Two men who had never met before had a fight as a consequence of a motor car accident. One, who was HIV-1 positive, head-butted the other who was wearing metal-framed spectacles on his forehead. The spectacles left imprints on the foreheads of both men, and there was copious bleeding. The man who was head-butted tested negative for HIV-1 3 days after the fight. 14 days later, however, he developed symptoms consistent with primary HIV-1 infection. About 3 months after the assault, he also had acute type B hepatitis; at which time he was found positive for antibodies against all the major HIV-1 structural proteins, although HIV-1 EIA was negative, and with CD4 T-cell counts of 606 10/L. The assailant had a history of intravenous-drug use. In May, 1990, he reported syringe exchange and sexual intercourse with an HIV-seropositive woman. At the time, he tested negative for antibodies against HIV-1 p24 antigen. Positive tests for HIV-1, hepatitis C virus (HCV), and hepatitis B virus (HBV) were found in May, 1991, when his CD4 T-cell count was 720 10/L. His CD4 cell counts were 124 10/L at the time of the fight. Sequencing of a 183 base pair of the gp120 V3 env region of DNA from both men’s peripheral blood mononuclear cells was done 126 days after the fight. Nucleotide sequence distances of the men and four Italian HIV-1 infected mother/infant pairs living in the same region were calculated with the DNADIST program of the 3.572c Phylogeny Inference Package. The average distance of the men (2·80 [SD 0·26]) was similar to those calculated for the mother/infant pairs, which ranged from 1·91 (0·36) to 7·05 (0·66). By contrast, distances between either of the men and mothers and infants were those typical of epidemiologically unlinked infections (variability range from 9·37% to 18·44%). The men’s pairwise distances were significantly different (p<0·0025) from the distances between either of them and the less divergent control, suggesting that the similarity between the men’s HIV-1 DNA was not random. The skin injuries in the man likely provided HIV-1 and HBV with a direct access to the bloodstream. Although the assailant was also infected with HCV, the other man tested negative for HCV 4 months after the accident. Parenteral exposure via blood or blood products leads to HCV infection in most cases, particularly at high levels of viraemia. The head-butter’s HCV viral burden was less than 1000 copies/mL plasma, which may explain the lack of HCV transmission.