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HIV Exposure - Family at Risk - Please help!

Question: 

Hello Experts,

Firstly,
Thank you for your sincere efforts in ending this HIV epidemic and sharing knowledge to help the people.
Well, I’m in dire need of your knowledge and advice to ease my throbbing fear of contacting HIV from the recent exposure.

Here is my story.

I’m 30 years old, straight, circumcised male. I tested for HIV 10 days ago, this was 100 days after a condom break (less than 2 mins) with a CSW. And test was a HIV combo Duo (ECLIA method) from a CAP accredited lab and the result was 0.21 i.e non-reactive, negative. (I believe this is conclusive).

Now, my question is regarding the recent exposure.

I went to a massage parlour, which STRICTLY does not offer sex services. The massage lady does massage and handjob. And only allows pressing and sucking of her boobs.

I was waiting in the parlour as the rooms were occupied by other customers, once a room was free, I entered after maximum of 5 MINUTES after the last customer.

I removed my shoes and walked near the table barefooted and I was literally walking on the semen on the floor left from the handjob of the last customer. And it was very sticky, and on that day, I walked a lot in my office, so my feet was tired and itchy but there were absolutely NO boils, blisters or any sort of bleeding on my feet.
Then the lady asked me to remove my clothes. While removing my underwear, my feet touched the inner cloth (crotch area, where the penis rests) of the underwear and I believe some semen from my feet could have touched the cloth.

Then I hanged the underwear on a wall hook and went to the massage table and lied on my back. I have some pimples on my back (I later checked none of them were broken), I didn’t feel any sticky dampness on the table, and I enquired the massage lady, she said that she is using a ‘single-use’ sheets for every customer.

Fearing contaminated oils, I told her not to use any oil, she massaged me with her bare hands, and I sucked her boobs, kissed her neck, forehead and cheeks (no sign of any skin diseases on her) and she did the handjob and I ejaculated.

After the whole massage session of 30 minutes, I stood up, walked on the same floor of semen to dress up and again when I put on my underwear my feet again came in contact with the inner crotch area of the underwear and I went home wearing the underwear and I removed it in home after 3 hours of journey.

Few days before this massage session, I abraded my urethral opening by wearing a very cheap underwear (scratchy stiches, but no bleeding). (I confirmed this because I took urine test couple of weeks ago and there was no organism found). And I continue to have that irritation due to abrasion PRIOR, during and after this message session.

Considering the above event, I kindly request you to answer the below question.
What are the chances of:

1. Contracting HIV (from the semen on floor) through my tired, itchy feet?
Note: The room temperate was about 21 degree Celsius (70 Fahrenheit).

2. Contracting HIV (from possible semen of last customer) from the massage lady’s hand to my urethra during handjob?

3. Contracting HIV (from possible semen of last customer) from the table through my pimples on my back?

4. Contracting HIV (from the possible semen in the crotch area of my underwear) from my feet? As I wore it for more than 3 hours, my urethra must have been in contact during this time and also had abraded, irritated urethra.

5. Do I need to take HIV based on the above incident? As the tests are expensive where I live.

6. What are chances of contracting other STDs, like Chlamydia, Gonorrhea, Syphilis, Hepatitis etc., from the above exposure?

7. Can I safely resume my unprotected sex with my wife?

Please doctor, please answer all my questions.
I look forward to hearing from you soon.
Thanks again
Kind regards,
Worried Guy

Answer: 

Hello and thank you for your inquiry.

The scenario you described is determined to be No Risk for transmission of HIV.

The details you provided do not meet the three components of the transmission equation. In order to contract HIV the following conditions must be met:

1 - There must be HIV present in a bodily fluid. The five bodily fluids that carry the HIV virus include: blood, semen (including pre-ejaculate), vaginal fluids, breast milk, and rectal secretions.

2 - The bodily fluid containing HIV must have direct access to the bloodstream. This can be through cuts, tears, rips, mucous membranes, open sores, or needles.

3 - Transmission occurs through a risky activity in which the first two conditions are met. For example: condom-less sex, sharing needles, unsafe tattoos or piercings, vertical transmission–from mother to child (in utero, during delivery, breastfeeding) (1)

Pimples on your back or tired itchy feet do not provide adequate access to your blood stream for an HIV transmission to occur. You can’t get HIV or sexually transmitted infections or diseases like syphilis, gonorrhea, or chlamydia from contact with air dried semen or vaginal fluid. (3) HIV can’t survive for long in the air. As soon as fluid leaves the body and is exposed to air, it quickly begins to dry up. This damages the virus, making it inactive. Once it’s inactive, HIV is “dead” and no longer infectious. (4) Even in the event that you transferred small amounts of semen from the floor to you underwear, via your foot, this semen would have been dried by the time you put your underwear back on 30 minutes later.

As for other STDs, there may be a very low risk associated with mutual masturbation with another person if that person has an infection. If a hand has direct contact with semen, vaginal fluids, discharge or a genital lesion of a person who has an infection, and then the hand has contact with the urethral opening of your penis, an infection could possibly be passed on. (5) This applies only to certain sexually transmitted infections, not HIV. It is entirely up to you whether you want to have STD screening done in the absence of symptoms. Since you have now had two reported encounters with CSWs in the last few months, I can not advise you to safely resume unprotected sex with your wife. If you continue to see CSW's, I would suggest having a discussion with your wife where you disclose these activities (assuming you haven't already done so), and then the two of you can decide together whether to use protection when you have sex.

Recommendation: No need for HIV test with the scenario provided, refer to a physician for other health related questions

Regards, AIDS Vancouver Helpline/Online, Dyson