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Does Skin Contact With Vaginal Fluid Or Lubrication Increase The Risk Of HIV Infection?

Posted on Tue, 10 Dec 2013

Question: Hi Dr. Batra, I am a 30 year old male.I had protected sex with a sex worker on 15th of August. As far as I could see, there was no visible breakage in condoms (I used 2) . I removed the condom with my right hand.Some vaginal fluid or lubrication (I don't know exactly) stuck to my fingers. I cleaned my penis with the same hand. I am circumcised. All this happened barely seconds after pulling out from the female's vagina. Then I took some water in my hand and repeatedly gargled. Do these activities put me at a risk of HIV? 1. I tested for HIV with a Retroquick test at 57 days after exposure. It was negative 2. I took my cd4 counts 25 and 57 days after exposure. On the 25th day it was 847 (43.2%). On t he 55th day it was 454 (42.7%) 3.I tested for Hepatitis c at 45 days after exposure. It was positive. RNA PCR count put it viral loda at 4.19 millions. Genotype 3 4. I had a blood transfusion done when I was an infant 5. My Liver Function Tests were normal on 25th day after exposure but SGOT,SGOT and Bilrubin were elevated at 55th day after exposure. 6. After being diagnosed with HCV, I was eating not more than 1 meal for a period of 8-10 days. I also did not sleep for more than 2-3 hours on an average after diagnosis. I had taken the second cd4 count 8-10 days after being diagnosed with HCV. I have researched extensively about c4 counts, HIV and HCV. Based on the sharp drop in cd4 counts and the sharp rise in SGOT,SGPT and Bilrubin, I have convinced myself that I probably I have also contracted HIV. I know that an HIV acclerates HCV. I do not want to die a painful death. I am thinking of ending my life. Please let me know if there is any possibilty that I might not have contracted HIV. I will get tested but I am looking for a detailed answer here. Thanks.

Answered by Dr. Roopa Hiremath (1 hour later)

Brief Answer: HIV tests, Hepatitis C Detailed Answer: Hi Mr XXXXXXX Welcome to Health care magic. I have gone through the details of your query and I understand that you are very stressed out because of confusion regarding your HIV status and Hepatitis C infection. Before I go into answering your question, I would like to mention that there is so much information available on the net about HIV and associated conditions that it can cause panic and anxiety in the readers. Here you have to trust your treating doctor and share all relevant information with him and allow him to guide you in the right direction. Protected sex definitely reduces the chances of getting HIV infection. So in your case, less likely chance of infection to have occurred. You have undergone a quick test for HIV which has given negative results. I would suggest you undergo one confirmatory test like ELISA for HIV1/2 antibodies or western blot test to confirm this negative status. This will relieve your stress regarding this matter. Coming to hepatitis C infection, this is caused by a virus which is most commonly spread by blood transfusion. This infection causes slow progressive liver disease and few patients may develop liver cancer after 15-20 years of infection. This infection progresses faster in patients whose immunity is low like in HIV infected. Hepatitis C infection can be treated by interferon and many antiviral drugs. These options can be discussed with your treating doctor. Outcome of this infection depends on these factors: 1. Age of patient - younger age has better outcome 2. Duration of infection - Chronic infection takes long time to heal 3. Cirrhosis - If liver disease is present, bad outcome 4. High viral load 5. HCV genotype - genotype 2 and 3 have better outcome. I suggest you discuss these details with your treating doctor and get a complete lab workup to rule out liver disease (cirrhosis) Dont give up so easily. Your CD4 and CD8 counts are only suggestive of viral infection and not HIV. Your liver enzymes are showing elevations due to hepatitis C infection and not because of HIV. I hope I have cleared all your doubts. Please get back if any more clarifications. Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Roopa Hiremath (26 minutes later)

Hi Dr. XXXXXXX Thank you for your answer. I will undergo a test at the appropriate time. I have a couple of other queries. 1. Can stress reduce cd4 counts. I under immense stress and I was not eating well for almost a week prior to getting the second cd4 count done. Can stress reduce cd4 count? 2. I have read that cd4% is a better indicator than cd4 count in case of HIV infection. Can I take heart from this fact? 3. I have also read that sexual transmission of Hepatitis C is very rare and it is blood to blood. Is this true? In my case there was no visible blood. 4. Doctor, I had touched my penis after removing the condom. I have read that unless one touches the urethera, the chances of hiv being transmitted through the penile shaft is very remote. Is this true? 5. Finally doctor, its possible that I ingested some blood while gargling, even though I did not see any? 6. Dr. I have read that Liver enzymes rarely increase during chronic phase unless it is end stage liver disease. So does that mean that in my case HCV was recently contracted? I would definitely take a test at the appropriate time. In the meanwhile< I would like you to answer these. I really need to talk.

Answered by Dr. Roopa Hiremath (1 hour later)

Brief Answer: CD4 count, HIV transmission Detailed Answer: Hi Mr XXXXXXX Welcome back. I appreciate the change in your attitude. You have understood my previous reply completely and you have asked appropriate questions. 1. CD4 counts and stress: CD4 cells are lymphocytes which mainly fight against infection. These cells are also called T helper cells. The normal range is 500 to 1500 cells per cubic mm of blood. These cells increase in number slightly during any acute infection and may fall later once that infection is controlled in the body. Studies have shown that fatigue and stress have shown low CD4 counts. 2. CD4 count in HIV: CD4 count is very important in HIV infection because HIV has affinity for these cells and multiplies in them and later destroys them. So initially there is rise in CD4 count and then drastic fall occurs. This fall causes very low immunity and person infected with HIV starts getting infections which are opportunistic (meaning usually these pathogens do not cause infection but cause infection only when immunity is low) 3. Hepatitis C infection is spread by transfusion, from mother to baby, tattooing, I.V drug abuse. It is rarely spread by sexual route. 4. Vaginal secretions and semen of infected HIV persons are very rich in HIV particles and they gain entry into the body through mucosa covering the genitalia during sexual intercourse. That is why using barriers/condoms reduces chances of spread of HIV infection. 5. Very less chances of infection by ingestion. 6. Elevated liver enzymes only indicate liver disorder and are not diagnostic of Hepatitis C infection. Anti HCV antibodies are diagnostic and occur at about 5 months after infection. Rise in titer of anti HCV antibodies indicates active infection. I hope I have cleared all your doubts. Please get the suggested tests for HIV and HCV confirmation. Wishing you speedy recovery. Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Roopa Hiremath (18 hours later)

G\Hi Doctor, Thanks for your detailed answer. I will get the tests done as suggested by you. However, I have one final question. Immediately after removing the condom, I touched my penis with the same fingers. Does that put me at risk? I will close this discussion after your answer.

Answered by Dr. Roopa Hiremath (5 hours later)

Brief Answer: Doubtful risk as minimal exposure Detailed Answer: Hi Mr. XXXXXXX I doubt that was a risk for infection as it was a very minimal exposure. The volume of vaginal fluid is important. Lesser the volume, lower the risk. Please get the appropriate tests done as suggested. Wishing you good luck. Thanks.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar