Handjob with Blood. Please Advise.

[r99732]

Dr. Handsfield,

Hope all is well.  I have read through various posts and understand that hand-to-genital contact carries no risk of HIV transmission.  I would greatly appreciate it, however, if you could provide me with a detailed explanation as to why.  My situation is as follows: I received a handjob from a stripper who used saliva as a lubricant.  During the encounter, I realized there was blood in her saliva.  I myself had razor cuts on the base of my penis.  Teak responded to my similar post in the community forum that I was never at risk.  But as a lawyer, I need to know the rationale as well as the rule.  The fact that there has never been a reported case is insufficient to allay my concerns.  After all, there are reported cases of blood to blood contact, right?  What distinguishes my scenario from, say, someone's infected blood entering into someone else's open cut on their arm, or leg?  For example, is a razor cut an insufficient entry for outside blood into my bloodstream?  Or does infection from blood on blood contact require a larger amount of blood than was present?  Also, some in the forum suggest that blood to blood contact requires significant open cuts that require stitching and that minor razor cuts, even if bleeding, are insufficient.  Do you agree?  Please assess my risk and whether I need testing.  I know that it can be tedious answering similar questions to those contained in the forum, but everyone feels their situation is unique.  As such, I would certainly be grateful for a comprehensive response.  Thank you for your time.

[Edward W Hook, MD]

No change in my opinion or advice.  EWH

[r99732]

Doctor Hook, sorry to trouble you again.  It occurred to me that I failed to mention that the exotic dancer was of African American descent and lived in a less than affluent area of New Orleans.  You had originally stated that the chances she even had HIV to begin with are remote, but does this information change that analysis?  Do I still not require testing?  And is it safe to resume unprotected sex with my wife?  This will be my last post and I apologize if I have taken too much of your time.  I realize there are others with more pressing situations.  Thanks again and be well.  

[r99732]

Thanks, Doctor.  Take care as well.

[Edward W Hook, MD]

Correct.  It is now time for you to put this episode behind you.  Take care.  EWH

[r99732]

Hey Dr. Hook.  I'm glad to have gotten you!  I certainly did not desire complex biomedical information - just general medical reasoning, which you have provided.  I am very grateful for that.  To answer your question regarding the blood, I did not know she had blood in her mouth.  After she had been fervently tugging on me she used her saliva, at which point I looked down and saw blood.  I cannot be certain whether the blood came from her mouth or from my razor cuts being aggravated or both.  The answer I desired to alleviate my concerns was of course the worst case scenario.  So, to be clear, HIV infected blood from her mouth entering aggravated, and therefore reopened, razor cuts on the base of my shaft is a hypothetical exposure of zero risk? And this is because HIV infected blood needs a deeper entry into the blood stream/skin than a razor cut provides? Thank you so much for your time.  I look forward to hearing from you so that I may put this incident behind me.

[Edward W Hook, MD]

Dr. Handsfield and I share the forum.  You got me.  FYI, the reason we share the forum is because we have worked together for nearly 30 years and while our verbiage styles vary, we have never disagreed on management strategies or advice to clients. the nature of the Forum is such that we are unable to provide a "comprehensive response".  I will briefly address your concern in a general fashion.  To get into more detail would require trying to express the information that biomedical scientists have learned and developed over years of schooling and study- this is not the place for that.

Let's break down your situation.
1.  Your exposure was from a person of unknown HV status.  Statistically it is unlikely that she had HIV- only a small proportion of exotic dancers have HIV.
2.  She used saliva as a lubricant for masturbating you.  HIV is not present in saliva in high concnetrations and infect saliva has high concentrations of antibodies and enzymes which reduce risk for infection. This is the reason that HIV is virtually never transmitted by oral sex, no matter whether a person has blood in their mouth, gum disease, etc (BTW, how do you really know she had blood in her mouth?)
3.  You are concerned that because you had razor cuts on your penis (??) something might have been introduced during masturbation.  Very unlikely.  Cuts start healing as soon as they stop bleeding, effectively "sealing off" the blood stream and target cells for HIV from the outside.  (BTW, your question implies that HIV is transmitted into cuts- that is rarely the case.  It is transmitted when introduced deep into the skin/blood stream by needles or through infectious sores which for complex biological reasons are far more susceptible to HIV than a cut)

For all of these reasons, it is safe to say that the hypothetical exposure you describe had virtually no risk of transmitting infection to you. Hope this explanation will suffice.  EWH