Some doubts about what Andy and Ann have said are NOT HIV Transmission Issues

[rudymacek]

Hi Andy and Ann and Sfath.

My name is Rudy and I am a researcher (sometimes in medical fields). I have spent the better part of a week perusing your forums and want to congratulate you on running a fine ship! However, a few posts where you have collectively said that a person's story did not constitute an HIV transmission risk have troubled me. One is this:

Reply #2 on: May 22, 2010, 08:44:06 AM »
 
"While having the protected vaginal, I felt a lot of discomfort on my penis and so I stopped and checked why there was this discomfort.  What I found was what looked like a bleeding pimple on my penis shaft (a good amount of blood leaking from my penis shaft), it was also completely covered in vaginal fluids.  This bleeding pimple on my penis shaft was not covered by the condom (condom only covered 65% of my penis) and this unprotected bleeding pimple definitely entered the sex workers vagina repeatedly - INSIDE her vagina - hence the vaginal fluids was covering the bleed.  In the moment of passion, if I can say that, I just reinserted my penis back into her vagina fully knowing that the bleeding pimple would be exposed to more of her vaginal fluids INSIDE her vagina.  Call me stupid and dumb I know.  I regret this so much.  Is this a HIV risk and is HIV testing warranted?"

As the man's bleeding penis shaft was completely inside the woman's vagina and in repetitive direct contact with possible contaminated fluid, I would think the hosts needed for transmission of undamaged HIV virus were indeed present, as this exchange of body fluids was taking place inside the bodies. I know that the risk would be minimal but should this person not have been advised to be tested?

A second concern I had was in response to Spath's post when Ann wrote that a male giving himself or getting a handjob with fresh infected blood on his hands would not be at risk for HIV. I again realize that this risk would be very small but should not a test be warranted there as well?

I do see that the vast overwhelming majority of HIV transmission fears on the forum are invalid, as you have responded perfectly to them, but the sole stressing of vagina/anal unprotected intercourse as the only real means of transmission might need to be addressed here.

Appreciate you response,
Rudy

[Tim Horn]

Hi Rudy:

Just wanted to let you know that I've deleted your other two identical entries -- there's no need to cross-post, as you spell out the key details of your argument here.

I'll leave it to Andy and Ann to explain their positions further.

Tim

[Andy Velez]

Rudy, the original poster said he developed a water blister, which suggests that the skin was never broken. He also didn't report  that the HIV-positive woman in question had either blood or vaginal fluids on her hand, but merely posited it as a hypothetical. In addition, as we all very well know, there's never been a documented case of HIV being transmitted via a hand job, water blisters or not. HIV is a very fragile virus and we'd have known long before this if such circumstances presented a risk.

The pimple situation is a bit more complex. It is  inflamed tissue with immunologic activity at the surface of the skin. This kind of situation is very common. Perhaps erring on the side of caution it would be advisable to get tested just for peace of mind. Given how common such spots and irritations are on the penis, again we'd have known long before today whether it presented a serious risk. However, with HIV exposure it's never a bad idea to be cautious. Even though I would certainly expect a negative test result I wouldn't argue against it if the guy decided to get tested at 3 months.

As far as I am concerned, peace of mind is often important enough in itself to justify testing.

 

[rudymacek]

Hi Tim and Andy,

Tim, thanks for telling me...I only wanted to draw Andy's response and won't do that again.

Andy, thanks for your response.

If you will permit, I would just like to clear my understanding of this a bit further. In spite of my accuracy in comprehending what the guy said or meant, let me put it hypothetically: If a man's penis shaft is actively bleeding (to the point where there is no new skin formation yet developing) and it is inside an HIV woman's vagina (even though condom is covering the penis opening), would her vaginal fluid entering into the cut penis shaft present any REAL HIV transmission threat, whether or not there is a documented case of any similar transmission? 

In the handjob scenario, if a man has fresh infected blood (say he just inserted his finger into a menstruating HIV-pos woman) on his hand, and the blood managed to enter his bloodstream via the urethra, what risk does that pose? Let's say that the blood immediately went from her to him with the minimal exposure to air posssible?

