[Question #6698] Spit in my eye

14 months ago
Hi - I asked a few questions before. If you read back I clearly was suffering from irrational anxiety. I got help as you advised and FOR THE MOST PART got better. Maybe I had occasional doubts but I mostly moved on with my life.

Now - my wife and I are trying to have another child. That's kind of proof how I've moved on because last year I wouldn't even touch her.

Anyway - at port authority this morning a homeless man asked me for change, and when I replied that I had none he felt it appropriate to spit a large amount right onto my face, definitively getting some in my eye. This brought back some of the fear I had previously without the guilt. However, I'm just asking you if there's anything I need to be worried about or if I should stop 'trying' with my wife before getting tested in 6 weeks.

Thank you. Also - please let me know if there's anything else I should worry about outside of the HIV realm. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
14 months ago
Welcome back to the forum. Before I had even read your question, I knew the main points I would make in my reply, based solely on the title you chose. Nobody has ever acxquired HIV from non-intimate personal contact, including contacts that allowed other persons' body fluids to get in their eyes, nose, mouth, etc. Second, saliva does not transmit HIV -- in fact, saliva inactivates the virus. This is one of the main reasons oral sex carries little or no risk of HIV infection -- which we discussed in your two other threads several months ago.

Of course I went on to read the body of your question. It doesn't change my opinions or advice. You do not need testing for HIV or any other infection. The only potential risks for such interactions with other persons are the standard ones, i.e. colds, influenza, etc (and now of course COVID-19, if that cononavirus gets a foothold in the US, which has not yet happened). For sure this event does not risk anything you could transmit to your wife other than a cold or flu. And by the way, homeless persons have no higher risk of HIV than anyone in the general population.

I hope these comments are helpful. Best wishes for successful conception!

HHH, MD
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14 months ago
Thank you Dr. I wasn't overwhelmingly concerned, but it was a bizarre and kind of shocking scenario at first and then my paranoia began to kick in, so I'm glad I got to you before the weekend so I didn't let it take over.

I have a few follow ups, if you'd allow.

1. Would you feel the same if for some reason the man in question had a cut in his mouth and therefore blood? I have no reason to think this and didn't see any blood on the liquid that missed my eye, but thought it prudent to ask.

2. Off topic. In no way am I trying to play 'gotcha'. I have a tremendous amount of respect for both you and Dr. Hook and I have even more respect/admiration for your services on here. I know you both consistently say that your opinions don't differ outside of style. However, one thing I've noticed reading is the all-important and often discussed ARS lymph node situation. Unless I'm mistaken, it seems that you say that ARS nodes are painless and Dr. Hook says that they are typically tender. Again, not trying to play gotcha at all but curious if this is something you two disagree on or if it's something I'm misunderstanding. 

Thanks. 
14 months ago
Also, for context - 

3. The reason I asked is that my wife had soreness under her arm, tenderness, about 7 days after s e x. We couldn't feel a lump, but it was pretty painful to the touch. It cleared up in about 3-4 days. I wasn't sure if that WAS typical of ARS lymph Nodes or wasn't. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
14 months ago
1) Yes, I would feel the same.

2) I'm not sure exactly what the medical literature says about tenderness of the enlarged lymph nodes in ARS. My impression is that they are generally nontender, but Dr. Hook may have different experience. Perhaps more important, enlarged nodes alone (without other symptoms), and whether tender or not, rarely if ever is the only symptom of ARS.
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14 months ago
Ok. Understood. Not everything or every symptom can be definitive and I'm sure there's variation anyway.

On that note, last round and you're free:

1. My wifes tenderness didn't have any obvious bumps or anything. I assume a swollen lymph node would have an obvious bean or bigger bump? She said her skin under the arm was painful and swollen, like the whole area, but there were no bumps under the skin felt. Just overall swelling that she said could be from shaving and irritation. A long winded way of asking if it was an ARS lymph node (or any other swollen lymph node) I assume would be an obvious 'lump', right?

2. Lastly - kind of surprised of your original comment regarding homeless not being more 'at risk'. My intention isn't to stigmatize but I just would have assumed that population would have more unsafe practices either in their relations and/or needles from a sociological perspective. But good to know. 

3. Good luck to you and your kind with this novel coronavirus. It seems like it's taking hold in Washington. I know not your specialty but I assume most ID's will be involved one way or another. Thanks in advance! 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
14 months ago
1) This symptom doesn't suggest a new HIV infection and certainly would never be the main or only symptom.

2) There are good data on HIV prevalence in homeless populations. Two risk factors account for 99% of HIV in the United States:  sex between men and injection drug use. In most homeless populations, these factors are present in the same proportions as in the population as a whole.

3) Thanks for the kind words. I'm quite involved in COVID-19 -- Dr. Hook even moreso (although it's not yet the problem in AL as in the Seattle area).

That concludes this thread. I hope the discussion has been helpful.
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