[Question #9193] hiv cut

35 months ago

Dear dr,

Thanks for the wonderful service you’ll provide on this forum .

My question is regarding Hiv exposure .

I got into an argument with a gay friend and accidently his mail scratched a pimple i had on my forearm . My pimple bled a bit (2 drops of blood ) and i washed it immediately.

My worry is if i am at risk of hiv from this incident ? i don’t know his status, though he is a gay man .

Please advise . Thanks

H. Hunter Handsfield, MD

35 months ago

Welcome to the forum. Thank you for your confidence in our services.

Nobody in the world has ever caught HIV from an event like you describe. There is no possibility of infection, even if your friend has an active, untreated HIV infection. HIV is not transmitted by such casual contact. I recommend against testing for HIV (unless you are actually at risk on account of unprotected sex or shared equipment for drug injection). If you have a regular partner, you can continue your usually contacts without fear of transmitting HIV to that person.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

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35 months ago

Thank you doc for your quick revert .

I am not very sexually active and don’t have unprotected sex , however i tested last week as part of my routine chekc up and tested negative .

The mail scratch incident happened about 2 days back .

I didn’t notice my friend bleeding from his nail or arm . However , assuming he was bleeding would there be a risk ?

I read that exchange of body fluids such as blood , semen , etc can result in transmission .

Hence was a bit concerned . Request your mimd advise please . Thank you .

35 months ago

also to add , i am a bisexual male . My gay friend bit my nipple , however i didn’t notice any bleeding or cuts . My worry is what if i had small cuts or cuts i didn’t notice , because of this incident . Request you to please advise . Thanks

H. Hunter Handsfield, MD

35 months ago

Thanks for the follow-up comments. First, about "exchange of body fluids such as blood , semen , etc can result in transmission": Public health messaging on this has often been poor, resulting in assumptions that ANY blood exposure is risky for HIV. But it takes much more substantial exposure than the sort of event you describe. Blood exposure means direct injury with a freshly used sharp medical instrument, still wet with visible blood from an HIV infected patient; blood transfusion; shared drug injection equipment; or perhaps massive blood exposure of the sort that might occur in tending to wartime injuries, helping the victim of an auto wreck, etc -- i.e. blood all over the place in large amounts. The standard educational materials typically take a highly conservative stance that can be interpreted as risk from even trivial exposure to exceedingly small amounts of blood. As I said in my opening comments, nobody in the world has ever been known to catch HIV from such a minor event of the kind you describe.

Love bites probably are entirely risk free. Oral exposure of any kind rarely transmits HIV, maybe never -- in part because saliva kills HIV. Assuming your bisexuality includes real sex with other men -- now or someday in the future -- that's where you will be at risk for HIV. By "real sex" I mean unprotected anal penetration; even oral sex is risk free for all practical purposes. If you are having unprotected anal sex, or do so in the future, for sure use condoms; always ask partners about HIV status before proceeding with sexual contact; and if anything other than a mutually monogamous relationship, plan on pre- or post-exposure prophylaxis (PrEP or PEP) with anti-HIV drugs. But for goodness' sake don't worry about day to day contact with anyone, including touching, hugging, social kissing, sharing bathrooms or kitchens, or any other daily contact with potentially infected (or known infected) partners.

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35 months ago

Dear dr,

Thanks a lot for your detailed responses . I don’t have anal sex . Oral sex only involves receiving , getting blowjobs .

1. I read that human bites can cause big and there have been cases where hiv had been caused through a bite .

Since he bit my nipple , wouldn’t this qualify as a human bite ? i didn’t notice any visible blood but there might have been minor cuts which weren’t noticed

2. Would Pep be necessary for such an exposure .

3. What if there were small breaks in my skin and i didn’t notice ? I don’t know his hiv status .

4. Can i consider taking PRep if i am just going to be having oral sex ?

Pls advise . Thanks

H. Hunter Handsfield, MD

35 months ago

1) I'm not aware of any scientifically validated cases of HIV transmitted by bites. If it occurs at all, it is exceedingly rare, and certainly a little love nip on a nipple is insignificant.

2) Even if your partner were known to have HIV, I would not recommend PEP.

3) Same deal. Not enough virus can enter small skin nicks to allow infection to take hold.

4) Personally, I would not recommend PrEP for someone whose only exposures are oral sex. However, some experts might disagree and would recommend it, at least for men to perform oral on other men. And the decision might be different for some men than others. For example, if you are 100% confident you will never have anal sex, PrEP would be a lower priority; but perhaps appropriate for someone who doesn't intend anal, but might get caught up in the moment, or perhaps whose resolve faltered in association with passion, alcohol, drugs, etc. If you wish to consider PrEP, do not do it on your own or after online advice only: see an experienced HIV health care provider in person for evaluation and advice.

Like many people, it seems you have the impression that "just one virus" can transmit infection, i.e. that trivial exposures carry at least some risk. It simply isn't true. Different infectious diseases are transmitted with greater or lesser efficiency. The saving grace of HIV is that it's actually hard to transmit: lots of virus must have access to certain kinds of cells, which typically are not in easily accessed locations. For unprotected vaginal sex -- when a man with ejaculates infected semen into a woman's vagina -- her risk is only once for ever 1,000 exposures. Given that, what could it possibly be for the tiny exposures you are asking about? The answer is zero, for all practical purposes. This is why HIV is an STI or transmitted by blood, and never to household contacts, through shared toilets or kitchens, or by the sorts of things you are asking about.

In other words, have safe sex, then stop worrying entirely about any other kind of exposure. Got it?

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

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