One final situation that happened to me:

I was frotting with a female sex worker (no condom), my penis rubbing between her buttocks. During the sessiion I felt a wetness on my scrotum and realized that it came from lubricant the fsw had inserted into her vagina in anticipation of intercourse. What alarmed me is that on my scrotum I have a colleciton of purple pimples or spots that are probably dilated blood vessels or fordyce spots. Though none of them were bleeding at the time, I am not sure as to the thickness of skin covering them. Is this any kind of transmission risk, and would it have been if one of the spots on my scrotum had bled during the session, assuming the fsw was positive?

Thanks again and I will continue reading your informative forums.   

[Andy Velez]

Hi Tim and Andy,

Tim, thanks for telling me...I only wanted to draw Andy's response and won't do that again.

Andy, thanks for your response.

If you will permit, I would just like to clear my understanding of this a bit further. In spite of my accuracy in comprehending what the guy said or meant, let me put it hypothetically: If a man's penis shaft is actively bleeding (to the point where there is no new skin formation yet developing) and it is inside an HIV woman's vagina (even though condom is covering the penis opening), would her vaginal fluid entering into the cut penis shaft present any REAL HIV transmission threat, whether or not there is a documented case of any similar transmission?  

I DON'T KNOW OF ANY DOCUMENTED CASE OF TRANSMISSION IN THAT MANNER. WE DON'T LIKE TO GET INTO SPECULATING ABOUT HYPOTHETICAL SITUATIONS AND PREFER TO DEAL WITH SOMETHING THAT ACTUALLY HAPPENED AND EVALUATE IT CAREFULLY FOR RISK. STOP AND THINK FOR A MINUTE ABOUT HOW (UN)LIKELY IT IS THAT A MAN IS GOING TO BE HAVING INTERCOURSE WITH AN ACTIVELY BLEEDING PENIS.  SPECULATIVE SCENARIOS ARE NOT USEFUL IN OUR EXPERIENCE.
  
In the handjob scenario, if a man has fresh infected blood (say he just inserted his finger into a menstruating HIV-pos woman) on his hand, and the blood managed to enter his bloodstream via the urethra, what risk does that pose? Let's say that the blood immediately went from her to him with the minimal exposure to air posssible?

ANOTHER WHAT IF SCENARIO. HIV IS A FRAGILE VIRUS SO IF IT WAS IN THE BLOOD ON HIS FINGER IT HAS ALREADY BEEN EXPOSED TO THE AIR AND QUICKLY BECOMES NOT VIABLE. IN TERMS OF ACCESS TO HIS URETHRA, BLOOD ON THE FINGER IS QUITE DIFFERENT FROM THE RECEPTIVE SETTING WHEN THE PENIS IS INSIDE THE VAGINA UNPROTECTED. EVEN THEN THE OPENING IN THE URETHRA IS SO MODEST THAT IT MAKES IT DIFFICULT FOR TRANSMISSION TO OCCUR, WHICH IS WHY IT IS THE FEMALE WHO IS AT MUCH GREATER RISK IN UNPROTECTED INTERCOURSE THAN IS THE MALE.
  
One final situation that happened to me:

I was frotting with a female sex worker (no condom), my penis rubbing between her buttocks. During the sessiion I felt a wetness on my scrotum and realized that it came from lubricant the fsw had inserted into her vagina in anticipation of intercourse. What alarmed me is that on my scrotum I have a colleciton of purple pimples or spots that are probably dilated blood vessels or fordyce spots. Though none of them were bleeding at the time, I am not sure as to the thickness of skin covering them. Is this any kind of transmission risk, and would it have been if one of the spots on my scrotum had bled during the session, assuming the fsw was positive?

THERE'S A WORLD OF DIFFERENCE BETWEEN UNBROKEN AND ACTUALLY BLEEDING SKIN. AGAIN, I HAVE NEVER HEARD OR READ OF TRANSMISSION IN SUCH A MANNER. AND SINCE IT DIDN'T ACTUALLY HAPPEN TO YOU, THIS IS JUST MORE SPECULATION ON YOUR PART. FRANKLY I AM UNWILLING TO GET INTO A DIALOGUE OVER THIS SORT OF WHAT IF.  


