Expert: Terry B - 5/28/2007

Question
QUESTION: I inserted my hand into a womans vagina and then used the same hand to touch the condom i used during sex, i also had a small laceration on my penis, i did use the condom effectively but i'm worried because i touched the condom like all around with the hand i inserted into her, i however did wash my penis with a multi-surface claener and cold water,I'm so anxious please help.

ANSWER: Dear Mandeza:

Peace.  And ouch.  Somehow washing your penis with multi-surface cleaner is the most disturbing part of your question.  I will address both.

Let me address your question about HIV transmission first - your risk is relatively small as the amount of fluid to which you were exposed would be limited to that which adhered to your hand and was transfered to your condom, and only that amount that was exposed to your laceration placed you at risk.  I would recommend being tested to know your health status and for your own peace of mind, but as I said, the risk seems quite small.

Regarding washing your penis with multi-surface cleaner, please be aware that many cleaners contain chemicals and/or abrasives that may in fact damage your skin and mucous membranes, and as such place you at greater risk of HIV transmission, not to mention discomfort and other associated problems.  In the early days of my training, it was pointed out that a persons receptive in an act of insertive sex place themselves at greater risk simply through douching afterwards, because of the disruption to the protective mucous and increase of the area to which the potentially infectious fluids are carried.

Please be careful with your body and that of your partner.  Again I recommend voluntary counseling and testing for relief of any fear or anxiety, but in my estimation your risk for HIV transmission in the case you describe is small.

Sincerely,

Terry

---------- FOLLOW-UP ----------

QUESTION: Thank you for your expert opinion I am South African the pandemic is an unbelievable concern this part of the world, I am now extremely confused in terms of limiting the risk of infection, washing the penis after the act with a soap solution has been recommended in recent eduction programmes as it apparently kills the virus before entry into the body I understand your point,  however it stands in contradiction with what we are being taught do,I did use non abrasive multi surface cleaner therefore i experienced no discomfort, thanks for the concern,how effective is circumsition in reducing my risk this is another huge issue this part of the world.

Answer
Dear Mandeza:

I have been to your country and know about your epidemic firsthand.  Also the concurrent challenges of the legacy of Apartheid.  There is also great hope and spirit of courage.

I do not mean to confuse you.  Washing your penis after a possible exposure is a good thing.  Douching, on the other hand, forces water into the receptive area and can push the virus deeper.  

I am not an expert on "multisurface cleaners" There are a great variety - some specifically for use on skin, others for cleaning ovens - and something mild yet disinfecting would be a way to remove residual virus from the skin, and as such enhances protection.  Something which irritates or damages skin and mucous membranes would alternately increase risk.  Thus the statement of concern.

There is research going in in your country and elsewhere on microbials - lotions that would kill HIV at the exposure site - but I believe these are still in development.

For clarity and to assist in discussion of circumcision and other issues, I find the following helpful to assess risk.

Understanding that every exposure does not necessarily mean an infection occurs, we talk about relative risk.  The factors that mediate (increase or decrease) the probability of an exposure becoming an infection include:

Chances that your encounter was with a person at risk.  The population at risk includes sexually active persons, injection drug users, persons who have received injections, blood or blood products, or invasive dental or medical care in areas of poor sterility or infection control, including piercing, tattooing, or other ceremonial rituals that involve blood, persons born to HIV infected mothers.  In short, most of us.  

Secondly, to which fluids were you exposed?  If a person is exposed to the blood, semen, vaginal secretions, or breast milk from an infected person, there is risk of HIV transmission.

Concentration of virus in the fluids:  Early on before the immune system partially suppresses HIV (shortly after initial infection) the concentration of the virus in these fluids is highest, also at times of active disease and end of life.  Even persons in treatment who show no detectable viral load retain the possibility of passing along HIV, though the chances are lower.

Another key is the route of possible transmission.  Skin and mucous membranes protect us from most of the pathogens (germs) in our environment to one degree or another.  Breaks in skin or these membranes, caused by injection or cutting, presence of sores or active infections, all decrease the effectiveness of our natural barriers.

Other factors: the amount of fluid (more fluid, more risk); duration of exposure (how long the fluids are present); the amount of skin or mucous membranes exposed (area); the number of times exposures occur (frequency), and; general health.

Looking at all of these factors can help you assess risk and devise strategies to reduce risk.  

Abstaining from contact with these fluids is fully effective, trying to abstain and protecting yourself and others should you falter is responsible.  Condoms reduce risk by impacting these factors; the fact that circumcised males are somewhat less likely to contract HIV than their uncircumcised counterparts was learned from a comparative study of two populations.  Looking at the factors above, a circumcised penis might have less skin area for exposure and be less likely to trap vaginal secretions or other fluids that could infect for as long a duration as an uncircumcised penis.

Sorry if too long in this answer but rather be complete than confuse you further.

Sincerely,

Terry