Eczema on back of shaft, condom half off sex worker... risks?

[happyguy2009]

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!

[Edward W Hook, MD]

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

[happyguy2009]

thank you kindly.

You answered specifically about eczema, which i could not find anywhere online.

This is great. So mild eczema is very unlikely an entry way for HIV thorugh vaginal fluid. The sex worker was an unregulated one from internet. But like you said, even if she had it its low risk, the eczema doesnt help the risk, but the condom even partially helps, cause most HIV is transmitted through urethra

right?

thanks doc!

Now i will stop worrying and get my life in order!

[happyguy2009]

also i should note, i got herpes this xmas in the sam spot i have eczema, but im gonna assume that doesnt really change much.. i looked closely at the eczema area, and it was just red and dry..  very mild..

thanks doc!

[Edward W Hook, MD]

Your summary is correct and having HSV in that same spot does not change my opinion.  Take care.  EWH