[Question #7338] Risk of HIV from fresh sore on penis shaft during sex

6 months ago
Hi Doctors,

5 days ago I had a protected vaginal sex with a commercial sex worker which I have met in her place.
I have a circumcised penis.

Before the protected vaginal sex she gave me a very rough
unprotected blowjob(without condom) with a lot of teeth rubbing involved and some bites also.

The rough unprotected blowjob has made me a fresh and deep sore
in the middle of my penis shaft.
The sore on penis shaft from unprotected blowjob
was active bleeding with relatively a lot of blood coming from it.

Before vaginal sex I tried to cover the active bleeding sore with the condom.
The protected vaginal sex lasted about 5 minitues.

In the end of sex I realized the condom was half slipped during the sex.
It was still covering the penis glan and urethra all the time,
but unfortunately, I saw that the bleeding sore
in the middle of the penis shaft was exposed and not covered by the condom
because of the half slippage of the condom.

My question is if my partner was HIV postive,
and the wound in penis shaft was deep enough to allow access for HIV,
and the active bleeding sore on penis shaft was exposed and not covered
by the condom during the whole time of the vaginal sex which lasted 5 minitues.
What is the HIV risk from such case with direct and continious contact
between the exposed bleeding sore on penis shaft and HIV vaginal fluid
and possible HIV menstural blood, when the bleeding sore was inside the vagina during sex,
and the condom did not cover the bleeding sore on penis during the 5 minitues of sex?

I know such contact like my last encounter 
is relatively high risk for HIV infection and I undertand this, 
can you give a rough estimate for the HIV risk 
in my last encounter in number (precentage or 1 in X cases)?

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
6 months ago
Welcome to the forum. Thanks for your question.

I do not agree with your closing comments:  this was not a "relatively high risk for HIV". First, in the US, western Europe, and most industrialzied countries, the chance any particular female sex worker has HIV is low, almost always under 1% (1 in a hundred) and usually more like 1 chance in 1,000. Second, with unprotected vaginal sex with an infected woman has an average HIV transmission risk of 1 in 2,500. Third, you used a condom (good move!), which reduces any risk by around 100-fold. So if we ignore the penile wound, your risk works out to a maximum of 0.01 x 0.0004 x 0.01, or around 0.00000004 (4 in 100 million, or one in 25 million).

Could the fresh would increase the risk? If exposed -- i.e. not completely covered by the condom -- it might raise your risk. Let's assume it increaes the chance 100-fold, i.e. the same effect as not using a condom. In that even, your overall risk recalculates to 4 in a million, or 1 chance in 250,000.

I hope you'll agree that even in the worst case scenario, there was very little risk of HIV in this situation. I really don't think you should be at all worried!

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

6 months ago
Hi Doctor,

Thank you very much for the risk estimate.
It has helped me reduce the fear to know that my risk is that low.
I will be checked for safety in 3 weeks hopefully negative.

I have 4 more questions for my general knowlage about HIV transmission and infection statistics: 

1.    When you said my overall HIV risk in my case is 1 chance in 250,000 is taking account that we don't know if 
       the sex worker is HIV positive or not. 
       Lets say she was HIV positive for sure,
       so my HIV risk in such case would be 1 chance in 2,500 cases according to your estimate?
       Meaning that the chance of HIV infection 
       through an unprotected contact of fresh wound on penis shaft during sex equals 
       the chance of HIV infection through an unprotected contact of penis urthra during sex?

2.     Which of the contacts is usually more likely to cause HIV infection during sex: 

A.     Unprotected contact between exposed penis urethra and 
        HIV vaginal fluid and possible HIV menstural blood in partner's vagina during sex.

B.     Unprotected contact between expoesd fresh bleeding wound on 
        penis shaft and HIV vaginal fluid and possible HIV menstural blood in partner's vagina during sex.

       Or each of the 2 contacts above have the same chance of transmitting HIV? 

