[Question #4804] HIV risk from Eczema

25 months ago
Dear Doctor,

I had protected sex with an escort in New York last week while having eczema at the base of my penis. This area was pretty red and irritated and itches from time to time. I think part of the skin there might be broken due to my scratching. 

Because this area was close to my body, I was not able to cover it with condom. I don’t think this part of my skin was in her virgina but was worried that her virgina fluid might have gotten splashed on it during sex.

Was I at any risk of being infected with hiv if her virgina fluid came in contact with my eczema? Do I need testing?

I look forward to your kind help!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
25 months ago
Welcome to the forum. Thanks for your question.

Congratulations for having safe sex with commercial or non-monogamous partners. That's far and away the most important factor here. In addition, most escorts -- meaning expensive female sex workers by appointment -- are believed to rarely have HIV or other active STDs. In general they know the score, choose partners at low risk (men like you), use condoms, and get tested regularly. So there's probably less than one chance in a thousand that your escort partner has HIV. And if she did, the average risk of transmsision during a single episode of unprotected vaginal sex is around 1 in 2,500. (Many spouses of infected persons never catch HIV.) And with a condom, your risk is at least 100 times lower than that. The math works out to odds of catching HIV from this exposure of 1 chance in several million.

Could contact of infected vaginal fluids with eczema raise the risk? Perhaps, but only a little bit. But even if the risk were doubled, your chance of infection would remain one in a few million.

In general, it is rarely necessary to test after any single potential exposure, especially for such a low risk event as this one. I certainly would not do it if somehow I were in your situation. However, it's also possible that you would find a negative test result more reassuring than my professional advice. (If so, I don't take it personally!) If so, feel free to be tested in a few weeks. But don't lose any sleep over this in the meantime. There's really no realistic chance you were infected.

I hope this information is helpful. Let me know if anything isn't clear.