Hello Doc, 

I am a male, 41 years old, living in Turkey. Last weekend i had a sexual encounter with a lady, (35 years old), she is not a sexual worker or, sth. She gave me unprotected oral sex, then we had protected vaginal sex about 7-8 minutes. The problem is i have a small lesion on my penis head for 1 year. Dermotologist said it is like a seborrheic dermatitis, or psoriasis lesion, totally benign, its not bleeding or itching. Sometime it goes away and sometimes it comes back, i use topical cream when it flares up. During the vaginal sex i always used condom.After the sexual intercourse when i went to the bathroom, there wasnt any tear in condom i gently removed it. But the lesion on my penis head was slightly more irritated and reddish, i guess it was because of a bit rough oral sex. But during the vaginal sex condom was always on my penis. 

In this situation do you reccomend any testing for HIV? Does that lesion increase the risk of transmission? I take all std and hiv tests once a year, but do you think this time is more risky than the other casual protected vaginal intercourses.

Thank you.

Of course there are no data on the possibility that various penile skin abnormalities like seborrheic dermatitis or psoriasis might increase the risk of STI/HIV acquisition from oral sex. But logic says there's Iittle or no risk. There has never been a scientifically documented case of HIV acquired by mouth to genital transmission. And of course various skin conditions are common, so millions of oral sex exposures with HIV infected oral partners in there presence of various penile skin conditions must have occurred over the years. Still, no known actual infections in persons who had not had vaginal or anal intercourse, usually unprotected.

Therefore, on scientific grounds I would judge there was no risk and you do not need testing. On the other hand, reassurance alone often is a valid reason for testing. If you remain concerned despite this advice and will sleep better and stop worrying if tested with negative results. If so, feel free to be tested with an HIV AgAb (fourth generation) blood test 6 weeks after the event. You can be confident the result will be negative. (Or just wait until the time for your annual testing -- it's up to you!)

Let me know if anything isn't clear.

HHH, MD