Question:

An HIV-negative man had a sexual encounter with an HIV-positive woman. Because he used a condom, one might think he is at relatively low risk of contracting the virus.

However, if, for example, if he had a cut on one of his fingers or he had a infected hangnail on a hand he used to stimulate her genitals, is he at risk of contracting the virus via the open wounds on his hand? If yes, are there documented cases of such transmission?

Answer:

The most common way that HIV passes between people is through sexual encounters. Sex between men and women is the most common way that HIV is transmitted around the World. Two recent studies suggest that HIV can pass as easily from a woman to a man as from a man to a woman. The use of latex condoms does reduce the risk of transmission but it is not zero. The risk goes from about 1 in 200-600 to about 1 in 1000-3000. This is about a 5 fold reduction in risk with the use of condoms. Transmission of HIV across broken skin is rare and reportable. There are less than a dozen cases of this event reported in the medical literature. Typically, cases where HIV was passed through broken skin involved direct contact with blood. The problem with trying to figure out the risk in this situation is that most people that stimulate genitalia with their finger also have intercourse. Thus, it is hard to say which event would lead to transmission. The risk of transmission through digital stimulation of genitalia is likely to be very, very low. I am unaware of any documented cases of transmission by this mechanism. The bottom line is that adults should continue to use latex condoms and practice safe sex.

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