POZ Community Forums
HIV Prevention and Testing => Do I Have HIV? => Topic started by: Shiblee on March 05, 2007, 08:35:34 pm
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A recent episode with a Thai SW (of unknown hiv status) has me worried. During vigorous fingering with index and middle finger deep into vagina there was vaginal bleeding which wasn't noted for a few minutes because it was dark (either from a cut in the vagina or menses). Hand was washed with no clear cuts or abrasions. Is there a risk to the fingerer? Could blood under nails or on cuticles cause transmission even if there are no overt cuts or abrasions especially if not all could be washed off because of location. It seems possible, but most people seem to say no. In addition, could different HIV subtypes (such as subtype E in Thailand) have a greater chance for transmission because they better infect Langerhan's dendritic cells which are all over the skin and mucous membranes (including the finger!). Is HIV testing suggested in such a scenario? Your thoughts are appreciated.
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You did not have a risk, even if you would have had a hangnail or small cuts on your finger.
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thanks--it seems reassuring--but if there is hiv positive vaginal blood, and it mixes with a small cut (not seen) on the finger, wouldn't this be the same risk as unprotected insertive vaginal sex which is a known mode of transmission. isn't hiv much more concentrated in blood than in vaginal secretions making such a fingering episode potentially risky?
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Nope. If you had a major laceration, then there possibly might have been a risk.
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Hi, I read your post and my first thought is that you are not at risk at all of hiv infection from this experience, and that you are trying to figuere out a new transmission route for hiv that has not yet been documented.
From what I have read all experts say that skin exposure to hiv only represents a risk if you are bleeding - ie fresh blood, semen or vaginal fluids comming in contact with a cut on your finger that is fresh and bleeding.
A risk example: Consider the chance for unprotected intercourse from a condom-breakage with a HIV+ infecting you to be around 1/1000 for one intercourse, and then perhaps 1/10 Thai SW have HIV ( wild guess- probably lower- but just an example) - this puts the estimated risk for the unprotected intercourse to around 1/10,000 with this play of risk numbers. Your risk is a lot lower than this example, and the risk of you getting hiv from this experience is from my guess around the risk that lightning from heaven will deliver a fatal blow to you on an appearant cloudless day- so nothing to worry about ! :)
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again, thanks for your thoughts. what this means is that transmission from unprotected insertive vaginal sex is not necessarily from microabrasions to the penis as this would put the risk for fingering in the same category (assuming microabrasions on the finger). hiv must have another transmission mode female to male during unprotected vaginal sex. otherwise there would be many more cases of vaginal secretions or blood on other parts of the body causing transmission. what is the exact way transmission occurs from unprotected sex female to male?
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virulens, do not post in others threads. If you have a concern or thought post them in your own thread. Please read the posting guidelines found in the "Welcome" thread.
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Shib,
It's nothing to do with "micro abrasions" on the shaft of the penis. The skin on the shaft penis is no different to skin elsewhere on the body. It's the head of the penis that is vulnerable - particularly the urethra. During intercourse, sometimes small amounts of cervicovaginal fluid (the thick mucus found covering and protecting the cervix) will get inside the urethra and this is were there are some cells that hiv is able to infect. Also, this takes place INSIDE the body, where hiv is in the exact environment it needs in order to be able to infect. Hiv is very fragile, and small changes in its environment will quickly damage it and render it unable to infect. The other vulnerable area found on the head of the penis is the underside of the foreskin on men who still have their foreskin intact.
As long as you wear a condom during intercourse and the head of your penis remains covered, you will avoid hiv transmission.
Not one person has ever been infected through fingering - cuts or no cuts - and you will NOT be the first.
Ann
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Just to ease my anxiety, I took a home access test @ 5 weeks post exposure (2nd gen Ab test) which was negative. I developed symptoms of sore throat, diarrhea, enlarged tonsils, soft palate hemorrage, mild truncal rash, and persistent headache BUT NO FEVER between 5 and 6 weeks--with persistent symptoms (still have them). Could this be ARS and I still haven't seroconverted? When, if , and how should I retest? Thanks. The explanation of transmission was helpful---but I've read so many places about "microabrasions" on the penis causin F to M transmission. Also there must be something about circumcised men that allows transmission outside of urethra (dendritic cells on foreskin? that virus can attack?). Thanks again.
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Shib,
You do not need further testing. You can take that test to be conclusive because you were never at risk in the incident you brought to us. NO RISK! I'll say it one more time, fingering, with or without cuts or abrasions or whatever other spin you can think of to put on it, is NOT a risk for hiv infection. Not one person has EVER become infected through fingering and you will NOT be the first.
You need to go to your doctor to find out what is causing your problems, because whatever it is, it is NOT hiv.
You ARE hiv negative and if you use condoms correctly and consistently for anal or vaginal intercourse, you will stay that way. It's time to move on with your life.
Ann
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thanks again--i see your point--could anxiety be enough to drive the above symptoms? i'm sure anxiety is the #1 problem on these boards.
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Shib,
Stress and anxiety can indeed have a huge impact on your physical health. Please see your doctor about your symptoms. Your health is nothing to self-diagnose or guess about.
But remember, you did NOT have a risk for hiv through fingering.
Ann
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how accurate is a home access test @ 5wks? is there a higher sensitivity @ 6 wks?
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Shib,
In your case, it doesn't matter. You did not have a risk so you are not anywhere in a window period. As long as it has been three months or more since the last time you had unprotected intercourse, you test is conclusive. There is no "five weeks" about it. You are conclusively hiv negative and it is seriously time for you to get on with your life.
Ann
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regardless of my risk which you say is non-existent, i'm still not clear about transmission F to M. if only sexual mode of transmission F to M is through urethra, then why are uncircumcised men more at risk than circumcised for transmission since the foreskin is on the outside of the penis? i'm curious. thanks for all of the input in calming my worries (i'm symptom hunting for ars as i believe many anxious people do).
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oops i meant circumcised men are at greater risk not uncircumcised (see above). any answers would be appreciated.
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It's nothing to do with "micro abrasions" on the shaft of the penis. The skin on the shaft penis is no different to skin elsewhere on the body. It's the head of the penis that is vulnerable - particularly the urethra. During intercourse, sometimes small amounts of cervicovaginal fluid (the thick mucus found covering and protecting the cervix) will get inside the urethra and this is were there are some cells that hiv is able to infect. Also, this takes place INSIDE the body, where hiv is in the exact environment it needs in order to be able to infect. Hiv is very fragile, and small changes in its environment will quickly damage it and render it unable to infect. The other vulnerable area found on the head of the penis is the underside of the foreskin on men who still have their foreskin intact.
Shib,
Did you read the above the first time around? It's men who still have a foreskin intact who MAY be at greater risk than a man who has been circumcised. There are some cells present on the inside of the foreskin (the part that lies next to the head when the foreskin is in its natural position - not pulled back) that are more vulnerable to hiv infection. However, being circumcised does NOT mean you cannot become infected. A circumcised man can still become infected via the urethra.
If you wear a condom when you have anal or vaginal intercourse, consistently and correctly, you will not have to worry about transmission via your foreskin OR urethra. Condoms have been proven to prevent hiv infection.
And fingering is NOT a risk for hiv infection.
Ann
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Shib,
I just re-read your second to last post.
You can symptom hunt all you want, but don't for one minute think we're going to entertain you coming here for the foreseeable future to ask about your symptoms. You didn't have a risk and your symptoms will have nothing to do with hiv. Take them to your doctor, not us.
I would also suggest you read the Welcome Thread (http://forums.poz.com/index.php?topic=220.0) and take note of our forum posting guidelines, particularly the one that says:
Anyone who continues to post excessively, questioning a conclusive negative result or no-risk situation, will be subject to a four week Time Out (a temporary ban from the Forums). The purpose of a Time Out is to encourage you to seek the face-to-face help we cannot provide on this forum.
Please consider yourself warned.
Ann
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yikes, i'm sorry if i asked too many questions. i thought the line of reasoning was reasonable. i won't post again regarding this issue. thanks.
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Shib,
My warning to you was in reaction to your admission of symptom hunting. You didn't have a risk so there is no point in you even thinking about symptoms, let alone researching them. I was heading you off at the pass before you started coming back here to ask symptom related questions.
