hiv transmission through love bite

[nedstark2214]

Hello Dr. Hook.

About a week back I brought home a girl that I barely knew. We cuddled and dry humped for around 30 minutes. We never kissed on the lips but I did kiss her on neck, back and cheeks intermittently. At one point I mildly bit her. I don't think it would have punctured her skin but my mind is playing tricks with me. I did ask her later if I gave her any love bites and she said she doesn't know of any. I did have a small blister right at the tip of my tongue and this is the cause of all my worry. My anxiety shot up the time she said she was heavily involved in kink and BDSM in the past. I don't like to be judgemental but its been eating away at me since. I will get tested soon but for now it would be nice to get an opinion from experts in this area.

1) What are the chances of any amount of blood on her skin to seep through that blister. I don't remember seeing or tasting any blood at all but I have heard even microscopic quantities can do it. Do blisters on the tip of tongue have cuts through which HIV can enter. The blister was in its formative stages meaning at that time it was just a bright red spot and converted to a white on two days later and its now gone about a week later.

2) How intense should the bite have been for such an infection to be a possibility. Should a normal love bite do it or it would have to be a clear puncture wound with blood seeping out.

3) What is a good testing timeframe. Would a 4th gen Ag/Ab test at 3 weeks give a good indication. The normal CDC guidelines suggest a 3 month period for 95% surety but then I have also read that most people seroconvert at around 6 weeks.

Thanks for all your help!

[Edward W Hook, MD]

Sorry, I thought there was some biting in both directions. There is NO known risk from ingestion of HIV infected blood- non at all.  Thus there would be no risk as well from your giving love bites to a partner.    A blister on the tongue would not change this and to my knowledge there are NNO cases of HIV transmitted in the manner you describe.  EWH

[nedstark2214]

"This makes sense- while saliva may contain small amounts of HIV, it also contains many enzymes and chemicals which would prevent HIV transmission as well- this is the reason exposure to saliva is a no risk event."

I am confused. In my case, i am the one biting so if anything I'll be exposed to blood in the worst case. Are you suggesting that the saliva will inhibit any blood I come in contact with. Also, I know you said do not worry for question 1 and 2 but I am someone who happens to enjoy love bites during sex but wouldn't do it if it puts me or my partner in danger. That's why i wanted to know about the intensity of a love bite and also whether having a blister on tongue increase the risk. Can HIV enter through a blister on tongue. Also, have their been any cases of infection similar to the one described.

Thanks for your prompt response and your reassuring words.

[Edward W Hook, MD]

Welcome to the Forum.  I'll be happy to comment.  A "love bite" is somewhere between a kiss and a full thickness bite and is at most a very, very low risk event. In the instance that you describe, you do not know that your partner had HIV and despite her past history and activities it is statistically unlikely that she had HIV.  It is clear however that there is NO risk whatsoever from kissing, even deep or aggressive kissing that does not result in skin breakage.  The bruising that accompanies many and most so-called love bites therefore is NO RISK.  If the skin is broken with a bite there is a theoretical risk for infection but such infections are incredibly rare. This makes sense- while saliva may contain small amounts of HIV, it also contains many enzymes and chemicals which would prevent HIV transmission as well- this is the reason exposure to saliva is a no risk event.  If I were you, I would see no reason to worry at all about the events that you describe.  There is no reason not to test, particularly if it gives you comfort but, at the same time, this is not something to worry about either.

As for your specific questions:
1) What are the chances of any amount of blood on her skin to seep through that blister. I don't remember seeing or tasting any blood at all but I have heard even microscopic quantities can do it. Do blisters on the tip of tongue have cuts through which HIV can enter.

See above.  I would not worry. Concerns about "microscopic quantities" are misplaced.  The blister you describe does not change my assessment- still no meaningful risk for HIV.

2) How intense should the bite have been for such an infection to be a possibility. Should a normal love bite do it or it would have to be a clear puncture wound with blood seeping out.

Again, and as stated above, this is not something I'd worry about.

3) What is a good testing timeframe. Would a 4th gen Ag/Ab test at 3 weeks give a good indication. The normal CDC guidelines suggest a 3 month period for 95% surety but then I have also read that most people seroconvert at around 6 weeks

The CDC Guidelines are overly conservative.  Currently available 4th generation tests provide definitive information about the presence or absence of infection at 4 weeks after exposure.  3rd generation, antibody 0nly tests provide definitive information at 8 weeks.

I hope these comments are helpful.  Please do not worry.  EWH