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A quick breakdown on how HIV can be transmitted.

This topic aims to show ways in which HIV can and cannot be transmitted. It ties in with a recently published topic found here http://www.drtanandpartners.com/how-does-hiv-enter-the-body/.

 

This topic will be split into 3 parts; Definite ways of HIV transmission, theoretical ways of transmission, and no way of transmission.

 

Bear in mind that in order for HIV to be transmitted fluid from a positive person has to come into contact with the negative person. Semen and blood hold high loads of the virus but saliva and vaginal fluid hold very little.

HIV-modes-of-transmission

According to Singapore Ministry of Health UPDATE ON THE HIV/AIDS SITUATION IN SINGAPORE 2014.

Definite ways of HIV transmission (risk will be listed as risk per 10000 – so 1/10000 means that for every 10000 people who engage in that activity, 1 person will become infected.

  • Blood transfusion – 9250/10000 (this is only with HIV infected blood which is very rare nowadays as every donor blood sample is screened before use).
  • Needle sharing in intravenous drug use – 63/10000.
  • Needlestick injury – 23/10000.
  • Receptive anal sexual intercourse – 138/10000.
  • Insertive anal sexual intercourse – 11/10000
  • Receptive penile-vaginal sexual intercourse – 8/10000
  • Insertive penile-vaginal sexual intercourse – 4/10000
  • Receptive and insertive oral sexual intercourse – low (too low for accurate numbers).

 

HIV_transmission-risk

Estimated risk per exposure to HIV transmission: assume that the ‘source partner’ is always HIV-positive. For a partner of unknown status, the risk is affected by the prevalence of HIV in the relevant community – i.e., the chance that the partner does in fact have HIV. Unless otherwise stated, the sexual acts are always without a condom.

 

Theoretical ways of HIV transmission:

  • Blood contact onto an open wound – possible but an unlikely scenario as open wounds should be tended immediately in order to reduce the risk of other infections. The risk of a bacterial infection would be higher than an HIV infection.
  • Blood contact onto mouth or eyes – again possible but extremely unlikely unless you happen to be in a horror movie.
  • Dried blood – although HIV can survive in dried blood for several days, the environment has to be favourable and transfer this way is very very unlikely.

 

No risk of HIV transmission:

  • Breathing the same air as someone.
  • Touching a toilet seat or door knob.
  • Drinking from a water fountain.
  • Hugging, kissing or shaking hands (although kissing may transfer fluids the level of virus in saliva is so low as to make the risk negligible).
  • Sharing utensils.
  • Sharing gym equipment.
  • Skin to skin contact with an HIV positive person even if they happen to have fluid of unknown origin on them (particularly applies to commercial sex workers).
  • Biting or scratching that does not break the skin or draw blood.
  • Essentially, as mentioned above, fluid-fluid contact is necessary for transmission – if this hasn’t happened then there is no risk for HIV.

 

I hope this helps answer most questions that concern people over possible ways of HIV transmission – if new questions pop up I will try and add to this topic to help allay people’s fears.

 

 

 

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600 Comments

  1. Raymond Tan

    Hi,

    My last exposure was just a massage and ended with a handjob from the massage lady.

    Am I at risk of HIV & any other STDs? If yes, when can I come in to get tested.

    Thank you.

    • There is no risk for HIV and an extremely negligible risk of certain other STDs, e.g. herpes – which can be transmitted with direct contact from an infected region. If you are concerned, please visit us for a proper evaluation.

  2. Hi doctor,

    I just went to a gay sauna. I had oral sex, but did not shoot any cum inside my mouth. And I also rubbed my penis against his penis – with no semen. But what if there was semen, will rubbing dicks cause Hiv to transmit? And will oral sex with no cum cause HIV too?

    • The risk of HIV would be extremely negligible. However, there are other potential STDs including chlamydia, gonorrhea, herpes and syphilis that you may wish to get evaluated.

  3. Hello dr
    is the 4th gen test conclusive at 28 days or 35 days? I hear from AFA that must test between 28 to 30 days , cannot after for the 4th gen test to be conclusive. is it true or not?

