[Question #8071] Protected deepthroat but vaginal fluid and blood on hands

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49 months ago
Dear Doctors

Because I know that I am easily afraid of even minimal  HIV / STI risks,  refuse to engage in any vaginal / anal penetration. My encounter was therefore alternating between:

- Deep French kissing
- Long but strictly condom protected deepthroat for 45 minutes with a lot of saliva. We change condom half way to avoir any breaking.
- Putting a dildo alternatively in her mouth and in her vagina, without directly touching her vagina or genital areas.
- Putting my fingers in her mouth.

At some point I unfortunately hit the roof of her mouth (palette) with my nails and I believe I hurt her. A few seconds after, when resuming deepthroat, we noticed blood (limited amount) on the condom and in her saliva when she spit in the bathroom immediately after (was like when you bleed after brushing your teeth)

We immediately and definitely stopped all activity. We whashed our hands with soap and antisceptic solution in the next few minutes. Then, I carefully removed the (second) condom not touching it directly and whashed my hands again.

After she starts bleeding the only contact we had were small kisses on lips.

We both performed HIV rapid test (finger prick after the encounter): both negative (I know it does not cover the last three months). Both condoms were later "water-checked" and were fully ok (no hole, no leak).

To sum up:
- I may have touched with my hand her vaginal fluid which was on the dildo
- she basically may have had vaginal fluid from the dildo in her mouth and I put my finger in her mouth and deeply kisssed her thereafter several times
- I am afraid I haven't washed my hand before changing the first condom and may therefore cannot be sure I have not touched the head of my penis with small amount of vaginal fluid
- I may have some very limited amount of fresh blood on my nails / fingers after I hurt her mouth and before I washed my hands. I had no cut, nor wounds.

Would you kindly give your opinion regarding this event. Is all this indeed no risk events, especially for HIV? Do I need testing? I do no want my anxiety to take over unnecessary.

Many thanks in advance for your time.
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Edward W. Hook M.D.
49 months ago
Welcome to our forum and thanks for your questions. I congratulate you on your cautious, safe approach to sex with new partners, Including commercial sex workers.   This will do much to keep you safe. Each of the encounters you describe was safe sex and represents no meaningful risk whatsoever for acquisition of HIV or other STI’s.

Specifically:
1.  There is no risk for HIV or other STI’s from French kissing and exchange of saliva. This is true even if the person you were kissing has recently had a sex toy which had been previously used on her genitals in her mouth.  In general, HIV and STDs are virtually never transmitted through indirect exposure in which genital secretions are transmitted on someone’s hands or an inanimate object to another location where exposure than takes place.
2.  Similarly and for the same reasons I stated above, if you happened to get your partner’s genital secretions on your hand at the time you handled the sex toy or changed the condoms, there would be no risk of acquiring HIV or STI’s should your hand have then immediately touched your genitals or other parts of your body.  Please remember that even mutual masturbation in which it is typical for partners to get each other’s genital secretions on one another represents a no risk activity for acquisition of HIV or other STI’s.
3.  Any blood or other material which got under your fingernails while your fingers were in her mouth would not put you at risk for acquisition of HIV or other STI’s.

Thus, each of the activities you described represents a no risk event in terms of your own risk for HIV and STDs. There is no medical or scientific reason for testing related to any of the activities you described. I hope this information is helpful to you. EWH
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49 months ago
Many thanks for your swift answer Doctor.
May I add the following follow-up questions?

1. For HIV, because we both performed blood rapid testing (negative), the only chance my partner has HIV would be the result of a less than 3 months infection. In such a case, she would be in her accute infection phase with very high viral load and carry much more infectious fluids. Is this still no risk for hand contact with her fluids or when deeply kissing her (in addition, my mouth health - follwing a previous breakdown and alcohol period has degraded ans is therefore not perfecyly healthy)

2. She indeed is a female escort, forgot to say. She told me she was working as on the call CSW in Poland over previous months. I have no idea how I could numerically evaluate the order of magnitude of my chance to have contracted HIV from this exposure. How many heterosexual Clients may she have had over three months, % of such kind of CSW clients that may be HIV+ in Poland, chance that on of them could be in accute infection... times a figure depicting my chance to have been infected during those acts, assuming she is in her accute infection phase. Any rough figure you could eaborate?
She told me she always refuses anal, cum in her mouth and unprotected vaginal. If she dors not lie, the only she does not protect with other Clients are fellation. She works in rather high-end districts.

3. Last, beacuse I feel my mind will eventually break. Should I elect and manage to take a HIV RNA PCR test (not easy to accessible in France for screening) to relieve the pressure at the soonest before the 4/6 weeks Elisa:
- what is the best time frame (earliest / optimal / latest for HIV RNA PCR?
- what is the eliability of such test (false négative) and the number of false-positive when performed at optimal nunbers of days after exposure?

Many many thanks to you.
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Edward W. Hook M.D.
49 months ago
Thanks for your follow up questions. Straight to my replies:

1.  You can approach the fact that your HIV test prior to the encounter was negative as being good news or bad news. I would encourage you to consider it good news. Your partner has gotten this far and Was not infected within three months of the time of your encounter. The probability that she had been infected in that interval, unless her behavior had changed markedly, was very, very low. That said, even if she was in the acute phase of infection with very high viral loads the encounters you described would still be virtually no risk events.

2.  This comment/question is a unanswerable “what if”, anxiety-driven question. Obviously I cannot comment as to her previous behaviors, her partner numbers, etc. The fact that she works with relatively high end clients however makes the likelihood that she had any STI including HIV relatively low, as does the details she provided you on what practices she would and wouldn’t do.

3.  As I believe you already know, I do not believe the testing is necessary. If you must test, most scientists believe that HIV RNA PCR tests are conclusively positive by 11 to 12 days following an exposure. Despite that, most scientists would also recommend follow up testing with a fourth generation combination HIV antigen/antibody test at six weeks following an exposure of concern. I would add that well over 99% of persons who have been recently infected have positive fourth generation tests by the time four weeks following the exposure has passed.

I hope this additional information is helpful to you. I believe you are worrying more than you need to. EWH
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49 months ago
Many thanks Doctor four your precious answers. 
I won't take more of your time.
I let you close this thread. If needed, only if and after I test, would post in a different one, should something go wrong or unclear with tests outcomes.
In between, i am not going to further cross read other posts and and keep my mind free of concern.
All my kindest regards.
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Edward W. Hook M.D.
49 months ago
Thanks for your thanks.  We can keep the thread open for another 30 days so you can easily post your results without opening a new thread.  I am confident that your results will show that you were not infected.  Take care, please don’t worry.  EWH ---
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48 months ago
Dear Doctors,
Just to let you know my HIV 4th gen Ag/Ab test at 26 days came back negative. I still suffer from periodic anxiety and wait for the 6-week test.
I guess waiting for those tests raise my anxiety and might not be the option. But still, wanted to share those preliminary results. 
Kindest regards.
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Edward W. Hook M.D.
48 months ago
Thank you for the update.  I hope it will prove helpful to others who visit our Forum.  I remain confident that future tests will remain negative.

This completes this thread.  Take care. EWH 
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