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Dr. Andrew Rynne

Family Physician

Exp 50 years

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How is HIV transmitted?

Answered by
Dr.
Dr. Kakkar S.

Dermatologist

Practicing since :2002

Answered : 8017 Questions

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Posted on Wed, 6 Aug 2014 in HIV and AIDS
Question: Hi Doctor,

I am very scared that I might have got infected by HIV. 12 days back, I went to a strip club, sucked and bit the boobs of a stripper. She wasn't lactating and there were no cuts or sores in her boobs. The next day I ended up in a happy ending massage parlor and inserted my finger (not completely, only top portion of it)only once inside the massauer. I felt moisture (not sure whether that is a fluid) on my finger top but immediately removed it out. After that I noticed that there was a small upper skin peel near the cuticle in my finger. She did a hand job for me. After 2-3 days of these encounters I started experiencing sore throat and felt heat all over the body every now and then. At the 10 day mark after the incident, I had muscle pain on my left shoulder in particular. Also, a small ulcer pimple appeared at the top of my jaw (but it is not painful). Now, I am at 13th day after exposure. Please!! Am fearing a hell and not able to get rid of the thought that I may be affected by HIV. Please let me know the chances of getting HIV based on my above mentioned encounters and whether the symptoms I experience are due to stress? Particularly, the mouth ulcer, can it happen due to stress and anxiety?
doctor
Answered by Dr. Kakkar S. 3 hours later
Brief Answer:
You are safe

Detailed Answer:
Hello and welcome to healthcaremagic

I am Dr. Kakkar. I have gone through your query and I have understood it

Sucking breasts particularly if she was not lactating is not a risk factor.

You cannot get HIV from fingering someone (unless there are open wounds/breaks in the skin of your fingers (a bit of dry or cracked skin would not count).

Your symptoms may be unrelated and may be due to viral Upper respiratory Infection.

Mouth Ulcer could be an aphthous ulcer. It can happen due to vit deficiency, stress and anxiety may also play a role.

For the mouth ulcer I would suggest a mouthwash, twice daily and a topical antiseptic gel e.g Hexidine gel twice daily after meals.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kakkar S. 24 minutes later
Hello Doctor,

Many thanks for your reply.
Please kindly help me by answering the following queries.

1. How big a break should be in the skin on the finger and what amount of vaginal fluid should come in contact with such breaks for one to get infected with HIV?

2. Is Aphthous ulcer not an ARS symptom?

3. Can someone get ARS symptoms like soar throat, muscle ache & Aphthous ulcer (if it is an ARS symptom ) within 10 days of infection?

4. Would you suggest me a HIV test? If so after how many days I should go for the test?

Thanks...!
doctor
Answered by Dr. Kakkar S. 10 hours later
Brief Answer:
You are safe

Detailed Answer:
Hi.

1) A break in the skin can as small as a pin prick, the size does'nt matter. As you had just peeling of the skin/ cuticle, that does'nt count as a break.

2) Oral aphthae are seen in HIV but aphthous ulcers most commonly occur otherwise in healthy population.

3) ARS usually begin 2-4 weeks after a possible HIV infection. Therefore even that does'nt fit in your case.

4)In those who are infected, most develop antibodies to HIV by 25 days of infection, So testing at 1 month with an HIV Combo test (both antigen and antibody based testing) can be taken up to allay all your fears.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kakkar S. 1 hour later
Hi doctor..

Thank you for helping me in relaxing against the fear of
HIV.

The last picture is a peel I have currently on a finger. I had a similar but a smaller (thinner) skin peel on the finger that I inserted ( not a full insertion, only partial and only once). Will this kind of peel is considered to be break in skin? What chances does one have of getting HIV in this mode?

The mouth ulcer is worrying me a lot.

The test that I take in 4 weeks time will be conclusive?

When you said the test is to allay fears, you say that I ill not have HIV for sure?

Thank you..
doctor
Answered by Dr. Kakkar S. 17 minutes later
Brief Answer:
HIV testing

Detailed Answer:
Hi.

I have seen the photograph and I still maintain that you are safe.

HIV should have direct access to the blood stream, through an open wound. An open wound is a cut which is freshly made and freshly actively bleeding. This does not mean an old healed paper cut for example. It does have to be fresh and open and bleeding for the virus to gain access into the blood stream.

Even for cuts, once a scab forms (usually within a few hours), this would no longer give access to the bloodstream, preventing HIV from entering.

Mouth ulcer is not diagnostic of HIV. It can be unrelated. For the mouth ulcer I would suggest a mouthwash, twice daily and a topical antiseptic gel e.g Hexidine gel twice daily after meals.

