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Author Topic: Real information regarding fingering with exposed dermis/open cut  (Read 19006 times)

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Offline ozzyt

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This is my first post here. I have a specific concern related to my own circumstances that has, through a lot of detailed research spilled out into a broader issue. I'll try to outline both. There are a lot of worried posts on the net, here, and elsewhere, concerning the risk of HIV transmission through an open cut on a finger whilst fingering - vaginal fluid getting onto expose dermis. The answers to these are almost all very vague - it tends to get a response of 'it is not a risk. zero risk. There has never been a documented case via fingering with cuts, bleeding or not.'

Now, my point is, that this is simply not a satisfactory answer for people. People are still continuing to post regarding this and I've not seen a single shred of scientific or well explained reasoning to reassure them. With other modes of possible transmission there are large amounts of information being given in response to quell fears - saliva containing HIV inhibiting substances etc but not for the case of fingering and an open cut. I will give below, very clearly, and point by point if you will allow me the concerns I have for myself, and have noticed from other posters in the hope that they might be addressed. It also concerns me that some very significant misinformation may be getting spread and I will get onto that.

In my case, I always used condoms for penetrative sex, but I am worried because I was involved a numerous situations involving fingering - now ordinarily this wouldn't be a concern, but for ten years I have had a small non healing cut on my fingertip (all other cuts heal, I have no problems there, it's just an odd thing several doctors have seen). Having had this for so long I didn't even think about it whilst fingering. It wasn't actively bleeding but I do remember once it bled after a hot bath when I squeezed it. I think it sometimes gets infected a little. Anyway, what it amounts to is about 5mm by 3 mm of completely exposed dermis - no epidermis.

So here are my concerns:

1. Vaginal fluid contains significant amounts of HIV and by being exposed to the dermis during fingering could easily have travelled (transcytosis) through the dermis to the blood vessels within it, and through those vessel walls, which in a cut, with inflammation may be attenuated, and into the bloodstream where it would have access to T cells.

2. It bothers me that an answer I have seen given a few times as if fact is that HIV is only at infectious levels in cervical mucous rather than vaginal fluid. I have seen a doctor speak about this and cast severe doubts on it. The people that give this answer have claimed to be privy to lots of scientific research - I don't mean to be confrontational but given the very serious concerns and worries people have they have a right to be told where this information is from if it is true - it would be highly irresponsible to spread information that has no sound scientific backing and just appears across the internet in forums occasionally. I, myself, did as much research as I could, but don't have full access to every medical paper and the only thing I could find on the matter was a study where the amounts of HIV were measured in cervical fluid, vaginal fluid and blood in positive people. The amount in blood was about 50 times higher than the other substances, BUT the amount in cervical fluid was actually slightly lower than vaginal fluid (5000 vs 6000 per ml if I recall correctly). Now, all I'm suggesting is that someone responds with the information that has been used that would contradict this.

3. Another thing that is often said is that 'there are not the target cells required in a finger for HIV infection, whereas these cells exist in the genital tracts'. As far as I can see this is also untrue. Again please do tell me if I'm wrong and with evidence - I really am genuine in wanting to be wrong here! It seems a complicated issue with the exact role of Langerhan's cells not fully understood (as they seem to be the main dendritic cell infected by HIV, bringing the virus to lymph nodes where it is then directly able to infect CD4 tcells - the immune function actually causing infection - but they produce langerin which kills/inhibits hiv, so there is confusion about whether more or less langerhan's cells aid hiv transmission and whether its the abundance of hiv that overwhelms their langerin capacity). However, what is a fact is that Langerhan's cells exist in number in the cells on normal skin - not just the genital mucosa. A cut would bring more into play. So why is it claimed the finger does not contain the required target cells?

4. There are studies I have read which test the capacity of HIV to permeate the rectal and vaginal mucosa. The efficiency of it doing this is extremely limited (about 0.02 percent in one study managed to permeate undamaged mucosa). A study of HIV transmission through abraded skin showed HIV freely permeating it as there was no keratinised layer or epithelium at all - there are protective layers in foreskin etc though they are thin. In addition to this the dermis is hydrophilic - it absorbs water, whereas even the rectum in studies has been shown not to absorb water or salt, that is the function of the colon.

5. In trying to assess if vaginal fluid coming into contact with exposed dermis internally while fingering is a risk, it is worrying that it seems to recreate the risky scenarios outlined by the above information. An internal situation, where the skin is broken, dermis having no protective layer, and HIV able to absorb into the skin. If it is the cases where there is mucosal damage that cause hiv transmission, then this is similar, is it not?

I don't wish to call into question information given for the sake of it, but it is essential that correct information is given out on this subject and that people don't feel scared to question its validity. I do accept that the fact there have been no documented cases of transmission via fingering, and it's encouraging but not particularly reassuring when usually there are other sexual acts taking place that would be focussed on, and one wonders in the cases of serodiscordant couples if torn cuticles etc would represent exposed dermis (I have read of dermal infection of herpes taking place this way). Are there many situations in which dermis is exposed? When would a case have been documented? Has it ever been investigated or simulated on laboratories? I'm always hearing about these tests being very specific to investigate modes of transmission but have never seen one testing this, while I have seen lots of people saying with absolute certainty that you cannot catch HIV via fingering even with an open bleeding cut. The epidermis even on the fingertip is only a mm or so deep.

I would very much appreciate some detailed information regarding the concerns raised here. Thanks very much.

Offline Andy Velez

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Re: Real information regarding fingering with exposed dermis/open cut
« Reply #1 on: July 14, 2012, 01:38:33 PM »
Ozzy, after all of that you're not going to hear anything different than what you are thus far unsatisfied with.

The parts of the vagina you would be fingering are not in the cervical area where the mucosal skin can contain HIV. HIV is a fragile virus and is not easily transmittable. And certainly not in the manner you are concerned about.

If you had a fresh and currently bleeding wound on your finger(s) that might raise the risk level. But frankly, is that the circumstance under which you would be fingering a vagina? I don't think so. Wounds on the skin also begin a swift and natural closing process not visible to the naked eye before something like a scab would be noticed.

I've never known of a single case of confirmed transmission in the manner you are concerned about. And it is a very common sexual activity.

The only confirmed risks for the sexual transmission of HIV are unprotected vaginal and anal intercourse.

Frankly the tone of your comments is in the direction of argumentative. We're not here to argue. You can accept what we say or not. We're not here to prove anything to you. Our evaluations of risk are specific and based on science and experience.

Take what you can use and leave anything you don't find helpful is my suggestion. 

en  t
Andy Velez


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