Expert: Terry B - 1/28/2008

Question
Transmission can occur if blood from an infected person comes into contact with "broken skin" but what exactly is broken skin? Does blood have to be visible? Does the broken skin need to be deep? is dry or peeling skin around the cuticle area of the fingertips "broken skin?"

Recently i was at a coffee shop when i asked for a lid.  the woman handed me a lid, and the lid had some type of a red residue; a substance i thought to be blood.  i had touched the small spot and there was some of that red substance on the tip of my index finger.  i quickly threw away the coffee and went to the restroom to wash my hands well.

if that substance was indeed blood, and infected blood, is there a chance of HIV transmission?  is there a chance that the running water could have diluted and spread the substance to the dry, slightly peeled skin around the cuticle area on the other side of my finger tip?  Is PEP treatment something that should be considered?  I would greatly appreciate your feedback.  thank you.

Answer
Dear John:

Peace.  There is some debate about what constitutes broken skin and/or an "open wound"; clearly something actively bleeding qualifies, but the rest is best directly evaluated by a health professional.  The possible exposure you describe does not constitute a "significant exposure" as it is more likely that if it were HIV-infected blood that the cells containing it would have been washed away, the amount was miniscule at best, and there appears no significant wound that would constitute a portal of entry.  PEP would not be recommended.

I hope that helps.

Terry