HIV Combo test at 1 month has a sensitivity of 99.8% and a sensitivity of 99.9% at 3 months. Usually it is recommended to get 2 negatives (at 1 month and at 3 month) if the exposure was a risky one (e.g unprotected vaginal or anal sex). However, since your exposure is not considered to pose any significant risk of HIV, therefore testing at 1 month is good enough to be sure and move on.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kakkar S. 14 minutes later
Hi Doctor,

Thank you again for your kind reply!

I will go for a test on 8th or 9th August as my possible exposure was on 6th July.

As you mentioned mouth ulcer CAN be unrelated. My mind thinks that it CAN be related as well. That is the trauma I have now.

Do you think my emotional stress is the reason for my mouth ulcer? From the pictures I have shared, do you think that I have a mouth ulcer which can be suggestive of HIV?

Sorry to ask these type of questions. I am getting married in 7 weeks time and hence I don't want to ruin my fiancee's life if I am affected. Please, clarify me whether my fears are unnecessary?

Thank you!
doctor
Answered by Dr. Kakkar S. 4 hours later
Brief Answer:
Go for RNA PCR Test at 2 weeks of exposure

Detailed Answer:
Hi

I can understand your concern and the dilemma you are currently going through. It is quite natural.

I can suggest you to undergo a NAAT test for HIV (RNA PCR Test). This test can detect HIV as early as 2 weeks after infection (the window period of detection is shortened from 1 month for HIV Combo test to about 2 weeks, with RNA PCR Test). The test can detect even small amounts of virus in the blood. Therefore, a negative result is highly accurate in ruling out HIV. Means if on NAAT testing, RNA PCR Test comes out to be negative then it is confirmatory that tested sample is negative.

However, rarely RNA PCR Test can give false positive results due to contamination. Therefore it is more of value in excluding a diagnosis of HIV rather than confirming a diagnosis of HIV. The disadvantage is that it is expensive, but a negative test surely would calm your nerves down.

Stress as such is not directly implicated in mouth ulcers.

Mouth ulcers in HIV are no different from those occurring in otherwise normal individuals. Therefore just by looking at the photograph, one cannot say whether it is due to HIV or some other cause

Just want to reiterate the fact that yours was a very low risk exposure and it is highly unlikely that you could have contracted HIV the way you think you could have.

Hope this helps
Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kakkar S. 28 minutes later
Hi Doctor,

Thank you for your suggestions.
I started believing that I wouldn't have contracted HIV.

But one more question.

'Stress as such is not directly implicated in mouth ulcers' - Does this mean, stress cannot cause mouth ulcers?

Thanks
doctor
Answered by Dr. Kakkar S. 17 minutes later
Brief Answer:
HIV testing

Detailed Answer:
Hi.

I mean to say, stress has no proven role in causation of mouth ulcers but it has been implicated as one of the possible causes.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kakkar S. 8 minutes later
Hi Doctor,

Thank you! I am very happy with the way you are treating me here.

Regarding RNA PCR test, will it be good to take this test on 16th day after exposure?

Will there be a possible false negative in this test?

What are the reasons for false positive results in this test? If because of stress, if my immune system is a bit compromised, then also will it show a false positive result?

Thanks!
doctor
Answered by Dr. Kakkar S. 16 minutes later
Brief Answer:
HIV Testing

Detailed Answer:
Hi

RNA PCR shortens the window period to about 2 weeks. Therefore you may take this test after 2 weeks post exposure.

False negative is unknown with RNA PCR and probably indicates that the sample was mishandled.

False positives can happen, contamination being one of the cause. Stress won't cause a false positive.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kakkar S. 45 minutes later
Hi Doctor,

Thank you.

I will come back to you after getting RNA PCR test by next week or HIV combo test after 20 days from now.

One last question.

What is your opinion in your experience, someone getting HIV by sucking boobs and fingering with a small cut in finger? ie., other than vaginal, anal sex and oral stimulation of vagina?


Thank you!
doctor
Answered by Dr. Kakkar S. 7 hours later
Brief Answer:
HIV Risk is negligible in your case

Detailed Answer:
Hi.

Unless the female is lactating breast sucking is a no risk. Even if the female is lactating breast milk carries the least chance of infecting as compared to blood transfusion, vaginal, anal and oral sex.

In my opinion and my experience says that the risk is negligible in your case. However, you can document it with appropriate testing.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kakkar S. 8 minutes later
Hi Doctor,

I should be very thankful for your patient & prompt consultations.

Would you recommend me exercising something in particular to not think always the worst?

I would like to close this discussion after ur reply to this query. Once again thank you so much..
doctor
Answered by Dr. Kakkar S. 23 minutes later
Brief Answer:
HIV test

Detailed Answer:
Hi.

Brisk walking, jogging, swimming, cycling etc are activities that can keep you engaged, and ward off negative thoughts. Besides, engaging yourself in constructive work and getting involved with just a single sexual partner in future would be my advice to you

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