[Question #6176] HIV RNA test timing and anxiety

18 months ago
Hello, 

I am having some bad anxiety and wanted to get a few answers. Yesterday I met up with a guy and we mutually masturbated together. Before he came over I trimmed my pubic hair and nicked my skin at the base of my penis on the front (on the pubic area and not my shaft). It stopped bleeding by the time he came over so I thought nothing of it. We masturbated each other and I noticed the small cut had opened up and was bleeding. I wiped it off and we kept going. I masturbated the guy and he masturbated me and then I ejaculated on his torso and then he ejaculated on his torso, his semen never came in contact with my body or penis. After he left I became very concerned about a possible HIV infection because of my open cut. I know mutual masturbation is not a risk of HIV but because of an open cut I became concerned. I was recently tested as part of a physical and everything was negative and when I asked him he said he was also negative and tested last month but did not have the results to show me. I am just concerned of a possible infection even though no semen came in contact with my cut but I am concerned about his pre-ejaculate fluid as he would masturbate himself and then me. These are my questions:
1) - how big of a risk was this? 
2) - If I get an HIV-1 RNA, Qualitative, TMA at 11 days post possible exposure (for peace of mind) would that give me a good idea of my status or conclusive results?
3) - Should I wait and have the test completed on 12 or 14 days for a more conclusive result? And if so do you recommend 12 days or 14 days post possible exposure?

I lost sleep over this and it’s all I can think about and is affecting my work! 

Thank you for your time to answer my questions and I hope to hear from you soon! 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
18 months ago
Welcome to the forum. Thanks for your confidence in our services.

The busiest STD and HIV/AIDS clinics never see persons with HIV whose only potential exposure was anything like yours. Virtually every patient has had unprotected insertive vaginal or anal sex, or has shared drug injection equipment. When people initially deny the standard risk factors, it just about always is found they were untruthful (e.g. embarassment at admiting certain behaviors) or didn't know they were at risk, such as a spouse/partner who, unknown to them, was at risk or infected. This sort of data allowed public health officials to inform the public in the earliest AIDS days, before HIV was even discovered, that non-intimate personal contact was risk free, and that advice has stood the test of time.

And this includes contacts of the sort you describe. There has never been a reported, scientifically documented case of HIV transmission following mutual masturbation, i.e. hand-genital contact, fingering, etc. Even unprotected oral sex is nearly zero risk for HIV. No penis inside a partner's vagina or rectum means no risk for HIV. And since there must have been millions or billions of events like yours following pubic area shaving, or in the presence of other superficial injuries in the area, it is clear that such things make no real difference in risk. To your specific questions:

1) Those comments direclty address question 1. No risk, even if you should learn your partner has HIV.

2,3) I recommend against any HIV testing at all. If you nevertheless decide to get tested, however, I recommend against the RNA test, which is expensive and unnecessary in this situation. Have an antigen-antibody (AgAb, 4th generation) blood test around 3 weeks -- only a week later than the 2 weeks needed for RNA testing. At 3 weeks, the AgAb tests detect around 90% of infections, so a negative result would be highly reassuring. You could then have a second AgAb test at 6 weeks, which would be 100% conclusive. If you DO have an RNA test, do it at 14 days, when it is nearly 100% conclusive. Howeer, for truly conclusive result, you also will need an AgAb test at 4-6 weeks. I stress that I recommend you have NO test at all. Personally, if somehow I were in your situation, I would not be tested.

Do your best to move on without worry. There is no way you have HIV from this event.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD
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18 months ago
Thank you for your quick reply!

Just to be sure, even though the cut at the base of my penis was bleeding while my partner moved his hand from his penis to mine (and my hand from my penis to his and back to mine) with his possible pre-ejaculate on his/my hand and none of his ejaculated semen got on me, I am at 0 risk completely? 

I know he told me he is not HIV positive but the bleeding really freaked me out and I assumed it was a risk. I can be a bit of a hypochondriac but your response has helped ease the anxiety. 

If I do decide to test, I will follow your recommendations. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
18 months ago
If you compulsively focus on theoretical possibilities, then I suppose there could be a risk. But please try to be realistic. You have to take into account 1) the chance your partner, despite his reassurance he is not (most people don’t lie when asked directly); 2) if infected, his viral load and whether he is on HIV treatment; 3) not just exposure of the cut, but possible.massage of infected fluids into it. Then HIV transmission might happen. But how realistic is it that all these factors would break the “wrong” way? And in the absence of any such known transmission in the 40 years of the known worldwide HIV/AIDS epidemic, with billions of events like this, that you’ll be the first?

In other words, get real. There is no point in asking “what if” or “could I be the exception” sorts of question when such an event has never been known!

So I’m glad my advice so far has helped, and hope these comments further help. While I still recommend you not be tested, the nature of your questions and your obvious continuing concern suggest you’ll probably keep worrying about it until and unless you’ve been tested with the negative results you should expect. (If positive, it will be necessary to explore other possible exposures you might be unaware of. If positive, when you case is reported to public health and CDC, nobody would accept this story as a plausible source.) Anyway, feel free to be tested if you’ll sleep better with the negative result.
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18 months ago
Thank you for your advice and information. It has helped me greatly. 

For my own edification why do some sites and professionals say the HIV RNA test can be taken from 9-11 days and yield a conclusive result? You stated 14 days. STDCheck.com has this 9-11 days as a major point of information for that test to be conclusive. I’ve also seen information that anything  past 10 days would be conclusive. I don’t plan on getting tested now due to your information you provided, but I was just curious and wanted to broaden my knowledge on the subject. 

Again thank you everything, you have truly helped me. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
18 months ago
Good questions. I can't say the origins of the information you are seeing, except that some test sites may slant their advice toward earlier times. The main problem is that there is actually no research that proves the exact times required, i.e. no studies in which, say, hundreds of people were tested at known intervals after exposure to determine the precise percentage positive at various times. And even clinical experience doesn't help much, because most newly infected people have had multiple exposures, often several a week, on an ongoing basis, and it's usually not possible to know which exposure was the source. In the entire US, very few persons per year have individual potential exposures (people like you) and turn out to have caught HIV, so there isn't much to learn from these experiences. Without conclusive data, we're left with theoretical understanding of the time course of HIV infection, and that doesn't take into account the details of different manufacturers' tests in regular use, including some home-grown tests (i.e. developed by individual labs). So all we really have is expert opinion without conclusive data -- which allows for a lot of variation in the opinions of equally qualified experts. The ones with whom Dr. Hook and I consult regularly -- who are among the top experts at CDC and a couple of academic institutions -- advise the time frames that we use on this forum, i.e. RNA testing only starting to become positive in some people by 7-8 days, usually (80-90%) detectable at 10 days, and nearly complete (~99%) 14 days and beyond. Because even then the estimates are not quite 100%, we also advise AgAb testing at 4-6 weeks, in addition to RNA testing.

That completes the two follow-up comments and replies included with each question and so conlcudes this thread. I'm glad the information has been helpful.
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