Need risk assessment please

[squigglyone]

Hi everyone! 

I've had 2 recent encounters with CSWs

1st -4 wks ago- she fingered her vagina, then immediately massaged the tip of my penis.  

2nd -3 wks ago- I fingered her for 5 mins, quickly used hand sanitizer.  I inspected fingers & noticed rough looking hangnail, and a pinpoint looking break in the skin.  2 hrs later, i noticed coagulated blood where the hangnail once was.  This sent me into a panic because it may have been open and bleeding during the fingering.

I'm not AS concerned about the first episode - i know HIV dies quickly once exposed to air - however, the fluid exchange was rapid, and was massaged onto my urethra.  The 2nd episode makes me really nervous.  i can't help but wonder if there was an open actively bleeding wound while i was fingering her.  

now i have fatigue, malaise, sore throat, and mild fever (mid 99's) 3-4 weeks out.  I know symptoms are bad indicators, but still!

1.  what are the odds of infection for these 2 encounters?  Would you say i have a better chance of being abducted by aliens and then having a meteor fall on the spaceship?  I realize i'm resorting to hyperbole, but i want to know if my chances are truly infinitesimal.  is the risk zero?

2.  If my finger wound was in fact fresh and bleeding during fingering, could a torn hangnail be a wound that would provide a route for HIV infection?   is a fresh hangnail wound deep enough (assuming it's actively bleeding)?  

3.  If your answer to #2 is no, why?  Biologically, what is the difference between sticking a finger with a fresh wound (like bleeding hangnail) in a vagina vs an exposed penis?  Aren't both equally opportune routes of invasion?  Clearly, HIV is transmitted through skin breaks or cuts - to health care providers, for example.

4.  is it possible for ARS to show with a sore throat/fatigue/malaise WITHOUT a high fever or rash?  How high typically is an ARS fever?  

Thanks so much!!  I look forward to your replies!

Best,

S.O.

[RapidRod]

HIV is unable to reproduce outside its living host (unlike many bacteria or fungi, which may do so under suitable conditions), except under laboratory conditions; therefore, it does not spread or maintain infectiousness outside its host.

You didn't have an exposure.

[Ann]

squiggs,

1. Yes, you have a much better chance of being abducted by aliens and then having the spaceship hit by a meteorite than you do of being infected through fingering. Not one person has ever been infected this way and you are not going to be the first.

2. No. You're not going to be infected through a torn hangnail. See answer #1 above. If you cut the tip of your finger off and then immediately fingered someone with the stump, you might have a reason to be concerned, but why would you want to do that?

3. Because hiv can only infect a very few, very specific types of cells, ones that aren't readily available in a shallow wound. Hiv is actually very fragile and difficult to transmit.

4. Many people never experience a single symptom of hiv seroconversion. For this reason, we do not put any emphasis on symptoms, because it may lead someone who has had an actual risk (you did NOT have a risk) to think they're ok because they had no symptoms.

Believe me, if we though you had a risk, we'd tell you and urge you to test. You did NOT have a risk and you do NOT need to test over either of these two incidents.

Here's what you need to know in order to avoid hiv infection:

You need to be using condoms for anal or vaginal intercourse, every time, no exceptions until such time as you are in a securely monogamous relationship where you have both tested for ALL sexually transmitted infections together.

To agree to have unprotected intercourse is to consent to the possibility of being infected with an STI. Sex without a condom lasts only a matter of minutes, but hiv is forever.

Have a look through the condom and lube links in my signature line so you can use condoms with confidence.

ALTHOUGH YOU DO NOT NEED TO TEST SPECIFICALLY OVER FINGERING, anyone who is sexually active should be having a full sexual health care check-up, including but not limited to hiv testing, at least once a year and more often if unprotected intercourse occurs.

If you aren't already having regular, routine check-ups, now is the time to start. As long as you make sure condoms are being used for intercourse, you can fully expect your routine hiv tests to return with negative results.

Don't forget to always get checked for all the other sexually transmitted infections as well, because they are MUCH easier to transmit than hiv.

Use condoms for anal or vaginal intercourse, correctly and consistently, and you will avoid hiv infection. It really is that simple!