Thanks again and I will continue reading your informative forums.    

[rudymacek]

Hi Andy, Ann and everyone.

Nearly everyday I visit FSWs and rub my UNPROTECTED penis in just about every area of their bodies but WITHOUT actual penetration into the vagina, anus or mouth. I slip it and thrust between the buttocks, as close to touching the orifices as possible, between breasts, thighs, etc.

Is this anything more than a low thearetical risk if vaginal fluids or blood are present on the womens' bodies?

If possible, can you tell me what the risk is of cpntracting herpes in this manner, if the woman has active sores?

Finally, realizing that I can indeed contract pubic lice in this manner...would vigorously cleaning my genital areas immediately afterward remove the lice before they attach, or would it already be too late?

I also assume that engaging with women whose pubic hair is shaven lowers the risk of contracting lice...is this true?

Thank you for your response...

FOR ANN:

I have read your blog in detail, including how you learned you were HIV-pos and when you realized the time transmission took place. If I may ask, (and of course I know you might not want to answer this), how were you infected? And also, was it because at the time you weren't as knowledgeable as today or were you betrayed by a lover?

Thank you, and please don't be offended by this. It's just that I found your blog posts very "feeling,"

Rudy

[Andy Velez]

The activities you are currently reporting are not risks for HIV transmission.

As for the aspects of other STDs which are you concerned about, you need to discuss them with your doctor. We are an HIV-specific site and prefer not to get into offering opinions on other STDs beyond anyone who is sexually active having regular checkups for them.

[rudymacek]

Hi everyone,

I have been reading just about all the HIV forums and when it comes to the question: Can fresh infected blood or vaginal fluids oozing from an HIV-pos woman that immediately enters an HIV-neg man's bloodstream through open cuts on penis shaft or urehtra via handjob or leakage cause seroconversion? All the forums including thebody.com and medhelp.com as well as most reputable sources state that this is indeed a risk. On this forum I get the impression that it is absolutely no risk. Is it that the other forums are saying this is a risk because it is only theoretically possible and that this forum translates that into odds so negligible that in reality there is no risk?

Please explain.

Thank you,
Rudy

[jkinatl2]

It is impossible to quantify an event that has not ever been documented.

Theoretically, HIV could someday mutate into an airborne virus. Such an event has happened before. It has not happened with HIV, and is extremely unlikely to do so.

Scientifically speaking, there is no such thing as 100% certainty. Variables, some of them beyond our current comprehension, exist to make that so.

In the history of the HIV pandemic, we have learned much about human behavior and the analysis of risk. Prior to the long-term studies of serodiscordant relationships, we relied on the following for HIV transmission science:

a) in vitro study, where specific cells were found to be vulnerable to HIV infection. This is the most sound science of all, I posit, because it is directly and continually observable. However, it does not always translate to real-life experience, as a multitude of variables (close to chaos theory, though I do not subscribe) are in play during each individual act.

b) in vivo using SIV, SHIV, or in chimps and other primates. HIV. This isuseful in a slightly different way, as observing the organisms under controlled circumstances is possible, yet variables are introduced that come relatively close to human experience. Sadly, primates react differently than humans when infected with SIV, SHIV, and HIV. Chimps, for example, almost always (I believe science has encountered two exceptions so far) seroconvert, then revert to negative at a later date.

C) Documentation of reported sexual activities. This is perhaps the weakest science regrding HIV, or for that matter, any sexual activity. It is not, for ethical reasons, possible to observe the subjects 24/7 for years, and it is not possible to experiment with people using live HIV (such as putting active virus into the mouth to see if indeed HIV can infect orally).

For many years, scientists and researchers relied on interviews with infected persons and, when possible, their partners. While this went far to advance transmission vector theory (especially in terms of ruling out vectors, such as casual contact), it relied on patient report. As you are, I am sure, aware, patient report is notoriously unreliable - particularly when dealing with socially stigmatized issues such as sexuality, homosexuality, and anal sex. Moreover, when a person is under the influence of mind-altering substances such as alcohol or other drugs, s/he may do things that s/he simply does not recall, or recalls far differently.

