I would like to seek your professional advice regarding a risk situation concerning fingering a high-risk woman with a cut on the finger. Can vaginal secretions when in contact with a cut (I don't remember it to be actively bleeding, but it was a cut of about 1cm length, that was partially scabbed) lead to HIV infection?

My situation is the following: I met with a CSW for a massage. The lady does not do escorting but did let me stimulate her clitoris area. There were a lot of fluids coming out and I did have the cut around one of my fingers. I don't remember when the cut happened, but I'm pretty sure it was before the event. Maybe same day or maybe the day before. The lady claims she is HIV-negative, but I'm having trouble believing that given that she engages in sex work of some sort. No other sexual contacts took place.

It has been about 4 weeks since the incident. Around week 3 or so, I have felt a lot of fatigue. A feeling of being sleepy and needing to take naps, which is a bit unusual. I haven't experience any sore throat, headaches, rashes, or fever ( I have measured my temperature 1-2 times daily and always between 97-98.5 orally).

My questions are:

1- is the fingering event despite the cut considered a risk for HIV, even we consider the lady to be infected and not treated? what would be the proportions of that risk if you were to quantify? I see a lot of conflicting information on internet on "low risk" vs. "theoretical" vs. "high risk for open wounds"

2- can symptoms of fatigue alone be indicative of seroconversion?

3- when is a good time to be tested if you recommend testing in the first place?

To expand.  First, it is statistically unlikely that she was infected.  Most women, even most commercial sex workers, and she says she is not, do not have HIV.  More importantly however, there are no proven instances in which HIV has been acquired by masturbation of an infected partner.  This is the case even in instances in which individuals have fresh cuts or scrapes on there hands.  Both the CDC and the WHO are emphatic that masturbation of an infected partner is a no risk event.

In response to your specific questions:

1.  See above.  No one has ever been proven to acquire HIV in this way.  You will not be the first.

2.  Fatigue is not part of the definition of the Acute Retroviral Syndrome which accompanies seroconversion.  It is entirely nonspecific 

3.  If you choose to test to prove that you have not been infected, testing at 4 weeks is 99% conclusive and testing at 6 weeks is entirely conclusive.

Hope this helps.  Please don’t worry.  EWH 

I appreciate the succinct and comprehensive response. Very much relieving of my worries. I went ahead and got a test done AgAb blood draw this morning. It resulted negative as expected. I have a few follow-up questions:

1- With this test result, can I know be 100% confident in me not being infected with HIV?

2- The test took place at 27 days and 14 hours since the encounter. Is this close enough to 4 weeks/28 days and is there any effect of this timing on the conclusiveness of the test?

 3- Do you see the need for an additional test at 6 weeks or beyond to achieve 100% accuracy on the results?

4- At this timing, and given how the ARS works, can I be sure that any future ARS-similar symptoms I may develop are not due to HIV? Does this also clear the doubt on any previous symptoms I had in the past?

5- I did look up some case reports of patients who have seroconverted between 4-6 weeks after having a negative at 4 weeks. I have not found anything. Is the 6 weeks guideline erring at the side of caution?

Thank you for your expertise and for bearing with these numerous questions. I'd like to say that I'm very much relieved by your medical opinion and especially my negative result this morning.

1.  You are encounter with classified as a no risk event even before you tested. You were test result confirms that you did not require HIV. Believe the test results.

2.  The official recommendation is that HIV antigen/antibody tests are 100% conclusive at any time more than six weeks following and exposure. At four weeks tests are more than 99% conclusive. I have personally never seen an individual who went on to have their test go from negative to positive in the interval between four and six weeks. It’s already noted however since your encounter was no risk to start with, I would have complete confidence in your test results

3.  As I’ve already indicated I saw no reason for testing to start with. I certainly see no medical or scientific reason for testing at this time.

4.  Yes. The ARS develops around 2 to 3 weeks following exposure and symptoms occurring more than four weeks after exposure or due to some other cause.

5.   Like you, I’ve never seen or heard of a person who seroconverted between four and six weeks. Once again I urge you to have confidence in your test results. 

As you know, we provide up to three responses to each client’s questions. This is my third response. Therefore this thread will be close shortly without further responses. 

Take care, have confidence in your test results, and please don’t worry. EWH

I see the thread open and I realized that I only used one of my follow-ups only. Do you mind responding to my second follow-up inquiry, as permitted by the forum guidelines?

I was very reassured with my initial results but I also went ahead and did a lab-based AgAb at 44 days (43 days and 14 hours). It came back non-reactive. I know this is further than the six week mark but is about a day short than the 45 day period indicated by the CDC. I know my situation is no-risk, but would this test be fully conclusive regardless of exposure at this time? Can I fully put this matter to rest and move on?

Also, why is there a discrepancy between 6 weeks and 45 days in a lot of sources? Which one is more accurate in this case?

Thank you. This will be my final question so I wanted to take time to thank you for your time and expertise. I really admire the work you do and I appreciate you as a tremendous resource for all the anxious minds around.

With this final follow up this completes this thread which will be closed. Please don’t worry. EWH