Hiv, condom and protection

Hi, a couple of months ago I made a bad decission and had vaginal sex with a thai sexworker.
It was protected with condom all the time without breakage (I even controlled the condom by filling it with water afterwards to see any leakage)
My concern is that I have a ecsema (eczema) on my penis that itches from time to time and then I scratch it....
So, Im worried that the skin was irritated or maybe had a scrats that (pherhaps) wasnt protected by the condom due to its location at the lower part of the penis, am I at risk of having HIV because of the high prevalence of HIV in Thailand?  
Since it was a while since I'm not sure if I had a scratch or not, but it could also just have been irritated, is that an increase in risk?

Thank you for a great service!

[Dr Sean Cummings]

Hi Andreas,

You're driving yourself mad!

I don't see any risk here at all for HIV transmission. I cannot contemplate even in a theoretical situation how that might happen.

Obviously you are now several months down the line so you can test reliably if you are still worried.

I though, am not worried for you.

best wishes, Sean

[andreas305]

Thank you for a quick reply, can I ask a follow up question?
Is your answer still the same if I would have scratched the exma (eczema) so that the skin was damaged or even have a hole in it?
If so, can you please explain why?

Tank you very much for a great service!

[Dr Sean Cummings]

Hello Sir,

You can certainly ask a follow up question.

My answer would be the same.

I do not see any risk at all.

best regards, Sean

[andreas305]

So, even if it isnt covered by the condom and it is injured it still is no risk,
Is this because the injury probably is to small to be any risk for transfer?  Thank you very much, this is very reassuring to hear.

Andreas

[andreas305]

Hi, Im sorry to bother you again, the reason Im asking again is because of this answer by Edward W Hook made earlier on a similar case that implies that it could be some risk, what is your opinion? The different answers makes me confused. Ok, he sais that the chance is very, very low, but that is partly due to the low chance of the prostitute having hiv in the first place, but in my case, the prevalence of hiv among thai sexworkers is rather high...
And if I had a crack or fissure, does it need to be a lot of them and is transfer very rare anyway?
So here is the other question with Edward W Hook's answer:

Hi,
Just hours ago , i saw a sex worker. It wasnt a high end one, just something online. She started by giving me oral sex without condom . I didnt have a strong erection but proceded with vaginal intercourse with condom. it was just a few minutes, after i ejaculated i noticed condom was almost half off (probably cause of not full erection) . I have a patch of red eczema on the back of my penis shaft which was exposed. The eczema is def red, but there arent any major cracks or fissures. But its irritated.
Im sure some vaginal fluid got on there on some point. Its red, but there are no major fissures or cracks.
Im totally freaking out. So can you tell me risk factors and likelihood of HIV transmission if some vaginal fluid got on patch of eczema?
This holiday i got herpes in the spot i had eczema as well, although i have not had a herpes outbreak since then.
Im pretty nervous and regret the whole thing, basically i thought using condom was safe, i didnt think it would be halfway off and leave exposed skin.
Any insight would be helpful!

by Edward W Hook, MD, Mar 04, 2009 05:06PM
Your risk of infection is very, very low.  I won't lie to you and tell you that no one  has ever gotten HIV through eczematous skin lesions, that is not true.  On the other hand, no one has ever gotten HIV through mild eczema.  The case reports in which eczema was a consideration describe severe eczema with lots of cracks and fissures.

A few other points to remember:

1.  Statistically the CSW you were with did not have HIV.  Very few do.
2.  The condom no doubt offered partial protection, both by coverage of your penis and by preventing vaginal secretions from coming into contact with your urethra which is where most HIV infections are likely to take hold.  
3.  Odds. IF your partner had HIV, the chances of you getting infected from a single exposure are less than 1 infection per 1000 exposures.  While the eczema probably slightly increases your risk, the presence of a condom, even as partial protection probably reduces your risk more than the eczema increases it.  

Overall your chances of infection are tiny.  I would not worry about it.  Get and HIV test in about 6 weeks when over 95% of persons who acquired HIV 6 weeks before will have positive tests.  when it comes back negative you can then be SURE that you did not get HIV from the exposure you describe.  In the meantime, work to stay calm and don't be worrying about every little ache and pain you have.  Your are much more likely to get hit by lightening than to have gotten HIV.

Hope my comments help.  EWH

[andreas305]

Hi again.
Took a test today which was negative, thank you for a terrific service!