[Question #8130] Potential exposure to mucous contact to possibly blood? Shortened version
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48 months ago
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Recently had an encounter with 3 sex workers in Mexico over
1 night (64 days ago). All protected vaginal. The next morning I noticed red
smeared on my boxers. Not sure if it was red lipstick or menstrual blood.
Boxers were worn between encounters with the 3 females. I’m HSV-2 positive.
Doctor says HSV infection occurred a while ago as I only had measureable IGG
levels when tested (day 16 tests were full panel, see below). No lesions or present
outbreak during the interaction with the sex workers. Circumcised 18 months prior
to the interaction with the sex workers. 4 tests have been performed since. All
4th gen tests. Day 16, day 43 and day 60 were all blood from a vein.
Day 32 was from a finger prick. All negative. Confirmed EBV infection on day
53. VCA IGM, IGG and EA-D IGG came back positive. EBNA IGG not performed. Could
this be hiding HIV acute infection or truly EBV mono? Red substance, was able
to be smeared off boxers by solely rubbing with finger. Never recall seeing
blood on condom at any point with any of the girls. Status of the girls is
unknown. Mono is going away. I’m really only concerned about the contact that occurred
while wearing my boxers. I doubt any got in my urethra while wearing them.
Highly unlikely. If it was blood, and I was in contact with it while wearing
boxers, could it have been absorbed through my glans? The majority of the red
was centered at the height of my testicles, latterly to the sides, not about my
penis; so intact skin basically.
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Edward W. Hook M.D.
48 months ago
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Welcome to our forum and thanks for your question. I appreciate the shortened version and would suggest that you contact the website operators at ASHA and ask that your funds for your prior question, which will go unanswered, be refunded. If there are further questions after my response to this set of questions feel free to use the app to to follow up opportunities to ask those questions. You do not need to pay twice to get your questions answered.
The exposures that you described were low risk and you have proven that you were not infected with HIV. Statistically most commercial sex workers in Mexico do not have HIV and, even if one of them did, without a condom your risk for infection following a single encounter would’ve been less than one infection per 1000 encounters. With a condom as you used, that risk is far lower, conservatively lower than one and 100,000. As for the red material that was on your boxers, even if it were blood, blood which comes in contact with the surface of your skin would not lead to infection. This is the case even if you do have herpes and I would not necessarily rely on a blood test to make that diagnosis (Blood test results were fall into the so – called “low positive”results range are frequently falsely positive).
Both your day 43 and your day 60 blood test results are conclusive and should be believed. The presence of EBV antibodies would not mask or change the result.
Based on the information you have provided, I can assure you that you did not acquire HIV from the exposure do you have described. There is no medical or scientific reason for further testing. Your results are conclusive and show that you were not infected.
I hope the information I provided has been helpful. If further clarification is needed or there are additional questions, please feel free to use your ability to follow ups as part of this thread for clarification.
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48 months ago
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What is the medical term for the skin that the glans is comprised of? I've read that contact with mucous membranes is a possible means of transmission. I know that what I'm about to state is stupid based on the conclusive response that you gave me but I'm just fearful that I'll be an outlier that tests positive after 2 months. There was a decent amount of red that was absorbed into the fabric so that's what scares me. 2 girls were wearing red lipstick and they both performed oral - so maybe lip stick, just venting. The exact contact between my glans and the duration of contact is unknown. Are these variables even meaningful given the event in question, assuming it was even blood? I'm an engineer, not a doctor so you're probably reading this thinking that my comments are childish. Apologies in advance, sir. My PCP and an ER doctor (went to the ER cause of EBV symptoms) both told me that my chances are low, given that I used a condom during sex and the event that I'm concerned with is, technically speaking, non-sexual. Assuming that I have HSV-2 and that there were no outbreaks present during the event, are there HIV target cells centralized on my "intact" glans than someone without HSV-2? Or are they only present when outbreaks are present. Is there any significance to this? Also, does my recent circumcision factor into any of all this? Lack of development of protective sheath over the course of 18 months? You seem incredibly confident so that puts me at ease a bit.
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Edward W. Hook M.D.
48 months ago
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The skin on the head of the penis is not a mucous membrane. It is epithelium.
Your concerns about being an outlier are misplaced. Please believe your test results. They are conclusive. I would add that HIV and STI’s are not passed through the fibers which make up material. With the virus contacts these fibers it sticks them and goes no further. STI’s and HIV are not transmissible through clothing of any sort, even the sheerest underwear.
I understand your apprehension. Symptoms of the sort you describe make people nervous. That said, once again I can assure you that your results are entirely conclusive. Your relatively recent circumcision actually has been proven to be a factor which reduces your risk for HIV acquisition by about 50%. This would offset any possible increase in risk associated with your herpes
I hope this additional information is helpful. EWH
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48 months ago
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Hi Doc,
I know I have 1 last follow up, so I'd like to use it. I know that you've stated that my test results are conclusive but I continue to stress a bit on the EBV. I feel like I should have had it by now since I'm 28. I've read that an acute HIV infection can trigger mono to reactivate it so that has me worried. I don't even know that's it's a reactivation since I wasn't able to find the EBNA IGG value listed anywhere on my testing paperwork. The other three were positive: VCA-IGM, VCA- IGG, EA-D IGG.
I also had CMV appear at an equivocal value: .61 U/ml. What does this mean?
.61 U/ml MEASURED
Interpretation
<.60 negative
60-.69 equivocal
>.70 positive
No CMV IGM's were detected. I also recall that you said that the presence of an EBV infection wouldn't mask an HIV infection. I know that my day 43 test and my day 60 4th gen tests, with blood drawn from a vein are conclusive. Here are my last questions.
1. Is there ever a time where seroconversion would begin after 60 days?
2. Is the requirement for testing at 90 days still current standard medical practice for potential exposures? Or is it outdated at this point with the abilities of current testing.
3. Should I retest at 90 days?
4. Am I overthinking / amplifying the risks of my exposure to an unrealistic degree? If so, please tell me.
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Edward W. Hook M.D.
48 months ago
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Welcome back. I think you are overthinking this and worry that you may be researching these issues on the internet. If so, I want to discourage you from continuing to do so. The internet is all too often misleading and serves no other purpose than to amplify anxieties. Remember that the internet has no filter and that for this reason much of what is found there is inaccurate, either because statements are made out of context, are out of date or are all too often just plain wrong, passing on what can only be called fake news.
Your EBV tests are most consistent with past infection. IgM tests can remain positive in persons with past infections.
Just as reported, your CMV test is equivocal and given just how low it is, most likely suggests that you are not infected
---1. Is there ever a time where seroconversion would begin after 60 days?
No, except for persons who have been taking medications specifically designed for HIV therapy. Not ever!
2. Is the requirement for testing at 90 days still current standard medical practice for potential exposures? Or is it outdated at this point with the abilities of current testing.
No, this 90 day requirement has been out of date for some time, both because even years ago it was overly conservative but also because currently used, combination HIV antigen/antibody tests have been proven to provide conclusive results in untreated persons at any time more than 6 weeks (42 days) after exposure.
3. Should I retest at 90 days?
There is no medical or scientific reason to test again related to the exposure you described. To continue testing would be a waste of time and resources.
4. Am I overthinking / amplifying the risks of my exposure to an unrealistic degree? If so, please tell me.
Please see my answer above.
Hope this helps. Please believe your test results. EWH