    • I would consider a 4th gen test from 28 days onwards as conclusive. It will check for both antigen and antibody, so one or the other will show up if it is positive. There is no time period after which this test is not accurate, for even if antigen disappears, the antibody will be present. If you still have concerns, it is best to visit us for a proper consult and evaluation.

  4. I gave oral sex to a female yesterday. I see that your article says it’s very Low risk to get HIV through this method. Should I be concerned and consider PEP?

    • I would not generally recommend PEP for this kind of exposure. However, if you are concerned, it is best to speak to a doctor for a proper risk assessment.

  5. Hi Dr,

    I had an exposure last week where I went for a massage and then it ended up with a handjob with oil from the lady.

    She used some hot clothe to wipe my groin area, penis, testicle & anus as well before she started to give me handjob.

    What will be my risk of contracting HIV & STDs from this incident?

    And if I want to get tested, when will be a good time to get tested for all the STDs for the most accurate result.

    Regards.

    • The risk of STDs from this type of exposure is negligible. If you are still concerned, you can do testing at one month post-exposure for an accurate result.

  6. Zeus Tran

    Hi, Doctor Tan,

    I came a gay sauna yesterday, When I sat on a bed in sauna, my butt and anus sat on a fresh cum big. I guess it is fresh from anybody released a little minutes ago. My feet aslo touched many cums on the floor. It is terrible that the sauna is not clean. Then, I washed my butt and anus and feet with water, without soap. Can i have any risk for hiv, and should i fake a pep in this situation?

  7. Mr. Anxiety

    Hello Dr, on 16 july I had an intercourse sex with massage boy. I was an insertive person with curcimsised. After having a sex about few minutes, I noticed that he used a body lotion as lubricant on my condom, then i pull it off then straight away to the toilet. I didnt ejaculated at tht time when having sex with him. Am i at risk? My condom didnt broke at tht time..😥

    • There is a low risk of HIV transmission from this exposure, as condoms are not 100% protective. If you are concerned, please visit us for a proper consult and testing.

  8. Hi doctor,

    I have one exposure with escort, we didnt have vaginal anal or oral during that time, what we did only kiss, fingering and she did handjob on me, during that time i also used condom. Any sign of hiv infection can transmit this way

    Thanks

  9. Hi, i hook up with an accuantaince for the first time, and later we had sex, we used lube and condoms, after i penetrated her anally (i didn’t cum) we were spoonning together, i was in the back and i started to rubb my penis (UNCIRCUMCISED) with the condom between her legs, and then i came, just in that moment i realize that the condom had slipped, and i was rubbing my penis between the lube , the used condom with her anal secretions and my semen, i begged her, and we went to a lab that opens 24/7 and we waited for the results, then when we knew i was negative and she was positive, i went to an ER, explained the issue but was not given PEP, because the doctor explained to me that it was a no risk situation because the condom was exposed to air (but i told him it was just a few seconds of air exposure). Later, I had to consult a private doctor who prescribed me only truvada as PEP, after 20 hours of the incident, and telling him that i hadn’t shower, i only used baby wipes in my penis because of the hurry. Am i at risk of getting HIV? it’s been 12 days and i’m coming down with a very mild fever, mild sore throat, cough, and a bit of thrush (i don’t know if it was from before), i don’t know if it’s ARS, PEP Side Effects or because of some rimming that i did, or some STD… please HELP!

    • I would consider your risk of HIV low, assuming your condom was intact throughout the anal sex. That being said, Truvada alone is not recognized as an effective PEP regimen – usually we would recommend Truvada + Isentress. At this point, I would recommend you to speak to your doctor for further clarification, and perform the appropriate testing after the window period.

