Dear Dr Cohen

I am sorry to bother you as I know this forum is not designed for transmission questions but I have tried the Safe Sex and HIV Prevention forum twice to no avail.

I am obsessed with the idea I have HIV. I have fungus in some of my toenails, tinea and I had a peeling rash on my hand that I thought could be tinea as well, although my doctor thought it was probably just dermatitis (now better). Earlier this year I also had sore mouth corners (no lesions, just sore, now better) and eczema for the first time ever on my ankles (now better).

However, I have none of the normal risk factors (celibate for 10 years since last HIV test, no drugs/needle sharing).

Yet I spend all my time going over and over possible modes of transmission like:

1. Acrylic nail salon - A couple of years ago my manicurist told me there was a transsexual in the day before (about 15 hours prior to my appointment). Very occasionally when they are filing acrylic nails they nick the cuticle skin and draw blood. I am worried this could have happened with this high risk group person, then the cuticle oil which is applied to all clients with a shared brush could have become contaminated with a trace of infected blood and entered my bloodstream through a small cut I had under my nail. (The operator swears there was no blood, however.)

2. Being kissed by a person with AIDS - I knew a couple of guys with HIV/AIDS and they once kissed me on the cheek.

3. Contaminated dental implements. I obsess about this even though my dentist assures me they were one of the first practices to get an autoclave many years ago.

I am constantly thinking about all this and it is ruining my life, but I am too petrified to take a test.

Please help.

Well. Sad to hear of your worry and obsession.

First - none of the issues you list are even remotely likely to lead to HIV exposure. Whether it be nail polish, a peck on the cheek, or a sterilized dental instrument.

And none of the skin conditions you describe indicate HIV - they are common in people who are negative.

This HIV virus is not that easy to catch. It is clear from studies of sexual transmission that even with highest risk sexual exposure, only 1-2% of the time does HIV transmission happen. And our intact skin, like your cheek, is an excellent barrier that just does not allow HIV in. And outside of the body, HIV dies off quickly. So it won't live on a cuticle brush. Nor does it survive heat - that is why we sterilize...

You mention a few scenarios in which the likelihood of HIV being present, and then getting through are lines of defense, all NIL. Is it impossible? Well - the scenarios you describe leading to HIV transmission are about as likely as being hit in the head by a ten pound turnip which fell out a window from the 5th floor of a building while you were walking down a busy street at 4:17 pm. Is that impossible? Nope. Sure could happen. Turnips are vulnerable to the forces of gravity. And you could be under one at that moment. Has it happened? Not likely...

So - you describe three - and could likely describe other life events during which HIV transmission could theoretically occur -- more and more remote ways than even you have thought of yet. And yet it is just so unlikely... How you handle this conundrum - of extraordinarily unlikely risk in your life - is your challenge. From what your write - you might do better to just get a test for HIV done again - since it sounds like you haven't done so in years? And since it will be negative based on what you describe - you might be able to redirect your mind's energies. Perhaps with some help. Since we have learned that obsessions like what you describe sometimes respond to not just talk but medications...

And once free of this worry, you might be able to redirect your attention. To more productive tasks, including for example, what you'll do with a smashed turnip which missed...