[squigglyone]

Thanks for the reassurances, Ann. I do also appreciate your Thorough responses. And, logically I do realize this.  And I will also test - not just for peace of mind, but also as a routine std screening.

With that said, I still dont quite get how anyone gets infected with contaminated instruments if an open wound cannot provide an avenue for infection. I gather CD4 cells circulate through the bloodstream, and if a wound draws blood, and that wound comes into contact with HIV infected fluids, why isn't transmission possible?  I mean, even if CD4 cells aren't RIGHT there, can't the virus make its way through the bloodstream to the lymphatic system where these cells are most certainly in abundance?

The standard response that fingering with an open and actively bleeding hangnail isn't a risk seems counterintuitive. I know that there have never been documented cases of transmission through fingering, but in reality I doubt that any study participants among serodiscordant couples have ever had mutual masterbation as the ONLY sexual contact risk, and we all know scientists assume (for good reason, no doubt) that if infection occurs it must have been caused by the more established riskier activities (unprotected anal or vaginal) as opposed to other activities that are simultaneously being carried out (ie fingering with recent open wound).

Sorry for the rambling. .

[squigglyone]

Of course, please do feel free to comment/respond - Ann, Andy, all. 

Best!

S.O.

[squigglyone]

Ann, Andy, Rod.. anyone??

[Ann]

Ann, Andy, Rod.. anyone??

Squiggs,

You need to be patient. When you posted the above, it was twenty past two in the morning here in the middle of the Irish Sea. Your other posts were made when I was having my supper and then when I had my feet up, watching telly. Those of us who answer questions here do have lives, you know.

With that said, I still dont quite get how anyone gets infected with contaminated instruments if an open wound cannot provide an avenue for infection.

What you're not getting is that it is rare in the extreme for someone to be infected in this manner. In the thirty years of this pandemic, there have only been one or two cases where a person has been infected through medical instruments (other than needle-stick injuries, in which case infections aren't all that common, or needle sharing by drug users). If you think of all the medical procedures that go on every day around the world, you'll see just how rare infection by this method is.

You go on to bring up the "what if" scenario of a negative person in a poz/neg relationship being infected by fingering but it being attributed to unprotected intercourse, but then why is this not happening in the couples who correctly and consistently use condoms?

Condoms have been proven to prevent hiv infection. There have been three long-term studies of couples where one is positive and one is negative. In the couples who used condoms for anal or vaginal intercourse, but no barrier for oral activities, not one of the negative partners became infected with hiv. Not one.

I myself was in a poz/neg relationship for over eight years. He is in the building trade and often has cuts, nick, hangnails etc on his hands and fingers. Yet he remained hiv negative and is hiv negative to this day - through the simple use of condoms for intercourse. 

The bottom line here is that you have not had a risk for hiv infection. We will not hold your hand over this matter.

Of course you should test - including a full panel of STI testing - because this is what responsible adults do at least once a year, not because you had a risk. (You did not have a risk.) Think of it like going for a yearly dental check up. You may not have a toothache, but you go and get checked out anyway.

Ann

[Andy Velez]

Ann has covered this situation throughly as to why you are worrying needlessly. HIV is a fragile virus. We would have known decades before today if what you are worrying about was a legitimate concern.

You are bothering yourself needlessly. Period.

[squigglyone]

Ann/Andy/Rod,

Sorry if i appeared impatient -- i'm sure you know the anxiety can be quite overwhelming.  plus, I'm obviously over-analyzing this situation.  No sex = No risk. 

I will just have to bite the bullet and get tested at 6 weeks and pray i come out ok.  You do a wonderful service to us all. 

much love,

S.O.

[Ann]

No sex = No risk.

Squiggs,

"Sex" is a pretty all-encompassing word. Let's get a bit more specific.

Sexually speaking, "no unprotected anal or vaginal intercourse" = no risk.

Sexually speaking, only unprotected anal and vaginal intercourse are proven risks for hiv infection.

Use condoms for anal or vaginal intercourse, correctly and consistently, and you will avoid hiv infection. It really is that simple!!!

Ann