[Question #7564] Dr. Hook (follow-up) - penis cut

3 months ago
Hi Dr. Hook,

My paranoia has led me back again. I'm thinking you are able to see my last thread and therefore know my situation.

While examining my circumsized penis, I noticed a small cut on the backside, halfway down. I'm sure condom would have protected this except for when I pulled out and condom stayed in her. I just noticed this cut as I spread the skin on my penis tonight (3 weeks after). It stings ever so slightly when I spread it but looks like it has healed. This probably happened at one of three points. Masturbation an hour before I had sex, during sex, or rough masturbation at home an hour after I had sex. Again, during sex I had been using lysol wipes before putting on new condoms, and hand sanitizer after sex which could have made this area sensitive and then if I had masturbated after could have created the cut. Again, I don't know and can't remember. Just worried about my chances if this cut developed during sex. The sex was a bit rough and hurt slightly. But there was no blood from my penis during of after sex that I can recall. I think I would have seen this. Also no blood from her vagina that I recall. No blood on condom.  Do you think this cut creates any changes in my current chances. You said I had a low risk exposure and my chances were well, well below 1/5,000 as I am on PEP and CSW (caucasian female in probably early to mid 20s) said she had tested clean 10 days after I saw her. Don't know much I can trust her but I do see her still putting up ads so I'm guessing she's still fine. 

But does this small cut create any significant changes to my chances for hiv?

I'm sorry, not trying to be like others who keep coming back with basically the same questions or small changes to details, but I'm just paranoid at this point. Thank you.
3 months ago
The rough sex and hurt was only at certain points. But sex overall was not too, too rough. I felt no pain from this cut and never would have known until I examined my private area tonight.
3 months ago
Reading my question back, i may have sounded like I exaggerated slightly.  Roughness and slight penis hurt was only at certain points of sex. Overall sex was not too, too rough. And no anal at all. I would have never noticed this cut until I examined it tonight.
Edward W. Hook M.D.
Edward W. Hook M.D.
3 months ago

I'm sorry to see you return to our Forum.  "Paranoia" is the right word.  No change in my assessment. 

I should also point out that the discovery of a small cut three weeks after an exposure is unlikely to be due to that exposure.  Cuts and abrasions heal much more quickly, over the course a few days to less than a week.  The cut you noticed may be due to some other cause- they Lysol and its after effects, repeated, over zealous self-examination, masturbation etc.  For the sake of thoroughness, to investigate a lesion appearing three weeks after exposure, you should have a syphilis blood test but I anticipate that this too will be negative, providing assurance that you did not get syphilis in your encounter of concern. 

We have found that it is not at all uncommon for concerned, anxious persons to repeatedly examine themselves repeatedly following an exposure of concern, leading to detection of lesions and symptoms that would have been overlooked or ignored had they not been looking so carefully.  Please don't worry, I remain confident that you did not acquire HIV or any other STI from the exposure you have described.  EWH

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3 months ago
Thank you doctor.

1. I tested negative last week (2 weeks post exposure while on PEP) for syphilis, chlamydia, hep a b c, and hiv. Also neg hsv2 6 days post exposure. I have not masturbated since the incident since penis has been sore and due to my guilt and paranoia.I have examined my penis regularly. I did experience slight burning/pain in the area near the cut a few days after exposure. But now I can attribute this slight pain/burning to the cut. The cut had healed, but it is now burning a little since I spread my skin and reopened the cut last night. Slight itching from cut to the tip of the backside of my penis. I experienced this a week or so ago too. Probably because the body is trying to close the cut. This cut definitely occured within the 4 hour window of prior masturbation, sex, and post masturbation after lysol and hand sanitizer. But do you still remain certain no exposure occurred even if the slight chance this cut occurred during sex? Again, I never saw blood. Sorry for asking twice. Just wanted to make sure you had all my facts for your response.

2. Also would like more insight on the efficacy of PEP. I hear it is ideally best to start within 24 hours (every hour counts) and efficacy decreases, from 48 to 72 hours. If I took PEP at 39/40 hours post exposure, am I still in the high efficacy range? I read on another thread that Dr. Handsfield, in his 40 yrs of experience, has never seen PEP fail if taken within 72 hours. Would you similarly agree to this? I have taken this medication at the same hour every day minus 15-45 minutes early on about 2 days. I am taking Truvada 200mg/300mg and Tivicay 50 mg. Both once a day. The Truvada has 30 pills but the nurse told me to discard the last 2 pills after my 28 days finish. Is this truvada and tivicay once a day combination of PEP a good medication combo? I know some people take other pep medications and take them twice a day. I don't know how this effects efficacy if I am only doing once a day.

3. Lastly, I did have coronavirus on December 6. I did quarantine, and was recovered at the time of my exposure on December 25. Could covid have weakened my immune system and made it easier for STDs like hiv to enter my body more easily. I had also been drinking excessively (2 liters a week or less for months) before the exposure and 6 or 7 shots a couple of hours after the exposure. I did not drink prior to exposure. I took take some sildenafil 30mg a couple hours prior to sex. Could this also affect my immune system in fighting off my virus? The covid/alcohol combination may have weakened immune system?  have not had a drink since exposure.

I think this will be a good place to stop as I have expressed all of my concerns now and have provided every "what if" scenario my mind has raced to and if you still feel strong no STIs will be contracted, then I will be thoroughly relieved. I will stop overthinking and just get tested regularly. Thank you doctor, you are providing the world a blessing through your service.
Edward W. Hook M.D.
Edward W. Hook M.D.
2 months ago
Thank you for the additional detail. It does not change my assessment however.  I believe you are seriously overthinking your risk and worrying about inconsequential details.

1.  No change in my assessment. Your risk for infection is vanishingly low. I would not worry.
2.  Available data suggest that the benefit of PEP is limited or nonexistent more than 48 hours after exposure to an infected partner.  Logically the benefit declines with increasing time from exposure to that point but precisely how much is unknown.  Please remember, your risk for infection was so low that most experts would not have even been willing to prescribe it for you.
3.  Coronavirus is not known to adversely effect the immune system. Nor does the sort of drinking you describe.

Please do your best to nor be distracted by these sorts of “what if” thoughts.  EWH 



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2 months ago
Thank you doctor. Your assessment has been a true relief for my mental health. I will stop overthinking about this circumstance and get tested at the appropriate intervals.

If nothing comes from this exposure, it has certainly been good in the fact it was a wake up call. I have quit drinking, and trying to become more religious and get closer with family. I simply became paranoid because I do not conduct in these types of activities often. Real vaginal intercourse with a csw was a first and made me a go a bit crazy after.

I would like to follow up on results post pep down the road. But they will not be anxiety related what if scenarios and will be shorter, concise questions. Your sage advice is always appreciated.

Good evening and health and blessings your way doctor. Please close this thread.

Thank you.