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Broken Skin?
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This forum is limited to prevention of HIV and to safe sex in general. All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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Broken Skin?

I can never really find the answer to what all constitutes broken skin that leads to HIV infection.

I had a full brazilian wax that resulted in the top layer of skin being removed right where the base of the underside of my penis and scrotum meet.  There was never any blood present.  At first, it was very red and tender and did burn when a salycic acid/rubbing alcohol mixture was rubbed on it, as other red areas that look like friction burns.  About 30 hours later, I had protecetd sex with a sex worker but the rim of the condom did not cover this "abrasion".

This particular spot did leak clear fluid for a few days.  60 hours after sex, I went to my GP and explained everything.  My GP considered it no risk since no blood was present and said that blood needs to be present to lead to infection in this area.  The GP further said the clear fluid is a result of scratched skin and it was unlikely any HIV could enter.  I liken the fluid to be similar to when you may have a popped blister, alcohol burns it when applied, but it never bleeds.  Then it may leak a fluid as the skin tries to heal.

Even though it was within days, my initial HIV, Hep Block, Gonorrhea, and Chlamydia tests all came back negative.  My GP said having the inital test coming back negative greatly puts the odds in my favor because having existing STDs could have made transmission easier.

Does this type of skin abrasion fit the definition of what open, broken skin, cuts and abrasions that we all read about that can lead to transmission entry points?   Should I re-test?

Most of what I read says the open sores are mainly from fresh bleeding cuts, STD sores, or abrasions inside the vagina, rectum, etc.
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You raise an important issue.  Certainly readily visible, open sores are the sort of lesions that make the risk for HIV acquisition higher but smaller, less obvious lesions are thought to also operate in a similar fashion.  Thus abrasions and irritations of the sort you describe also increase risk.  Think of it this way.  When you skin is intact, irritants such as alcohol are not irritating but in your case, when it was applied, it felt similar to the way it would if you had a more obvious open sore.  

Having said this, having negative tests for gonorrhea and chlamydia indicate that you do not have either of these infections.  On the other hand, for HIV and hepatitis B, the meaning of a test so soon after exposure is hard to interpret.  A single, protected exposure makes it unlikely that you have infection but if you want to have test results you can really believe, you should wait until at least 6-8 weeks after exposure to be tested.

Hope this helps.  It is a complex issue.  EWH
4 Comments
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Dr. Hook,

Final follow-up questions if I may...

Would you comment on the statement made by my physician about how "there was little risk because no blood was present and we are actually looking for more direct contact with the bloodstream"? And, what exactly is the clear fluid and does that fluid provide avenues to the bloodstream?  My doctor also stated that the fluid flow was outward and that indeed would make it more difficult.  It seems to me that if only the epidermis was damaged and did not lead to blood flow, then risk is greatly diminished.

Thank you in advance for the response.
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Maybe with Dr. Hook away from the forum you can answer my last post?  There really aren't many discussions on the web about my type of abrasions and cuts. It seems only to be an unknown, theoretical route of transmission.

FYI--I am at 31 days from my encounter and have no symptoms over than a very dry, tickle throat from the upper part of my throat behind the roof from maybe post-nasal drip due to a feeling of slight congestion probably caught from my elementary-aged children, of which one has congestion that went into the chest.
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239123_tn?1267651214
I'll just reiterate that your risk was low.  There are no data to answer your question with clarity, which probably is why Dr. Hook chose not to respond for more than a week before he took his current break from the forum.  Further, the biological reasons that HIV risk is low in various circumstances doesn't much matter:  that no such transmissions have been documented is the best evidence there is.  But getting tested is the only way to know with certainty.
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Home Access test at 5 weeks is negative.  Couldn't wait.  Is another test now (6 weeks today) or 2 weeks from now warranted?
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