[Question #97] Worried about HIV by fingering a prostitute with a possibly bleeding cuticle

38 months ago
I had peeled skin around cuticle of my ring finger and using that finger I fingered deeply a prostitute in her vagina. The prostitute was a cheaper one as I was not wanting to have sex and was supposedly engaging in a "zero" risk activity. I believe with the friction of fingering, the peeled skin peeled further down and I noticed a little stinging sensation while fingering the lady. I did not check whether I was bleeding around/at the peeled skin. I am worried like hell that I might have infected myself with HIV. This happened on 3rd June. I later did a RNA Quantitative and 4th Gen Combo test simultaneously and both came back negative at week 7. Another combo/4th gen test at week 10 came back negative. I had both these tests done through online testing service STDCheck.com. The first ones at Labcorp and the second one at Quest. I have read Dr. Handsfield and Dr. Hook's responses to similar questions on medhelp however I cannot stop obsessing and am haunted by fear. I have had a few symptons, but it could be me assigning everything to my fear of HIV. In any case, one thing I believe I have understood well from medhelp's posts is that testing is far better than obsessing over symptons. I would appreciate your kind response if I may rest easy with my current tests and results. Do I need further testing at the hallowed 3 month mark recommended by CDC? May I resume my love life with my wife without using any proctection?

Edward W. Hook M.D.
Edward W. Hook M.D.
38 months ago
Welcome to the Forum and thank you for your thoughtful assessment of your situation.  I realize that sometimes it is hard to be rational when you are dealing with a problem like HIV.  My purpose in this  reply is to congratulate you on your knowledge of how HIV is transmitted from person to person and to repeat what you have said back to you with a little additional information.  The additional information is to remind you that even commercial sex workers who charge less are statistically unlikely to have HIV or, for that matter, any other STI.  Irrespective of whether she did or not however, there are no instances in which HIV has been proven to be transmitted from person to person through masturbation of the sort you describe, even when a person's finger has a recent cut or open sore present.  The CDC's recommendations are overly conservative.  Your testing at both 7 and 10 weeks serves to absolutely rule out the possibility that you were infected with HIV.  there is no need for further concern, no need at all for further testing and no need to be concerned about sexual contact with your wife in relationship to the exposure you describe.  EWH
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38 months ago
Hello Dr. Hook,

I wish I had written to you earlier. My plan was to wait until 3 months and then get tested. However, I just couldn't handle the fear, got the tests done that I described to you and decided that I get your opinion. I cannot describe to you how much at peace I have been in the last few days after hearing from you. I think I am done with this now and feel ready to move on.

However, if I may, I would really appreciate your response and be grateful to you from the bottom of my heart if you would answer a few more questions:

1] Before I went into the motel room to meet the lady, I noticed peeling skin/hangnail on my ring finger. As mentioned, while I was fingering her vagina using the same finger, I felt stinging sensation around the hangnail which later made me suspect whether the peeling skin peeled further as a result of friction while fingering her and made me bleed during the act. Assuming this happened, would I be at risk for HIV infection.
2] Given I was so afraid of the possibility, I actually went to an urgent care facility within 48 hours of the incident. I explained to the doctor that I indulged into mutual masturbation with a prostitute, however, did not elaborate on these details on possibly bleeding hangnail etc. He did not find it necessary to put me on PEP. I later realized that I left out the important details during my consultation with the doctor, mostly because of anxiety and probably subconsciously thinking that the doctor would inquire about any details he may deem necessary/important. I later started to wonder whether he would have put me on PEP if I had described the situation to him in detail. If you were the doctor and knew all these details, would you put me on PEP?
3] Was HIV testing recommended/necessary in my case in the first place.

Again, I feel very grateful that I can write to you and get your advice. This is a wonderful service and I thank you for your time and compassion in answering our questions.

Edward W. Hook M.D.
Edward W. Hook M.D.
38 months ago

Straight to your questions:

1.  In experimental animals abrasions (and this, by extension peeling skin) does increase the efficiency (likelihood) of HPV transmission.  How important this is for humans however is not quantified and if there is any risk at all, that risk is tiny.  I would not be worried.

2. There are countless instances in which persons with abrasions, sores, or scrapes on their fingers have masturbated HIV infected persons and gotten HIV infected genital secretions directly on the cuts.  Despite that, there are no instances in which HIV has been transmitted from person to person through masturbation.  I certainly would not give PEP to someone whose only exposure was the sort of masturbation you have described. 

3.  I really do not think you needed testing related to the exposure you described.  It is now done however and I hope the results add further reassurance to your concerns.  Glad I could help.  EWH

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