is it also true in my case?
Correct.  See above.

2) If I merely touched my urethra with the fingers (maybe for a second or two) after I fingered the girl, without massaging the urethera, would that be considered an exposure or zero risk?
Correct, still no risk.  During the mutual masturbation I mentioned above, it is quite typical for genital secretions to get on the penis and the opening of the urethra yet there is still no risk for infection.

3) if I were to take the pcr RNA test after two weeks, what will the accuracy be? (I don't want to wait 6 weeks for 4th generation).
PCR tests for typical, common STIs such as gonorrhea and chlamydia are conclusive after 3-5 days.  For HIV, most labs and experts agree that the PCR tests will detect virtually all infections aby day 11 or 12.  At the same time, many experts still recommend a follow-up, combination HIV antigen/antibody test at 6 weeks but to be honest, I think this is overkill.  I have never seen or heard of a person who was not taking PEP become positive if they had a negative HIV PCR RNA at day 11 or 12.

4.  And, one last thing, is the accuracy for PCR RNA Different at 2 week, 3 weeks, and 4 weeks after exposure? 
No, not measurably.  One a PCR test is positive, untreated persons will remain positive thereafter.

I hope that this information is helpful.  EWH

---
18 months ago
Thanks doctor for the response. Just a clarification, I saw that you once said that “if someone tapped their penis head with fluids it could be a theoretical risk”. Two questions:
1) I didn’t tap my penis, but I probably touched it briefly with the fingers, is that considered ZERO risk? Is it because there were not enough fluids (given that the secretions were on my fingers only in little amounts, or is it because the vaginal secretions from fingering can’t enter the urethra? 

2) doctor hashfield on multiple forms said that hands and fingers can’t carry enough secretions from hand-genital contact. So my question is this: if I fingered the girl for five minutes, and then waited 10-30 seconds, would there be enough secretions to cause infection? I tested that with putting water on my fingers, and after 30 seconds there was no water at all on my fingers. So in conclusion, does that mean fingering a girl and then briefly touching you penis CANT possibly carry enough virus to transmit hiv? 
You are a hero of mine doctor thank you so much
18 months ago
And doctor, is PCR RNA after 14 days conclusive more than 99%
18 months ago
And for questions 2, assuming I touched my penis briefly with my finger right after I fingered the girl (there won’t be enough fluids right doctor?)
Edward W. Hook M.D.
Edward W. Hook M.D.
18 months ago
I really think you are worrying more than you need to.  Remember, you could theoretically be struck by lightening while reading this too- just as I would not worry about this, I would urge you not to worry about getting an STI from the events you describe.  As for your questions:
1.  Please read my comment about risk above.  I would classify your risk as virtually zero. There are multiple reasons for this including both of the reasons you mention as well as the fact that STI pathogens become non-infectious upon contact with the outside environment.  
2.  As indicated above, you would not be infectious under the circumstances you describe in question number 2.
3.  Regarding the HIV PCR, I said "For HIV, most labs and experts agree that the PCR tests will detect virtually all infections aby day 11 or 12.  At the same time, many experts still recommend a follow-up, combination HIV antigen/antibody test at 6 weeks but to be honest, I think this is overkill.  I have never seen or heard of a person who was not taking PEP become positive if they had a negative HIV PCR RNA at day 11 or 12." above.  Repeating the question will not change my answer.
4.  For your 3rd follow-up question- still not infectious.

I urge you to not overthink this.  You are not at risk for STI from the encounter you describe.  Try your best to move on.  EWH
---
18 months ago
Doctor, because of being worried immensely about the theoretical risk exposure, I took the HIV 1+2 PCR RNA test at 3 weeks post exposure. The results were negative (there were fewer than 34 copies). My questions are as follow: 
1)does the fact that my test measures copies in the range of 34 (llower or higher than) make my test more accurate? If yes, does it make it 99% accurate?
2) my doctor told me that my test at 3 weeks is  conclusive (99%) because nothing is 100%. Can you verify that my test is 99% reliable? 
3) with the theoretical exposure I described, can I be 100% sure I didn’t catch hiv? 
4) do I need any further tests doctor?
5)Is my test reliable enough (meaning more than 99% accurate) is it almost the same as hiv fourth generation at 6 weeks?
Edward W. Hook M.D.
Edward W. Hook M.D.
18 months ago
Welcome back.  I guess by theoretical risk exposure" since in my (and other expert's opinions) this was a no risk exposure- correct?  I'll be glad to comment.  If you don't mind, might I ask you how much you paid for your HIV RNA PCR test- knowing the cost will help me help others considering the test.

As for your somewhat repetitive questions:
1.  As I said above, "For HIV, most labs and experts agree that the PCR tests will detect virtually all infections aby day 11 or 12.....  I have never seen or heard of a person who was not taking PEP become positive if they had a negative HIV PCR RNA at day 11 or 12."  The lower limit of the test you used is irrelevant as persons with untreated HIV typically have HIV concentrations in the thousands or tens of thousands.  The lower limit of the test becomes important when persons start therapy and clinicians are interested in documenting response to therapy by a decline in HIV concentrations.
2.  I agree with your doctor.  Because new information is being gained on a daily basis, there is no as 100% but the results of your HIV PCR are certainly more than 99% accurate.
3.  Yes. As I told you I (and the CDC, WHO, and other experts) would classify the activities you described as NO RISK.
4.  No
5.  Yes, see my comment no. 1 above.

This thread should be closed at this time, as per Forum Guidelines.  Because I am interested in what you paid for the HIV PCR test, I will leave it open for a few hours to give you a chance to respond.  Take care.  EWH

---
18 months ago
Sorry for late reply. It cost 120 dollars but I live in a foreign country. doctor, you said my test is more than 99% accurate. Is it still more than 99% accurate if I took it by day 12? Thank you doctor!!
Edward W. Hook M.D.
Edward W. Hook M.D.
18 months ago
Thanks for the information on price.  In answer to your follow-up question, yes, any time after day 11 and HIV PCR will be more than 99% accurate.  I urge you to put your fears aside and not worry further.  You clearly did not get HIV from the no risk event you described.  

This thread will now be closed.  EWH
---