Risk of HIV Transmission Due to Biting

[redwsam]

Dear Doctor,

First, let me thank you for all your help in this wonderful forum. Two days ago, I had an encounter that is making me a bit worried and I was hoping that you could help me with. This involved mainly kissing so I assumed it was perfectly safe. However, after coming home, I noticed a big bruise on my neck where at some places the top layer of skin was peeled although the inner layer was intact and no blood was present. Additionally, where he bit my nipples, there was a very small cut (1mm by 3-4mm) that had some scab on it. The cut seemed to be healed by the time I got home and during the encounter I did not notice any bleeding from either myself for him. Based on the suggestions in the community forum, I tend to believe that this encounter did not involve significant risk for HIV transmission, however, to ensure that I can move on, I have two questions that hopefully you can answer,

1- If the cut on my nipple was fresh and it was due to my partner's biting, what is the risk of HIV transmission (if he is assumed to be positive)? In case he had a minor bleeding in his mouth (although I didn't notice/taste any blood during kissing).

2- As a general question, both for me and for other people that read the post, under what conditions, HIV can transmit due to biting (assuming an HIV positive partner)? I mean with respect to bite size, amount of bleeding from the cut and also amount of blood in his mouth?

Again, I don't assume that there is a significant risk in my case, however, in order to fully move on, I just want your medical opinion on this issue. Finally, do you recommend testing at 6 weeks or should I just do it for my own peace of mind.

Thanks.

[redwsam]

Thanks Doctor for your prompt answer.

[H. Hunter Handsfield, M.D.]

ARS doesn't cause such symptoms.  The sore throat would be severe and there would be fever and probably a skin rash.  Testing at 6 weeks is fine; you don't need to wait longer.  It will be negative.

[redwsam]

Dear Doctor Handsfield,

Your comments really helped me reduce my stress over the past 3 weeks, however, about 7-8 days after my incident , I started to develop a mild throat discomfort (similar to post nasal dripping) that is still not gone. I never had any other symptoms (such as fever and generalized rash). This stops me from moving on (as you suggested) so just wanted to know if this is suggestive of ARS? Also, for testing, is 6 weeks enough or should I wait longer?

I really appreciate your help. This is my last question.

[redwsam]

Thanks again for your very helpful and prompt response. It certainly reduced my anxiety and hopefully I can move on with my life without thinking about this incident.

[H. Hunter Handsfield, M.D.]

I wasn't certain about your sex -- and tried to cover both bases in my response.  No, it doesn't make any difference in my advice.  It raises the probability that your partner had HIV -- although he probably didn't, since most people don't lie when asked directly.  But even with an infected partner, the transmission risk still remains nil from this kind of event.  

[redwsam]

Hello Dr., thanks for your very detailed comment. Just wanted to clarify that I am a male and my partner was also a male. Does this change your assesment of the risk or am I still in clear? He also claims that he is negative but I am just considering the worst case senario. Thanks.

[H. Hunter Handsfield, M.D.]

Welcome back to the forum.

Second question first:  HIV transmission by bite wounds is largely theoretical.  Any trauma sufficient to cause bleeding, if contaminated by an infected person's blood or certain body secretions, could result in transmission.  However, I am not aware of any actual reported cases of HIV transmission by biting or from tooth wounds.  If it really occurs, it's very rare.  One reason is that biters don't usually have blood in their mouths; and saliva inactivates HIV and is generally not infectious.

As for the first question, the comments above largely answer it.  Surely you would have noticed if your partner had blood in his mouth; scant blood that you can't see isn't sufficient to be a risk.  And assuming your partner isn't in an obvious high risk group for HIV (sex with other men, injection drug use, etc), the odds he has HIV are miniscule.

You are exactly right that there was no significant risk from this event.  Sexual safety for HIV means a) choosing partners wisely (avoiding those high risk groups) and b) using condoms consistently for vaginal or anal sex.  That's it.  All the rest -- kissing, mutual masturbation, nicks or cuts in the course of normal sexual activity, and so on -- makes absolutely no difference.  Just stick with the two basics and you'll never be at risk.

Should you get tested?  From a risk assessment perspective, there is definitely no need.  But the fact that you felt necessary to come to this forum suggests you have a level of anxiety that might be reduced further by having a negative test result.  So if my words still leave you wondering and worrying, get tested.  But medically there is no reason to do so.  Your decision.

Best wishes--  HHH, MD