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Hope for Finger Jockeys Everywhere
Apr 11, 2005

Dear Doctor Bob and Finger Jockeys Everywhere,

I would like to begin my thanking Dr. Bob for setting me straight a few weeks back after a CDC phone counselor left me in a state of near panic by telling me that I should get tested after having fingered a high-risk women's vagina. I write today to help set the record straight on the risks associated with "fingering", otherwise known as digital-vaginal or digital-anal penetration. I have read a mountain of information about this subject since my talk with the CDC counselor and Dr. Bob's enlightening response to my concern.

Let me begin by saying that HIV can only be passed if: (1) you come in direct contact with a person's body fluid that contains HIV; and (2) there is a means by which the fluid and the HIV cells it contains can enter your blood stream. This could happen directly by injection, such as with a shared syringe, or a percutaneous needle stick or if the fluid makes contact with a mucous membrane, such as those in your eyes, inside of the nose, opening in the penis, anus, or vagina, or through an "open" wound, cut, or abrasion. As far as I can tell, nobody has really defined "open" but I take it mean that the scabbing process has not yet begun. If the wound is fresh and bleeding it is definitely open, if it has a scab on it, even a new scab, it is closed!

Now I will state that facts I have found with regard to the real probability, call it risk if you want, of acquiring HIV from fingering a woman's vagina or anus or a man's anus.

First, according to the CDC, there have been no documented cases of HIV transmission from fingering. This does not mean that it can't happen, but there have been no documented cases, thus, for now, it is only a theoretical risk. Lets hope it stays that way!

Second, it is worth examining the risks of HIV transmission from a percutaneous exposure and mucous membrane exposure in a healthcare setting to put the risk from fingering in perspective. According to the CDC's Guidelines for the Management of Health-Care Worker Exposures to HIV and Recommendations for Post-exposure Prophylaxis, the chance of acquiring HIV from "a percutaneous exposure to HIV-infected blood is approximately 0.3%... and after a mucous membrane exposure is 0.09%." Percutaneous means that a needle, syringe, or sharp object penetrates under the skin. So, you will note that the chance of acquiring HIV from a percutaneous stick with something known to be contaminated with HIV-infected blood is around 1-in-250. As far as I can tell, there have been no similar calculations done with respect to the risk associated precisely with fingering, but suffice it to say that the risk is surely much, much less than 1-in-250 if the body fluid you come in contact with contains HIV. Add to this number the probability that the fluid indeed contains HIV and your likelihood of acquiring HIV from fingering plummets. No one seems to want to talk probability, but I would say that youre more likely to win the lottery twice in a row dont laugh, I know somebody that did win the lottery twice!

Third, it is telling that the CDC does not recommend post-exposure prophylaxis for healthcare workers whose only exposure has been HIV-infected blood on intact skin. The CDC guidelines that I quoted above state "For skin exposures, follow-up is indicated if it involves direct contact with a body fluid listed above and there is evidence of compromised skin integrity (e.g., dermatitis, abrasion, or open wound)." The fact that the CDC, known to be very conservative when it comes to prevention, does not recommend prophylaxis for contact between HIV infected blood and intact skin suggests that the risk is very, very low.

Fourth, let me end with a quick look at Women-to-Women transmission of HIV in order to put the risk from fingering a bit more in perspective. Generally speaking, the risk of women to women transmission, so long as neither of the women engages in sex with men, of HIV is much lower than the risks associated with male-female and male-male sex. According to the CDC, "Female-to-female transmission of HIV appears to be a rare occurrence. However, case reports of female-to-female transmission of HIV and the well documented risk of female-to-male transmission of HIV indicate that vaginal secretions and menstrual blood are potentially infectious and that mucous membrane (e.g., oral, vaginal) exposure to these secretions have the potential to lead to HIV infection." Through December 1998, only 347 women who were reported to have had sex only with women had acquired HIV, but it is important to note that 98% also had another risk-- injection drug use in most cases. What does this tell us? Considering that lesbians sex options are limited to digital-vaginal and oral-vaginal intercourse, along with the use of sex toys, it seems to indicate that fingering and oral sex on women is very low risk but not risk free. Of course, it could be that these were the only 347 lesbians that did not use protection, but somehow I doubt it.

OK, in summary, fingering is a no-risk activity if your skin is intact (no obvious open cuts, wounds or abrasions... I don't think ripped-off cuticle's count as open wounds? DOC?) and a low risk activity if an open cut, wound, or abrasion is present. There is a risk, but the risk is less than driving your car to work or walking through Central Park after sunset.

Howd I do Doctor Bob!? Do you concur that fingering is a no-risk activity if your skin is intact and a low risk activity if an open cut, wound, or abrasion is present?

I hope this helps to put some people at ease, because people are not going to stop fingering one another and very few are going to put finger cots or condoms on their piggies before they go to the market (please do put a condom on you willy though!, even if your piggies are free to explore uninhibited by latex).

Sincerely,

Ignorance is Bliss

Response from Dr. Frascino

Hello,

I "set you straight . . . ???" Hmm, usually I get accused of the exact opposite, but OK.

How did you do with your report? Very good. Check-plus-plus as they say in grade school. Yes, I agree HIV cannot penetrate intact skin and consequently, digital play with intact skin would not be an HIV risk. The "open cut" level of risk would of course depend on several variables size and depth of the wound, amount of virus in the fluids the wound is exposed to, etc.

Finally, I don't agree with your sign off, "ignorance is bliss." Actually, I think ignorance is dangerous. But thanks to your report, hopefully now at least ignorance has been banished and enlightenment reigns supreme for all those who love to let their fingers do the walkin'.

Stay well.

Dr. Bob


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