3.    Are you familiar with previous cases of approved HIV infections during sex through
       a fresh bleeding wound that was exposed inside vagina(wound is not covered by condom like my case) 
       to HIV vaginal fluid and possible HIV menstural blood inside vagina during sex?
       I ask this question, 
       becuase I have heard that HIV infection through unprotected sex 
       with open sores on penis caused by STD is common reason for HIV infection.
4.    What would be the HIV risk in therory(1 in X cases) 
       if the vaginal sex is unprotected without condom
       together with the presence of a fresh bleeding wound 
       on penis shaft(which can allow access for HIV)  : 
       In a situation in which in the same time both penis urethra 
       and fresh bleeding wound on penis shaft
       have contact with HIV vaginal fluid and possible HIV 
       menstural blood in partner's vagina during sex?

Of course I will continue using condoms for vaginal sex and avoid having such 
fresh bleeding sores on penis shaft during sex.
I am just intrested to know these thoretical HIV risks for my general knolwadge,
or in case such fresh cuts
(from unprotected blowjob before sex or shaving cuts before sex)  will happen again
and/or condom breakage happens in future.

Sorry for the multiple questions, as I wrote I am just intrested to get
some knowladge and right proportion of HIV risk through unprotected contact 
of penis urethra and/or a fresh wound on penis during sex if such will happen again in future.

Thank you for your time and knowladge
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
6 months ago
The follow-up comments are intended for clarification and follow-up of the original question and reply -- not to raise entirely new issues. And you've asked 7 questions, not 4. Therefore just brief replies.

1. My numerical calculation includes my guesstimates for the different elements of risk. You can recalculate as you wish. For example, if you want to assume your partner definitely has HIV, replace that fraction with 1.0 (i.e. 100% certain she is infected).

2. There are no data to esimate the risk from a bleeding penile sore and I cannot estimate different numerical risks for scenarios A and B. Undoubtedly higher for a large, bleeding wound than a superficial scrape with minimal blood.

3. Nope. I've never heard of anyone  acquring HIV from such an exposure.

4. I'm not sure I follow the complicated wording, but the risk of HIV from exposure to a woman is no higher or lower during menstruation. The amount of HIV in menstrual blood isn't any higher than in cervical or vaginal fluids. 
6 months ago

Thank you for your answers,

I just got complicated with your formula calculation. 
Just to know my  HIV risk for worst case scenario if partner was HIV positive,
What is your estimate for my HIV risk, 
in 1 in X cases if she was HIV positive for sure 
with my detailed encounter with the exposed fresh wound on penish shaft?

About question number  4 you misunderstood me.
I will reask again in a more short 
What i was asking in short is what is HIV risk in theroy with an 
HIV partner during unprotected sex with a fresh penlie wound on penis(like the one I had)
when during the encounter both urethra and fresh penelie wound come into 
contact with inside vagina(with vaginal fluid and possible menstural blood)

Thank you for your help

6 months ago
Hi Doctor,

Another clarification I forgot to ask you in the follow up before,

when you said in your last answer to my question number 2 I quote: 

"I cannot estimate different numerical risks for scenarios A and B"

What you mean by that is that your professional opinion is that the HIV risk for 
scenario A(unprotected contact of urethra), and scenario B (unprotected contact of fresh  bleeding wound on penis shaft)
during unprotected sex is the same HIV risk("I cannot estimate different numerical risks for scenarios A and B")?

Or you mean by that that you can not put a numerical number for a  HIV risk for each scenario?

Thank you for you time and help
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
6 months ago
If your partner had HIV, your risk of HIV was under 1 chance in 2,500.

My "professional opinion" is that I cannot estimate the risks for such events. And no, I cannot put a numerical risk for these scenarios.

I'll bet that in the past 10 years, not 10 people in the US have acquired HIV from exposures like yours. The vast majority of infected persons in the US have have had repeated (hundreds or thousands) of truly high risk exposures, like entirely unprotected anal sex between men. It is really rare for someone with only heterosexual contacts -- even with sex workers -- to catch HIV. Of course I'm not recommending you ignore sexual safety. And if you continue to have occasional non-monogamous sexual encounters, especially with sex workers, use condoms and get tested for HIV from time to time. But you need to stop obsessing about the details behind this quesiton. Just use common sense!

That competes the two follow-up comments and replies included with each question and so ends this thread.  I hope the discussion has been helpful.