  10. Hy!
    I m straight male. I had a insertive oral sex without condom after going from club. He is gay/bisexual and Mexican, 26years. Thats all I know about him. There was no cuming into his mouth or cuming at all. All went for 30 minutes ,some of that was also he masturbating me. This is first risky behaviour in my life and he looks like he was just searching for anyone ,like High risk person. I asked him few times about his health ,he said he takes care of himself more because of others than himselves ,takes tests every 6 months. But who knows. Also tomorrow I saw some blood in foreskin of penis, it looks like it isnt on surface . It assume it was from masturbating.So it was small cut on foreskin of penis. Is that enough that virus enters the system? I didnt see any blood on his mouth, no on my penis from him. What are my risks,should I test for Hiv and other STD? How big does the wound or cut must be and how many blood and is it this enough to get infected. I have strong anxiety from that day.
    Kind regards!

    • While the risk of HIV from oral sex is negligible, I would certainly advise you to check for other STDs including chlamydia and gonorrhea – these are much more common and can be spread through oral sex. It would be best to visit a doctor for a proper consult and assessment.

      • Even do it was small cut on foreskin on penis? Is that enough that virus enters the system? I didnt see any blood on his mouth, no on my penis from him.How big does the wound or cut must be and how many blood and is it this enough to get infected. It was rough and prolonged oral sex. It lasted 30 minutes. I have read that superficial cuts dont transmit Hiv and proteins in saliva make Hiv virus untransmittable and there is not enough Hiv virus in saliva and virus dies on air.

  11. Hi Doctor, Can HIV transmit through mild eczema/fungal rash at the shaft of penis from vaginal fluids (when penis is inside the vagina) whereas head of the penis is covered by condom.

  12. Jayjay

    Hey Dr,

    I have a dinner with a couple of my friends and I accidentally use one for my friends (Unknown Status) spoon to scape some little food from the bowl and eat it.Am i at Risk for HIV??

    Regards
    Thanks

  13. Hi doctor, is it possible to contract hiv from toilet splashbacks if the toilet water had hiv blood and some of the water splashed onto your anus or penis after using the toilet?

  14. Paranoidguy

    Hi doctor, I had a massage with with a massage lady, after the massage she used her fingernails to tickle and lightly scratch the glans of my penis head for quite a while, my foreskin was pulled back at that time, is there any risk of hiv infection to my mucous membrane if she had semen residue in her nails from a previous customer?

  15. Mathew

    Dr i had exposure with csw workers without any sex, oral, vaginal and anal or hj or fingering and even we are on clothes. We just had chatting for all the time roughtly around 18min. Then i was pass her bnk note then walk away. Dr am i at risk?

  16. Jonathan

    Hi doctor, I may be overly paranoid. I know Singapore’s health safety standards are quite high, but am I at risk of HIV for taking a blood test at a local clinic in Singapore? Could the doctor have used an unsterilised/reused a needle on me? I have never had any sexual encounters whatsoever.

    • Dr Elaine Loh

      We cannot speak on behalf of other clinics. However, generally, healthcare clinics in Singapore only use disposable needles and syringes.
      If you are very concerned, you can call up the clinic and ask.

  17. Hi doctor, I never had any sexual encounters whatsoever before. About 2 years ago, I had a blood test at a local clinic. I know that Singapore’s health safety standards are pretty high but I can’t help being paranoid that the doctor could have used an unsterilised/reused a needle, putting me at risk of HIV. Am I at risk as a result of the blood test?

    • Dr Elaine Loh

      We cannot speak on behalf of other clinics. However, generally, healthcare clinics in Singapore only use disposable needles and syringes.
      If you are very concerned, you can call up the clinic and ask.

  18. Hi doctor, I may be overly paranoid, as I never had any sexual intercourse before. About 2 years ago I had a blood test at a local clinic. I know that Singapore’s health safety standards are quite high but is there any chance the doctor could have used an unsterilised needle/ reused a dirty needle on me, putting me at risk of HIV?

  19. Dr. Tan & Co please help!!! I had an encounter one night with a man. We had no intercourse. I was doggy style position and he just masturbated himself and came on my butt cheeks/butt. Some may have dripped down onto my butt hole and vagina. When I went to wipe with his shirt I’m worried I may have wiped some inside. He says I didn’t but I’m still so scared.

  20. Sir I touched a lady Virginia with my finger,so after 1hour I used the same finger without washing them to remove some particles off my tooth.sir is there any possibility of contacting hiv

  21. David

    Doctor,

    I had an massage, the masseuse and I were both naked. There was NO intercourse, however I saw her touching her vagina with her index finger.

