[Question #728] Hiv exposure

55 months ago
Dear Doctor, 

36 year old married man with a 1 year old son healthy and no diseases. 

Last week went out for some drinks and we decided to wonder around the red light district in Frankfurt. After a while, a couple of us decided to get into one of the booths. I chose a Romanian young CSW of unknown status, she looked clean and I did notice any noticeable sign of disease. 

I decided not to have "full" sex with her and I just asked her for a handjob (which she performed without a condom and put some lubricant on her hand). After a few minutes she let me finger her. Before starting the fingering I put a condom on the two fingers that I used, to my recollection, the condom covered fully the two fingers and was there until finishing (for around 10 minutes). The condom was intact and did not show any sign of blood from her. I know this since I took with me the condom back to the hotel. 

8 hours before the incident, I cut one of my fingers with a cardboard (similar to a paper cut), the wound was about about 1-1.5 cm long and not so wide. It bled in the beginning but I just put some water and a band aid and it stopped. I am almost sure that it was not bleeding before the incident but could not be 100% sure. 

After 1-2 days after I started experiencing some pain on my neck, especially on the left side and immediately I started checking for lymph nodes (which I found). Since then I have been constantly looking for lymph nodes and as of today (6 days after exposure) I feel like I have enlarge lymph nodes on my neck and in one of my armpits. 

I have been in fear thinking that I might have put my family in risk. My questions are the following: 

1. Considering I was drunk I cannot assure 100% that the condom covered all the time my injured finger. Assuming that at certain point some vaginal fluid was in contact with my "fresh" wound would that represent for me a risk? Should I be worried? Is it even possible to get HIV like this? 

2. Can my symptoms be ARS? 

3. Can I have sex with my wife without protection? 

Thank you 

Scared stupid
Edward W. Hook M.D.
Edward W. Hook M.D.
55 months ago

Welcome to our Forum.  I will be pleased to comment on your questions. Before I do however, a few general statements.  The events you describe did not put you at any risk for HIV or other STI.  both receipt of masturbation (i.e. a hand job) or participating in masturbation of a female partner (i.e. "fingering") are no risk events so that, even if your partner had HIV (which is statistically unlikely), there is no risk of infection.  this was safe sex.  It was safe even if the cut on your finger had been present before the event or even if the cut occurred at about the time you started to masturbate her.  Still no risk at all.  there is no need to even test after an exposure of this sort.  Now, on to your other questions:

1. Considering I was drunk I cannot assure 100% that the condom covered all the time my injured finger. Assuming that at certain point some vaginal fluid was in contact with my "fresh" wound would that represent for me a risk? Should I be worried? Is it even possible to get HIV like this? 

Even without a condom, what you describe was safe sex with no risk of HIV infection.  this is true even if you got some of your partner's genital secretions on your cut.

2. Can my symptoms be ARS? 

No, these symptoms are only part of those describe for the ARS, are too mild, and have occurred too soon after your event to be the ARS.  When people have the ARS, typically starting a week to 10 days after exposure, they have high fever, severe muscle and joint aches and a bad sore throat as well as other flu-like symptoms. 

3. Can I have sex with my wife without protection?

Certainly.  There is no risk of HIV from the event you have described.  I would not hesitate to have sex with your wife because of the events you have described and, as I said above, there is no medical reason for testing.

I hope these comments are helpful to you.  EWH

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55 months ago
Hi Dr. Hook, 

Thank you for your very thorough and clear explanation, it definitely has helped me to ease down my fears and anxiety. 

Doctor, as a follow up to your reply I have two additional questions. This morning when getting ready to go to work and washing my genital area I noticed a lump on my left testicle, it is not on the testicle per se but in the sac and very close to the perianal area. I do remember the CSW massaging my scrotum also barehand while she was masturbating me, the following are my questions: 

1. Could any STD been passed like this (what if there was some vaginal fluids in her hand with some bacteria/virus of an STD that can be transmitted skin-to-skin)? Unfortunately due to the location of the lump I cannot see and determine if the lump is more like a sore or a wart or something like that. Does my activity represent a risk for an STD that would show like this? 

2. In terms of HIV infection, can these be a continuation of my potentially swollen lymph nodes? Would you still be confident to say that this is not HIV ARS related or any other STD related? I’ve continued to feel in general unwell and with the feeling that my lymph nodes are swollen. 

Dr. Hook, I will really appreciate your feedback on the above, I already had sex with my wife twice before finding out this lump or whatever it is in the scrotum and I am going insane with guilt and anger thinking that I might just have given something to her. 

Needless to say, I am so very grateful for your responses. 

Stupid scared 
55 months ago
Dr. Hook, I will really appreciate your final feedback on my last thread, this lump is driving my mind insane and my anxiety to very very high levels.
Once again, thank you very much Dr. Hook, please reply to these last two questions.

Scared stupid
Edward W. Hook M.D.
Edward W. Hook M.D.
55 months ago

1.  The lump you feel on your testicle does not sound like any STI at all.  Further, nothing about the exposure you reported places you at risk for infection.  I suspect what you have felt is something other than infection- perhaps a benign, non-infectious cyst.  It also certainly not a wart as warts take months (three on average) to appear. 

2.  No, what you describe is not an area where lymph nodes occur.  I am confident that what you have described is not HIV or any other STI that you acquired from the no risk exposures you have described.  EWH

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55 months ago
Thank you very much Dr. Hook. I am dealing with a great amoubt of anxiety here. I promise to you that this is the last and final follow up question for you, I know how valuable time is.

I have had a very stiff neck since two days after exposure and the worry is killing me.
My question is - why HIV cannot be passed via vaginal fluids directly to an open "fresh" cut, is is your answer just based on the fact that there have been no documented cases or is it because it cannot be transmitted like that because of the healing process of wounds in fingers?

Please doctor, reply to this last question so I can move on with my life, I have been avoiding kissing and carrying my son and taking him to school and playing with him which is actually killing me inside and have also been very evassive with my wife and I just can't continue like this, all I do at work is browsing cases, symptoms, etc. and I just can't deal with it anymore.

Thank you so very much for this last answer.

Stupid scared
Edward W. Hook M.D.
Edward W. Hook M.D.
55 months ago

As outlined by Forum guidelines, this will be my third and therefore final answer.  This thread will be closed later today.

The answer is that both of the facts that you mention contribute to my confidence that you were not infected with HIV by the activities you described.  There are NO documented cases of HIV acquired through receipt of masturbation, despite the fact that millions and millions of people have engaged in masturbation with infected persons- NONE!.  Secondly, cuts and scrapes begin to heal immediately after they occur, sealing off the blood stream from possible infection.  Thus any HIV that might have been present (remember, it is unlikely that the CSW you were with even had HIV) would not have gained access to the bloodstream to cause infection.

I suspect your stiff neck represents tension due to your anxiety.  Please try to set your worries aside.  EWH

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