[Question #6693] HIV concerns over fingering with cut

65 months ago

I had a one night stand with someone who i consider to be very promiscuous. Activities included kissing, licking breasts and fingering. The concern is that after fingering her with my middle and index finger, I noticed I had a fresh cut on the thumb of the hand I used to finger her. The thumb was not used to finger her but it was clear it had her genital fluids on it. About 20 days later, I had flu-like symptoms including headache, fever of 100.6, severe fatigue, nausea and diarrhea. The symptoms are ongoing as of day 21 after exposure. The cut on the thumb was not actively bleeding. On Day 20 after exposure, I went to an urgent care, tested negative for flu, but was given tamiflu as a precaution. At that time i requested and was given the 4th gen ab/ag HIV test via blood draw. Test results are pending. Questions: What is the risk I contracted HIV from these sexual activities? What is the reliability of the HIV test at day 21, particularly if the flu-like illness which started on Day 20 was ARS?

H. Hunter Handsfield, MD

65 months ago

Welcome back to the forum. Your questions largely echo some of the ones you asked in your other discussions with me and Dr. Hook a year and a half ago. Directly to the current questions:

"...someine who I consider to be very promiscuous." The odds are that your partner doesn't have HIV. Even among the most sexually active women in the US or western Europe, well under 1% and usually fewer than 1 in a thousand have HIV. (If you're still able to contact her, why not call and ask? If she hasn't been tested recently, perhaps she would be willing to do it now. For all you know, you might find she is just as nervous about your HIV status as you are about hers. If you both have negative tests at this time, you'll both know you were not at risk from these events.

"kissing, licking breasts and fingering" are zero risk for HIV, even in the presence of cuts and wounds. I have a little difficulty believing you really had a "fresh" cut, i.e. actively bleeding. There must have been billions of fingering events with HIV infected partners in the 30+ years of the worldwide HIV/AIDS pandemic, and millions of those undoubtedly with finger cuts, nicks, hangnails, etc, etc -- but no known HIV infections have resulted.

Your symptoms sound significant and I understand why they are worrying. I'm glad to hear your influenza test was negative -- but your symptoms are more suggestive of viral gastroenteritis anyway, since influenza doesn't generally cause nause or diarrhea. (Usually ARS doesn't cause these symptoms either.) And this illness began on the late side for ARS, which usually starts 8-14 days after exposure.

Your pending HIV AgAb (4th generation) test will be highly reliable, although not yet perfect. Somewhere around 80-90% of newly infected people have positive results at 20 days. Equally important, the symptoms of ARS are due to the immune response, not to the virus itself. Virtually everyone with ARS symptoms has posiitve results with AgAb testing. So a negative result -- which is what you should expect -- will be nearly 100% proof your symptoms aren't due to HIV, and 80-90% reliable that you didn't catch HIV during the events described.

You should also have a follow-up HIV AgAb test at 6 weeks (for 100% reassurance), and maybe at 4 week (98-99%). I stress "reassurance", knowing a negative result will probably be more reassuring than anything I can say. But you really should stay mellow in the meantime. There is no realistic chance you have HIV.

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

HHH, MD

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65 months ago

Thank you. A few clarifications and a follow up:

In terms of her promiscuity, she openly bragged about being with 5 men and a regular girlfriend in the past two months. And then she asked for vaginal intercourse repeatedly, knowing neither of us had condoms. So I would consider her promiscuous. I tried to contact her several times to inquire about her status, but there was no response from her. Alarm bells. She is either infected, or simply does not care.

In terms of my follow up, I read in several places a gen 4 test at 20 days is at most 50% reliable, although silent on if ARS is present. I believe either on here or on med help you or the other doc indicated it takes about a week of ars symptoms in order for a test to give highly reliable results. In my case the ars symptoms started on the same day of testing, perhaps a day before. Can you clarify why you believe my test, if negative, is highly reliable? Thank you

H. Hunter Handsfield, MD

65 months ago

That sort of behavior certainly raises alarm bells. But it doesn't change my comment about the low chance she has HIV. Other STDs are far more likely.

Scientific knowledge has move quite a bit since the MedHelp days, which ended a few years ago. The AgAb tests are 75-80% sensitive at 3 weeks (correcting my 80-90% figure above -- sorry) and usually always positive as soon ARS symptoms start. And those aren't the only reasons i do not think your symptoms are due to ARS. In any case, all this is hair splitting: since your negative test won't be 100% reliable, what does it matter if it's 50%, 75%, or 90%?

You have one more follow-up comment coming on this thread. I suggest you hold off until your test result is available.

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