[Question #6619] Need for testing?

12 months ago
Hello Doctors,I am a 27 years old female, never had sexual intercourse. The last time I got intimate ( deep open mouth kissing)  was in February 2019. I usually get tested once a year. My last test for HIV was in April 2019, which was negative. been focusing on my medical career since then, as I'm a final year med student.I noticed a black spot on my right toe nail proximally between the nail bed and the cuticle, 3 weeks back. when I closely looked at it, there was a pit in the same area. I ignored it thinking it will outgrow itself and it might have been due to some accidental trauma which I dint recall. last night, while I was showering, I noticed that the block spot was still the same. so I took a cuticle remover and tried to remove it off, which I successfully did. It was between the nail and the skin fold so I had to scoop it out. but now my mind is running to the gutter. I'm afraid it was a fungal infection, which gets me thinking if it could be due to HIV? the gap between my intimate interaction and my test was around 9 weeks, so I assume my kissing episode did not put me at any risk. I have never used any drugs ( only mentioning for you to assess my total risk ).  I am an Asian, so I do visit my home country for a couple of months every year. and I have got cuts and scrapes from the environment once in a while, both here in the US and back at home. I also pop zits with unclean hands which sometimes bleed. I do understand sex and iv drug use being the most common route. but I was wondering if my black dot on toe nail could have been related to an immunocompromised state due to hiv in case of contracting it through my cuts and scrapes? I otherwise am healthy. haven't had any fever or any other illness in the last 1-2 years.am I at risk? do I need to get tested? how often should I get tested given I have not had a sexual intercourse? do I need to do anything to reduce my risk?

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
12 months ago
Welcome to the forum. It's a pleasure to help the occasional medical professional or health sciences student who visits for advice.

There are numerous reasons you can be sure the black spot was not due to HIV or any other immunocompromised state. Kissing is free of risk for HIV, and so are the various cuts and scrapes you describe; nobody has ever been reported or suspected to have acquired HIV by cuts, scrapes, or otherwise from a contaminated envinronment. Unless and until you become sexually active, you'll never be at risk -- assuming no shared needles for drug use or a work related accident like injury with an HIV contaminated sharp instrument.

With few or no exceptions, everyone sufficiently immunocompromised to develop an opportunistic infection or tumor is otherwise seriousy ill. If you are outwardly healthy, you can safely assume your immune function is normal. In addition, the only HIV related condition that could present as a "black spot" is Kaposi's sarcoma, but that opportunistic cancer occurs only in HIV infected men who have sex with men. (KS is caused by human herpesvirus type 8. HHV8 is an occasional infection in MSM with multiple partners, but rare otherwise.) Equally important, you could not remove a KS lesion -- or even a dark mole -- without considerable trauma, bleeding, and pain. This must have been traumatic (dried blood) or perhaps a foreign body (dirt?) following an injury. You'll probably agree it was a mistake to remove it, i.e. to delete the evidence allowing proper diagnosis. But I'm very confident this could not have been anything serious.

Accordingly, you certainly do not need testing for HIV now or in the future, nor have you needed any past testing (unless perhaps your medical school tests all stuidents routinely for blood borne viral infections). You should not have any further HIV testing until and unless you become sexually active in an unsafe manner (i.e. partner at possible risk) or you have a traumatic sharp instrument injury from a potentially infected patient.

Please don't take this personally, but I'm surprised that in your final year of medical school your knowledge about HIV and AIDS is as little as it seems to be. At a minimum, your medical education around HIV/AIDS seems to have been suboptimal. (I would be interested to know what country you're in, if you don't mind saying.) It would make sense for you to educate yourself with some basic reading. Numerous excellent textbooks and other resources of course are available, both in medical libraries and online.

I hope these comments are helpful, but let me know if anything isn't clear. Best wishes for your continued medical training and for a successful career.

HHH, MD
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