Cut toe

Hi there,

A rather strange one this!

Walking without socks in a new pair of shoes all day/night, the middle toe, around the first joint/knuckle basically got rubbed to the point of bleeding. It took a good couple of weeks for the scab to fall off which makes me wonder whether the wound went deeper than I'd thought at the time - when I didn't really pay it much attention. I've also checked the shoe which has blood soaked into it where rubbing was happening. Looking at it now, the skin was broken about half a centimetre across and the 'darkness' of the area under the scab makes me wonder whether it was surprisingly deep.

That evening I saw a csw - and unexpectedly (I don't think she looked beforehand) she put my foot into her vagina - I don't think it was in there for more than a minute or two? Assuming that I'd taken my shoes off only a few minutes before - would this constitute a deep enough and fresh enough wound to merit hiv testing? Does this fall into the category of not possible to contract hiv this way - or unlikely - in which case I would probably get a test.

thanks

[H. Hunter Handsfield, M.D.]

Welcome back to the forum.

The only injuries ever known to result in HIV infection are those in which the injury itself was caused by a sharp instrument contaminated with HIV infected blood or other body secretions.  If there is a risk from pre-existing injuries, it probably requires a brand new, freshly bleeding lesion. Once bleeding stops and healing starts -- within a matter of hours -- it is likely that there is no measurable risk of HIV transmission.

Further, in the US and other industrialized countries, the large majority of female sex workers do not have HIV, and your partner probably did not.

So my judgment is that there was no HIV risk from the events described and no need for testing (or for any worry at all).

Regards--  HHH, MD

[ltb486]

Thanks Dr.Handsfield,

My concern was that if the toe was being rubbed by the shoe directly on the wound (in other words, the skin having come off), would it not then be classed as bleeding when I took the shoe off? If so, it may have been bleeding when it was inside the lady?

[H. Hunter Handsfield, M.D.]

If it wasn't spilling blood in an obvious way, you can assume it wasn't "actively bleeding".  But you were there, I was not.  If you want 100% assurance that HIV trransmission could not have occurred, I cannot give it to you. But the odds are in the same range as being hit by lightning.  Actually, they're not even that high.  You seem to be determined to believe you are at risk, and it seems my advice isn't going to change your mind.  But I encourage you to accept the reassurance I have tried to give and move on with your life.

[ltb486]

thanks