Ann
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1) How reliable is a 6wk negative elisa antibody test post exposure?
2) Are the symptoms of ars related to seroconversion and antibody positivity? Meaning have people studied how long after ars symptoms antibodies develop? Is someone who has late ars symptoms more likely to develop antibodies later than usual?
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The average time to seroconversion is 22 days. All but the smallest number of those who are going to seroconvert will do so within 4-6 weeks after a risky incident. So a negative at 6 weeks is very encouraging. It should still be confirmed by re-testing at 13 weeks for a conclusive result.
Neither appearance nor the absence of symptoms is ever the way to know about your HIV status. Only an HIV test done at the proper time will give you a reliable answer. Everything else is guesswork.
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1. 6 weeks is a good sign of what you're 13th week conclusive test will be.
2. Doing your window period when your body is serocoverting is when ARS happens, if it happens at all. Antibodies start to be manufacted as soon as infections takes place and continue to replicate as time goes on.
What was your risk? Please take time to read the "Transmission" section. You can find the link in the "Welcome" thread.
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Shib,
I've merged your new thread into your original thread - where you should post all your additional thoughts or questions. It helps us to help you when you keep all your additional thoughts or questions in one thread.
If you need help finding your thread when you come here, click on the "Show own posts" link under your name in the left-hand column of any forum page.
Please also read through the Welcome Thread (http://forums.poz.com/index.php?topic=220.0) so you can familiarize yourself with our Forum Posting Guidelines. Thank you for your cooperation.
As you have been repeated told, you never had a risk in the first place and that means your five week negative result is conclusive. You ARE hiv negative.
Protect that negative status by using condoms for anal or vaginal intercourse, correctly and consistently, every time, no exceptions.
Ann
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I should have put this in my own thread, not GTBs. I'll ask again. Any takers?
Why does Massachusetts recommend a 6 week ELISA as conclusive regardless of risk while this site's moderators recommend a 13 week test as conclusive if there was moderate to high risk (which I assume fingering with blood is?) Can you clarify the discrepancy? Does it refer to different generation of tests? I won't post again in this thread.
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I was doing fine (tested negative ELISA and RNA PCR @ 11 weeks) until I started having ARS type symptoms @ 5 months. Also, @ 11 weeks my labs showed epstein barr virus reactivation (high titers). I'm worried that my immune system was suppressed because of epstein barr and therefore I am possibly a late seroconverter. Then, I did the worst thing--I started googling late seroconversion and came up with a few reports like this:
"Am J Med. 1997 May 19;102(5B):117-24; discussion 125-6. Related Articles, Links
Time course of viremia and antibody seroconversion following human immunodeficiency virus exposure.
Busch MP, Satten GA.
Irwin Memorial Blood Centers and the University of California, San Francisco 94118, USA.
Rational application of diagnostic assays in the management of healthcare workers (HCWs) following occupational exposure is needed to rule out pre-existing human immunodeficiency virus (HIV) infection, detect HIV infection or seroconversion as early as possible in the small proportion individuals who become infected, and to rule out infection in the high proportion of individuals who remain uninfected following occupational exposure to HIV. An understanding of the time course of viremia and seroconversion following HIV exposure is essential in developing recommendations for management of occupational exposure among HCWs. Several data sources that address the timing and dynamics of HIV viremia and seroconversion following primary infection are reviewed. The implications of each data source for management of occupational exposure among HCWs is assessed. Although the majority of infected HCWs seroconvert within 2 months of exposure, the possibility of delayed seroconversion is well established, with approximately 5% of infected HCWs estimated to seroconvert >6 months after exposure. In contrast, the period of viremia (detectable by p24 antigen or RNA assays) preceding antibody seroconversion is consistently brief (1-3 weeks). Animal inoculation studies indicate that a variable period of localized viral replication in lymphoid tissue draining inoculation sites exists prior to systemic viremia and subsequent"
I am freaking out! Do I need to retest?
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Shib,
I've merged your thread AGAIN - we've been through this several times with you now, between posting new threads and posting in other people's threads. Read the posting guidelines and get with the program already.
Don't bring any more ten year old articles here and that have nothing to do with you and try to squish them into fitting your situation.
You do not have hiv. Period. End of story.
Ann