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Blood on toilet paper

Question: 

Hello,

If toilet paper had blood on it and it was used to wipe the vagina, would that be worry enough to get and use PRep?

Thank you!

Answer: 

Hello,

Thank you for your inquiry. From what we gather from the question, you were asking about your risk of HIV acquisition after wiping your vagina with toilet paper that may have had blood on it. You are also inquiring whether or not you should use PrEP for this situation. From the information given, this scenario is determined to be No Risk (transmission of HIV is not possible in the given scenario).

The scenario mentioned above does not meet the three components of the transmission equation(1). It does not satisfy the equation because:

  • For transmission to occur there must be HIV present in a bodily fluid (ie: in blood, semen or rectal secretions), direct access to the bloodstream (ie: inside of the vagina, anus and other mucous membranes) and a high risk activity (ie: unprotected anal or vaginal intercourse, sharing needles, mother to child)(1).

  • There must be an exchange of bodily fluids.

  • HIV does not survive long outside the human body (such as on surfaces), and it cannot reproduce outside a human host(2).

For your scenario, this means that any blood on the toilet paper had been outside of the host and exposed to environmental conditions which would not have allowed the virus to reproduce(2). There was also no direct access for HIV to enter your bloodstream and no exchange of bodily fluids. Simply wiping young vagina with toilet paper does not meet the conditions necessary for direct access to your bloodstream.

You also inquired about whether or not you should use PrEP, or pre-exposure prophylaxis, for your situation. We believe that you actually meant to ask about PEP, or, post-exposure prophylaxis. The PEP and PrEP acronyms are indeed similar and it can get confusing. Let's break this down and learn about when each are used.

  1. PrEP, (or, pre-exposure prophylaxis) is a daily medicine that can reduce the risk of acquiring HIV. People at very high risk for acquiring HIV in take HIV medicines daily to lower their chances of acquiring HIV. Daily PrEP reduces the risk of HIV acquisition from sex by more than 90%(3).

  2. PEP (or, post-exposure prophylaxis) means taking antiretroviral medicines (ART) after being potentially exposed to HIV to prevent acquisition. PEP should be used only in emergency situations, after engaging in a high risk activity, and must be started within 72 hours after a recent possible exposure to HIV(4).

In the scenario that you described there was no high risk activity resulting in the scenario being assessed as No Risk (transmission of HIV is not possible in the given scenario). PEP is not required in your scenario, whereas there is No Risk for HIV acquisition. Below is a reference to the CDC links which provide details about PEP and PrEP, and when they are beneficial to take.

Recommendation: No need for HIV test or PEP (post-exposure prophylaxis) with the scenario provided, please refer to your physician for other health related questions.

Regards, AIDS Vancouver Helpline/Online, Hilary