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hiv+ semen -> finger -> nose, need PEP?
Dec 14, 2008

Hi, Doc.

I want to begin by thanking you for having a site like this. Your Q/A have really helped me in the past. This is the first time I am submitting a question of my own. If you could please indulge in one more can I get HIV from insert phrase here? In my case, I found some conflicting answers, so wonder if you can set the record straight?

I wonder if I need to consider PEP in the next 48 hours, after an incident that occurred 24 hours ago. I am younger guy (25-30), good shape, work out 6x a week, eat healthy, etc. who is HIV-. I am generally monogamous in relationships and non-promiscuous when not in relationships. I am concerned after having a mutual masturbation session last night with a good friend of mine (guy I used to date 2 yrs ago) who is HIV+ as of about 6 months ago. He's not taking meds yet but is under doctor supervision. This is the first time we have messed around since he got the results that said he was HIV+. I have never messed around with a guy who had HIV, so I was nervous about doing it, and we were both very cautious last night. We did mutual masturbation. He also blew me briefly (30 seconds or so, did not cum in his mouth). From what I know, me getting head is also very low risk. However, after he finished, I felt something on my thigh with my fingers and found it was a spot of his semen he accidentally got on me. I know semen on unbroken skin is very low risk. After finding his semen (30 seconds or so after he finished) I went to the bathroom to wash up. On the way, I felt a dry booger near the bottom of my nose that was blocking my breathing. Not thinking, I stuck my thumb in the base of my nose to get rid of the obstruction. As soon as I put my thumb in there, I immediately panicked because I felt my thumb was still wet with his semen. So, I slowly removed my thumb, did not remove the blockage in my nose for fear it would pull a nose hair or cause a micro tear in the mucous membrane. I washed my hands and body and put a small bit of soapy water on my clean hands and just gave a quick clean to the base of my nose, not wanting to push fingers in my nose to possibly cause any potential semen to go farther in my nose. I also blew my nose to try to clear the airway of any potential semen in there.

Let me put a disclaimer that it is winter here. I do not have a cold, but did spend some of the day walking outside in very cold windy weather (15-20F and windy). Perhaps my nose passageways may be irritated from the cold weather and low humidity of winter. I do not often get bloody noses, but I do sometimes see small amounts of blood in my tissues after blowing my nose in the winter.

So, I understand semen on skin is low risk. I understand HIV must enter my blood stream within minutes HIV does not survive well outside the body. I also understand there have been cases of semen shot directly in the eye (another mucous membrane) causing HIV to be absorbed into the blood. However, there was a previous post of nose-picking with a man who had dry vaginal fluid on his fingers or a woman who may have picked her nose with semen and in both cases the answer was minimal to zero risk. In my case, it is not like I had huge gobs of semen on my hand, and I was not digging deep into my nose, but my thumb was definitely wet when I (stupidly) put it in my nose. I called my doc and the response was this is very low risk that I could catch anything from this instance. However, it is the weekend and the doc on callback duty is not my normal doc. I wonder if I should consider the PEP? I neglected to ask the doc who called me back if I should consider PEP, but I did tell her the whole story as described here. How concerned should I be? Obviously I am concerned enough to write, so it is definitely weighing on my mind.

Appreciate any quick advice you can give so I know if I should pursue PEP. Thanks!

Response from Dr. Frascino

Hello,

Your HIV-acquisition risk is similar to that of the other nose pickers: "minimal to zero." PEP is definitely not warranted.

Happy Holidays.

Dr. Bob



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