    Assuming her index finger had some vaginal fluid, and she touched my penis glans, will I get infected with HIV or any other STDs?

  22. Ken Tan

    Doctor I went for a Massage, I saw the masseuse touching her private and she accidentally touched mine.

    There is no sexual intercourse, will I get an STD from this? Because she briefly brushed until my privates

  23. Hi Doctor,people get cuts and abrasions in public places all the time. Should I worry about contracting HIV from accidental superficial cuts from objects in public places like broken glass, wires or other sharp edges in parks or playgrounds if these objects have cut a HIV positive person a short while beforehand with remnants of their blood on them within a time ranging from seconds to a few minutes before I accidentally cut myself on them? Please do answer as I’m driving myself nuts worrying if HIV could be transmitted this way.

  24. BigBoy

    hey Dr Tan

    I hope you can asses my risk of HIV infection.

    My Co-worker has HIV and he touch my phone to see some stuff on my phone..I had a cut(open skin from scratching) on my middle finger. Once he give me back my phone, my exposed skin accidentally touch the surface where he touched. I am i at risk of contracting the virus?What if my co-worker has blood stain on it,am i still at risk?

    Paranoia Overload!!

    Sincerely Thanks.

    • Dr. Julian Ng

      Hi,

      I would consider the risk is zero. Casual contact is not considered a risk for HIV transmission.

      • BigBoy

        Even though I have a open skin (abrasions Wound) on my finger?

  25. Hi doctor, is it possible to get hiv if you accidentally cut yourself on a sharp object, ie the edge of the table that has been contaminated with HIV blood?

    Like when you accidentally scratch your arm against any object with a sharp edge that has been contaminated by HIV blood and where your skin is broken and bleeding from the impact(ie superficial cut) and if the HIV blood present is fresh.

    • Hi Doctor, just to make it clearer, people get cuts and abrasions in public places all the time. Should I worry about contracting HIV from accidental superficial cuts from objects in public places like broken glass, wires or other sharp edges in parks or playgrounds if these objects have cut a HIV positive person a short while beforehand with remnants of their blood on them within a time ranging from seconds to a few minutes before I accidentally cut myself on them? Please do answer as I’m driving myself nuts worrying if HIV could be transmitted this way.

  26. Hi Dr, I kissed someone in early Jan. Not sure if the person have any disease. Since late Jan, I have been losing weight and not having good appetite. Any sign of infection by the hiv ?

  27. Prestige

    Hi doctor..I had sex last night..I stuffed cotton wool in my vagina though…twice..but my boyfriend didn’t cum inside me..at least he didn’t..
    But I’m still curious and scared please..I’m I at any risk?.even with the cotton wool and no semen?
    Thanks

    • Dr Elaine Loh

      I am not sure why you inserted cotton wool inside your vagina. It does not help with reducing STD risk nor pregnancy, and it is not very safe to do so. Unprotected sex puts you at risk of STD and pregnancy even if he did not ejaculate inside your vagina. If you are concerned, please see a doctor to get an assessment.
      Click here to contact us

    • Dr. Julian Ng

      Hi,

      If the sex was unprotected, there is always risk of HIV transmission. Also, I would advise you not to put any foreign bodies (like cotton wool) into the vagina as there is a risk of getting other infections especially if some of the cotton wool is left inside the vagina. Also stuffing your vagina with cotton wool does not prevent HIV transmission. Wearing of condom greatly reduces the risk if HIV transmission.

  28. Hi doctor, is it possible to get hiv if you accidentally cut yourself on a sharp object, ie the edge of the table that has been contaminated with HIV blood?

    • Like when you accidentally scratch your arm against any object with a sharp edge that has been contaminated by HIV blood and where your skin is broken and bleeding from the impact(ie superficial cut) and if the HIV blood present is fresh.

    • I had sex with a condom and no oral sex both ways could I have gotten affected

      • The risk would be considered low as it was protected, but condoms are not 100% protective and there is no way to tell conclusively without testing.

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