The groundbreaking Romero study http://www.ncbi.nlm.nih.gov/pubmed/12045500 used that unreliability to an advantage that had not been considered before. It followed serodiscordant couples who engaged in sexual activity over a long period of time (ten years) but used condoms solely for vaginal and anal intercourse. Dr. Kimberly Page Shafer conducted similar studies among gay men in the US, and found the same conclusion.

No incidents of transmission through either insertive or receptive oral sex were found.

Obviously, these studies contradicted earlier ones, which were based on patient report after infection. A resulting round-table discussion amongst scientist and researchers reveals that this is an ongoing controversy.

http://hivinsite.ucsf.edu/InSite?page=pr-rr-05

However, the hard science, the verifiable science, supports Page Shafer and Romero completely. 

Recent discoveries such as the fact that there are very few receptor cells in the oral cavity, the fact that the Bartholin's glands (also called Bartholin glands or greater vestibular glands in females do not carry HIV in greater concentration than sweat or tears, leads to the conclusion that getting HIV from cunnilingus is as close to impossible as science will allow.

Even menstrual fluids, which can and do contain infectious blood, have never been documented to transmit HIV. The fact that there has been exactly zero documented cases of female to female HIV supports this.

HIV is an extremely fragile virus, not nearly as hardy as bacterial STDs. When exposed to temperature and pH changes, the elements of the virus that attach to receptor cells almost immediately become unstable. It is unable to infect another cell without these elements (outside of carefully controlled in vivoexperimentation.

Nothing in life can be called 100 percent certain, scientifically. No promise beyond a doubt that an asteroid will not hit the earth tomorrow. No promise that human mortality will always be a constant. no promise that you will not be the first in the documented history of the HIV pandemic to become infected through the activities you describe.

However, if that happens, and I certainly hope it does not, you would be under extreme scrutiny and study, as your physiology would appear to conflict with the recorded history of human physiology as regards HIV vulnerability. It could even lead to a cure.

This site is the only one in which I participate, specifically because it does not speculate into the realm of the theoretical unnecessarily. It does not give Las Vegas-style odds of infection because to do so would be ludicrous. It does not cover it's collective ass by hedging, and it does not promote stigma and fear by contradicting itself.

This site, thanks in large part to Tim Horn's own scientific and research expertise, uses first-tiered peer-reviewed science with near exclusivity. And science changes, it evolves. What was considered a risk in 1981 was certainly not considered so in 1991. Now, almost twenty years past that, we have refined transmission theory much further. No new vectors have been added, and several have been dismissed.

I hope this has been of some service. I know that as a researcher yourself, you would appreciate the long version.

[Andy Velez]

I'm going to caution you about something. We are not here to serve as your resource everytime you come up with another "what if" or concern. Generally we prefer to focus on particular actual situations which have happened to someone and make an educated evaluation as to what level of risk there may have been.

By your own description you're having frequent sex. Other STDs are much easier to acquire than HIV, so if you aren't already having a regular checkup with a full STD panel, that's something you might consider.

I suspect from the tenor of your remarks there are more feelings about your practices than you are expressing and intead they are coming out indirectly in a somewhat challenging tone in your remarks.
So you need to be aware that unless you have a specific incident that occurs, you need to do research on your own. And we're defnitely not interested in getting into evaluating or discussing what you pick up from other sites.

You're certainly free to have any doubts you choose to about the responses you receive here. Doubts and fear aren't facts and we're just not here to debate with you.

[rudymacek]

jkinatl2....thank you for that in-depth response. It clearly answered my question as to how you qualify real rsiks vs hypothetical and imaginative risks. Much appreciated!

Andy...you are a little off base here. My question was not personally biased in any way. It was simply a request to investigate a difference of opinion and statement. I am not doing any research and certainly feel I was not deserving of your rebuke.

Howver, thanks for the attention you have given my posts.

Rudy