Case reports of transmission

Fisting

One case has been reported of infection as a consequence of fisting. A man who had not engaged in anal or oral intercourse for several years seroconverted eighteen months after beginning a sexual relationship with a man who was already symptomatic. Their sexual practice consisted only of dry kissing, mutual masturbation and fisting.

The subject of the report had frequent ulcers on his hand, and it was common for him to fist his partner without covering the cuts. He had a previous history of contracting syphilis by the same route.

Fisting received considerable attention as an `AIDS risk' in the early years of the epidemic because many of those who practised anal intercourse were also likely to have been fisted. This case suggests that a small potential risk may be attached to fisting.

Being fisted and insertive fisting have both been identified as possible risk factors for hepatitis C acquisition among HIV-positive gay men, with this practice being one of the possible explanations for a recent increase in sexually-transmitted hepatitis C infections seen among gay men (especially Hiv-positive gay men) at clinic in London and other European cities.

For more on the possible link between fisting and hepatitis C, see the chapter on hepatitis.

Use of semen as a lubricant in mutual masturbation

One case has been reported. A South African man reported that his only possible route of exposure was by using the semen of his partners to lubricate his own penis whilst masturbating. It is possible that the man, who preferred not to have sex with fellow homosexuals and instead seduced `heterosexual men' by getting drunk with them, and showing them erotic films, may have preferred to censor from his memory other sexual activities which put him at much greater risk of infection. See Oral transmission, earlier in this chapter, for further discussion of this phenomenon.

Common sense nevertheless suggests that a small risk might be attached to this activity.

Semen in the eye

One case has been reported where a man is believed to have been infected by getting his partner's semen into his eye. This case was reported by the same Swedish team which also reported six cases of oral transmission (Grutzmeier), see Oral transmission above. Two factors suggest that it is likely to be more reliable than some other case reports:

• The serostatus of the individual's sexual partners and confirmatory accounts of the sexual acts which took place has been obtained for each case through the Swedish compulsory partner notification scheme.
• The serostatus of the presenting patient was matched to his previous test result, obtained through clinics in Stockholm. Almost all cases had tested negative within the previous year; repeat testing by seronegative gay men is the norm in Sweden.