HIV - Prevention Expert Forum
Is this a risk?
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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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Is this a risk?

Hi Doc, long story but the other day I got In a fight and got grabbed in the face. I had a small healing scab on my cheek which was caused from when I scratched a bit of excema earlier that day. I don't remember seeing if the guy had any blood on his hands but he broke the scab as it bled a little. I used to apply a steroid cream to the area but stopped a while ago as it thinned it out a little and was told not to use the cream in that area. Can you tell me 1. if this slight wound would be a risk for HIV to get in if he had his blood on his hand when he grabbed me? 2. Does the fact that although it was a small wound the skin may be less protective because it was thinner? 3. And would it therefore be classed as a deep would? 4. Do you think it would be more susceptible? 5. Or would it have to be a wound requiring stitches. I'm just unsure about this whole blood open wound thing.
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Welcome to the forum. Thanks for your question.  The quick answer is that there is no appreciable risk of HIV and I don't recommend testing.  Here is my reasoning:

First and most important, although it is commonly stated that HIV can in theory be acquired by exposure to blood during fights, to my knowledge this has never actually happened.  Any blood exposure is theoreticallly a risk, but this sounds pretty trivial.  As you suggest yourself, a wound generally must be deep and fresh (actively bleeding) to risk HIV from exposure to infected blood.  Exposure of skin rashes like eczema also is often listed as a risk, but here too there are few if any actual reported cases of such transmission.  And of course even this assumes your fighting buddy has HIV, which probably isn't the case.

I think those comments cover all four of your specific questions, but let me know if there is anything you don't understand.  I don't recommend HIV testing -- but of course you are free to do that, if these words are not sufficiently reassuring and you would feel better knowing you have had a negative test result.

Best wishes--  HHH, MD
5 Comments
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Avatar_m_tn
Thanks Doc. I'm happy with you advice and won't bother testing. Feel crazy asking about this but just got stressed when thinking about it too much. Have a great Christmas ad new year!
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239123_tn?1267651214
Thanks for the thanks.  Merry Christmas to you as well.
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Avatar_m_tn
Hi, just wanted to come back for clarification and for future reference.

1. When you say 'no appreciable risk' do you mean not a realistic risk?

2. If the guy had fresh blood on his finger tips when he opened my healing scab (wound) would could entry to the bloodstream have been possible? I've heard before that if wound occurs the instant it is in contact with infected blood there could be a risk. Probably because it hasn't had time to clot. Is that true?
I'd be grateful if you could answer these 2 last questions.
I won't ask any more.
Thank you.
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239123_tn?1267651214
1) Yes, "not appreciable" and "not realistic" mean the same thing.

2) From my original reply:  "...HIV can in theory be acquired by exposure to blood during fights, [but] to my knowledge this has never actually happened" and "Any blood exposure is theoreticallly a risk".  Under the specific circumstance you describe ("if wound occurs the instant it is in contact with infected blood"), the risk would be higher.  But since this must have occurred many times over the 30 years of the worldwide AIDS epidemic, and yet there are no known cases of HIV transmission during fights, even in these special circumstances the risk obviously is very low.

In other words, my opinion and advice are unchanged.
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