Greetings, I have a situation and I want to inquire if it involves any risks or if it's zero risk.

I went for a massage, and the masseuse performed the massage for thirty minutes. Afterwards, he scratched an area at the top of my shoulder - I'm not sure if he scratched it with his hand or with a coin - a technique used in some treatments. This area became very red, but I don't think it was injured. However, it turned red and after two days it turned to a relatively dark red color. Within seven days, it healed completely without leaving any trace. I'm worried that it might have bled very slightly without me noticing.

Assuming the worker is infected with HIV and had blood on his hand, could it be transmitted through this exposure?

Additional details:

1- I showered after this incident and wore a T-shirt, and I checked it for any blood coming from my injury but found nothing.

2- I passed a white tissue over the area of my injury after four hours and found no trace of blood, which means that if there was bleeding, it was limited.

3- There is no crust formed like the one that forms in superficial wounds.

4- I am worried about the nature of the injury and don't know if it would allow the virus to enter if it came into contact with external blood.

Thank you very much.

The short answer is that this was zero risk for HIV. You may misunderstand about how HIV can and cannot be transmitted. I don't accept the premise that the massager had HIV. And if he has sex with other men and has HIV, the odds are strong he is on treatment, which is 100% effective in preventing transmission. Further, the idea that he would conduct a massage with visible blood on his hands is obvious unlikely -- and blood in amounts too small to be obvious never are a risk. In addition, HIV has never been transmitted by scratching; and the severity or healing time of the scratch isn't likely to make any difference.

Those comments pretty well cover your questions, but to be explicit:

1,2) Whether or not there was blood in the scratch doesn't matter one way or the other.

3) Also makes no difference.

4) Even a deep scratch with lots of bleeding would have been no risk for HIV, even if the person had untreated HIV. The virus isn't transmitted in this manner.

If and when you have unprotected sex, or if share drug injection equipment with other persons, I'll be happy to address whatever concerns you might have about HIV. Until this happens, however, you can safely believe you will never be at risk for HIV.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

My English is not very good, so I use translation programs.

What I clearly understood from your words is that even with the assumptions (blood on the masseuse's hand and a scratch on my shoulder), the transmission rate is zero?

Also, what I understood is that HIV is only transmitted through the following ways:

1 - Unprotected sex.

2 - Sharing injection needles.

Regarding the assumption that if the masseuse was infected, he would be undergoing treatment, this is not correct. Unfortunately, infected individuals in my country return to their home countries if their infection is discovered, which means that infected people only undergo mandatory tests.

But I understood from your answer, doctor, that even with these probabilities that I have presented, the risk is still zero, correct?​​​​​​​​​​​​​​​​

I also thank you for the quick response because I am worried about this.

Correct about the dominant transmission modes. Others include mother to infant transmission (during birth, nursing) and injury of doctor with blood-contaminated sharp instruments. Even sexually, HIV is hard to transmit:  if a male has HIV and ejaculates semen loaded with HIV into a woman's vagina, there is only one chance in a thousand she will be infected.

Good point about treatment of HIV infected persons -- not as likely in some countries, especially where HIV and homosexuality are deeply closeted and taboo. Thanks for the reminder. However, those countries have extremely low rates of HIV in such men.

Truly, you should not be worried about this. Perhaps it will also help you to know this:  In the 20 years of our forum, with thousands of questions from persons worried about possible HIV, nobody has yet reported they tested positive. You will not be the first. If it finally happens someday, I am confident it will be a truly high risk situation -- something like unprotected anal sex between two men.

Thank you, doctor, for this quick response. There's a point I didn't explain properly about my injury. It's more like a superficial skin irritation, similar to what forms when you scratch a part of your body, creating microscopic red dots. There's no cut in the skin, and I didn't notice any blood. If there was any, it would be very superficial.

Your answer that the transmission rate was not zero was somewhat concerning.

1. Am I at risk?

2. If this is the only risk, should I get tested?

3. Am I putting my wife at risk if I have sex with her?

The knowledge I've gained from reading this site is that if the wound is not deep, like injuries from sharp medical instruments, then the risk is zero. Why is it not zero in my case?

Thank you.​​​​​​​​​​​​​​​​

There is absolutely no reason to suspect that different types of scratch would have different risks. All are zero risk for all practical purposes. It doesn't matter what additional details you think of:  it will make no difference in my assessment and advice,

1. Am I at risk? NO.

2. "...should I get tested?" NO.

3. Wife at risk? NO.

"Why is it not zero in my case?" Because not nearly enough virus can be carried by fingernails or introduced into the skin for infection to take hold. Please go back and re-read every word of my replies above. If you do not completely understand, try a different translation program. My replies above explain why you are not at risk.

That completes the two follow-up comments and replies included with each question and so ends this thread. Please do not be tempted to return with any more question about this exposure and your concerns about HIV. Thank you. Best wishes and stay safe, as you have been.