[Question #7728] overall assessment on my case.

19 days ago

Dear Dr's, I feel so ashamed of this honestly as it was not intended but stupid thing happens, I was unpacking my stuff the night before and I had many fingers were superficially injured while only one with deep cut and bleeding a lot, next day night I have asked for massage services, she was pure SW and I have not had any sexual intercourse the only thing have happen that I fingered her for like 7 min and she had many fluids out that touched my hand, I have remembered that I have had cuts on my fingers so I quickly removed them and course ended. for peace of mind I did HIV testing 40 days from this incident and it was 4th gen antigen and antibody test and the result was (-).

1- is this test considered conclusive despite the nature of the encounter? note: I was thinking that 4th gen test is kind of sophisticated lab test but got shocked to see that they are exactly similar to pregnancy test strips and result was so fast less than 15 mins. 2- is these testing strips considered official error free test or other testing methods required? 3- should I wait to 3 months per CDC recommendations then conduct retesting? or 6 weeks? 

4- I have low WBC 2.3 will the number of low WBC impacts the testing window period. I always get sick very quickly, as I was told by my doctor that I have weak immune system but not difficent. Do you think antibodies will not be generated? 

5- I found this " HIV virus requires specific cell to latch onto, cells that are not found anywhere in the body, moreover fluids during fingering are not infectious as the infectious area are deep under the mucosal cervical fluids, each cell has cell membrane that it self-act as wall against HIV but HIC has one key gp120 that can open (CD4,CCR5) that is only found on very few cells in the area underneath the mucosa and they are not available at fingers. Is this correct? 

6- do I need other STI testing? 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
18 days ago
Welcome to the forum. Thanks for your confidence in our services.

Your questions suggest you may have some misunderstandings about HIV risks and testing. The important thing is that the antigen-antibody (AgAb, combo, 4th generation) HIV blood tests are among the most accurate diagnostic tests ever developed, for any medical condition. There are no external factors -- illnesses, medications, or anything else you can think of -- that alter their reliability or the time required for accurate results after exposure ("window period"). (The only exception is anti-HIV drugs take for post- or pre-exposure prophylaxis:  the window period starts when that treatment is completed, not at the time of exposure.) Therefore, the test results overrule all other considerations. No matter how high the risk of HIV at the time of exposure, and no matter what symptoms or other medical issues someone may have, a negative HIV AgAb test 6 weeks after exposure is 100% conclusive. At 40 days, you're close enough to 6 weeks that your result proves for sure you didn't catch HIV.

I'll also point out that nobody has ever been known to catch HIV by fingering, even with fresh, bleeding cuts on the fingers. And also that the large majority of female sex workers do not have HIV. There is also no significant risk of any other STD from fingering or other hand-genital exposures.

Those comments cover most of your questions, but to assure no misunderstanding:

1. Ideally, you should have been tested a full 6 weeks or more after the event. However, 2 days makes little difference and 40 days is conclusive for all practical purposes -- especially after a virtually zero risk exposure. There are several kinds of AgAb tests, both lab based and rapid strip tests. The rapid tests are considered just as conclusive and reliable as the lab based tests.
2. There is no distinction between "official" versus non-official tests -- that is, no particular AgAb test is more or less "official" than others.
3. CDC no longer recommends 3 months, but advises 6 weeks as conclusive for the AgAb tests.
4. WBC count has no effect on HIV test results, and neither does a "weak" immune system. In fact, in theory a weak immune response might make the AgAb tests positive even sooner and more reliably than in immune competent persons.
5. You correctly state one of the biological reasons that a) HIV is fairly hard to transmit and b) that there have been no reported cases caught by fingering.
6. Based on the exposure described, there is no need for any other STI testing.

I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD
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16 days ago
Dear Dr. Hunter, thank you so much for your swift reply, this is really amazing and very detailed answers, I can not thank you enough and I have asked many doctors either at internet or during last medical visit and all the answers I got were like test after 3 months for assurance! also Mr. Google is full of misleading information and truly very scary to read. the confidence and the details of the reply are simply outstanding! few clarifications and I do hope that you may help on these:
1- I have checked the test name actually its HIV I+II Ab & Ag (Rapid test), it was not mention 4th generation actually, is it the same? 
2- I made a counting mistake actually I did the test 44 days since that day not 40 days which is more than 42 days (6 weeks), now my result is conclusive correct? . 
two more things not sure if you can help me on? which are
a- I do as said have always low WBC 2.3 to 3 max with lower neutro of avg 35.1 and higher lymph 60.3, is this something I need to worry about I have seen these results for the past 5 years with no improvement and I do always get sick quickly, any thought or recommendations? 
b- what are the common STI that are associated with massages services? 
thank you so much again! 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
16 days ago
I agree 100% about google and web searching. Anybody can write anything they want. You'll get more consistent and valid information on medical issues if you restrict your searching to sites run by professional agencies and/or moderated by legitimate health professionals. In particular avoid nonprofessional sites run by and for people with the problem(s) you're concerned about.

1. It is 4th generation. 4/gen means the same thing as antigen-antibody (AgAb).
2. Correct, conclusive.
a) I haven't changed my mind that your WBC count or immune system function do not affect HIV test timing or reliability. We don't advise about health issues other than HIV and other STIs; I have no opinions about potential reasons for your chronically low WBC. However, I suspect it is entirely unrelated to your perception of "weak" immune system or "getting sick quickly". You should keep working with your doctor -- and if not done so far, consider asking for referral to a hematologist (blood diseases specialist) for the next level of expert advice.
b) No STIs are associated with massage per se. For those massage workers who effectively are sex workers, the risks are no different than for any other partner at risk for STI. All STIs are possible, depending on particular sexual practices, condom use, etc.

Thanks for the thanks. I'm glad to have helped.
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15 days ago
Thank you so much Dr. Hunter, I wish that many people read these questions to correct overall the misunderstanding. honestly sepaking I have had sleepless night and any tiny symptoms immediately drives me crazy to search and read more about STD. thank you so much for this great platform and great services that can not be possible found anywhere. I have used other websites to address my questions and all of the answer were max one sentence of " for reassurance re test after 3 months" or "there is a possible risk of infection", very surprised to read your answers specially about CDC recommendations. as this will be my last follow up and I truly wish you have great life a head and thank you for the great community services provided to every one. my last question are: as young human being the exposure to sexual activities are common and some of the services are legal and certified in many developing countries (not intercourse or viginal / Anal sex), they are common in where I am now and some are using these part of their customers services, what are the DO and DON'T in such activites and the risks (1- erotic massage. 2- body to body massage, 3- happy ending,  4- fingering) in term of STI? 
last thing, why there is no HIV vaccine so far as they managed to develop one for COVID19 in no time? 
thank you so much, wish you all the best and good bye Doctor.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
14 days ago
Massage is no risk for any STD or HIV. "Body-to-body" contact (often called "frottage") conceivably could risk transmission of herpes or HPV, if it includes genital contact without penetration. By "happy ending" I assume you mean either hand-genital stimulation or maybe oral sex? Hand-genital contact and fingering are zero risk for all practical purposes. Oral sex carries risk for several STDs, although less risky than unprotected vaginal sex.

COVID-19 vs HIV vaccine development: These are very different viruses and the mechanidms by which they infect and cause disease very different as well. The world was just lucky that SARS-CoV2 (the COVID-19 virus) is one for which vaccine development was straightforward and relatively easy. The details are very complex, but you should be able to find lots of information on these topics online.

That completes the two follow-up exchanges included with each question and so ends this thread. I hope the discussion has been helfpul. Best wishes and stay safe.
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