[Question #8532] Foreskin tear risks?
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43 months ago
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Hello doctors, I have a question regarding a foreskin tear and oral sex risks. I received oral sex and noticed a slight tear on the tip of my foreskin. I believe this tear was there or caused during the sex.
1. It has been 24 hours since this incident, should I try and get prep immediately or his this window closed?
2. Can I get hiv or any other sti’s from this?? I have read that if the person has a cut in there mouth I’m susceptible to HIV?
3. I have ordered azithromycin and doxycycline, will these stop the spread of any infection from this encounter?
Thank you.
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H. Hunter Handsfield, MD
43 months ago
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Welcome. Thank you for your confidence in our forum.
You say nothing about your partner or the nature of the relationship. Male or female? Regular or casual partner? Commercial (i.e. did you pay for sex?).
1) Even with a high risk partner, receipt of oral sex is low risk for all STIs, including HIV: there has never been a proved case of HIV transmission oral to penis. I am aware of no data on whether acquisition of an injury during oral sex might elevate the risk. It seems plausible, but still probably an exceedingly low chance of infection. While penile injuries during oral exposure would seem to be rare, there still must have been millions of oral sex events in which this occurred -- and still no known cases of HIV transmission. The same is true if you had an ulcer or "tear" before the exposure: still no known cases of oral to penile HIV transmission. For those reasons, I would not advise post-exposure prophylaxis (PEP) in this situation. That said, if you talk to your partner and learn that he has untreated HIV, you might consider seeing a local HIV expert provider for in-person advice about PEP.
2) The risk of other STIs from oral sex is higher than for HIV, but still low. The main risks are gonorrhea, nongonococcal urethritis (NGU), often likely due to non-STI oral bacteria, and genital herpes due to HSV1 (but not HSV2). An exposed open lesion would not have any effect on the first two of these. I suppose it might elevate the risk of herpes, but I'm not aware that any such case has ever been reported.
3) I strongly advise against taking azithromycin, doxycycline, or any other antibiotic in this situation. They would not prevent HIV, herpes, or gonorrhea; the only important STI they would prevent is syphilis, and that's very unlikely -- at treatment would interfere with assessment for the more likely infections, especially gonorrhea.
Finally, it seems you are unsure if the "tear" was present before the sexual exposure. Are you sure it's really a tear, i.e. from trauma -- either from a partner or perhaps from vigorous masturbation? It's quite common for people to assume an injury, when in fact the problem is a genital ulcer -- for which the most common cause is herpes, with syphilis also a consideration depending on risks (e.g., by far most common in men who have sex with other men). If you have any doubt about the cause or origin, the lesion itself should be professionally evaluated. And for sure without potentially interfering treatment like antibiotics.
I hope these comments are helpful. Let me know if anything isn't clear.
HHH, MD
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43 months ago
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Thank you for the reply.
This person is trans and it was a casual hook up but she did not inform me of her status, which in hindsight is more of mistake on my part. I have tried reaching out but haven’t heard anything back. I do not know how bad the tear is because it hurts to pull my foreskin back and it just looks really red at the tip.
So you advise me to stop taking the medication? And this wouldn’t help with any sti’s? A previous doctor has told me that this was a combo medication that would eliminate gono, chlamidya, syphilis, trich and ngu. Essentially a cure all for all these. Was that information wrong and if so what would be the correct combination? I apologize if this question is unanswerable.
Should I just disregard this encounter as a no risk?
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H. Hunter Handsfield, MD
43 months ago
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Hmm.... with a penile lesion (tear? ulcer?) this uncomfortable and with the redness, it should be professionally evaluated promptly.
Yes, I would stop taking any antibiotics at the point. Yes, they would be active against the infections you mention, except for gonorrhea (unreliable) and trich (no effect at all). And there is no way any of those could have been acquired and causing your symptoms at this point. In general, after exposure it is far smarter to wait events and not attempt preventive treatment (except when a partner is known for sure to be infected). As noted above, the treatment is more likely to interfere with evaluation and proper treatment than any potential benefit from preventing infection this soon after exposure.
At this point, I am most concerned that your penile lesion is due to herpes or possibly syphilis -- not new from this exposure (onset much too soon) but pre-existing and exacerbated by the exposure. I'm not saying this exposure was low risk, but that your current symptoms likely are not from that event. I would advise stopping treatment and seeing a doctor ASAP.
I'll be happy to comment further if you'd like to report back after seeing a doctor or clinic -- but won't have anything more to say until then. OK?
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H. Hunter Handsfield, MD
43 months ago
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As I think about it, there is another possibility, especially if your penile lesion is getting worse in the past day: That you had a minor ulcer before the exposure, or an injury during it -- and that there is now a secondary bacterial infection, as perhaps suggested by the pain you are experiencing and apparently increasing erythema (redness). Gonorrhea can do this; and so can staph, strep, or various oral bacteria. None of these would reliably respond to doxycycline or azithromycin, but both drugs could obscure the diagnosis and selection of the best treatment.
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Hoping to hear from you again after you've been professionally evaluated.
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43 months ago
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Hello Dr. Handsfield, I was able to see a doctor today. The pain from pulling my foreskin back wasn’t there this morning, it just felt a little tight? If that makes sense. Anyway to the appointment.
I told him about the injury and he took a look and he said that it was just irritation from the encounter possibly due to her doing a little too rough while masturbation. Also he said to keep on the antibiotics because he reiterated that this will clear up any bacterial sti’s, so I’m not really sure what to believe in regards to this.
On the HIV risk he told me if she is hiv positive there is nothing much I can do because he said the time line for PREP is expired which is bad news for me. He also said that if she was positive it wouldn’t matter if I had a tear on my foreskin or not, if she had any injury in her mouth it would have entered my penis. I’m so scared right now. I feel like I’m getting differing opinions on everything.
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H. Hunter Handsfield, MD
43 months ago
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I disagree with your doctor's advice on taking the antibiotics and have given you my reasons. Up to you whose advice to follow.
And it's clear your doctor doesn't understand much about HIV transmission risk: his statement (or your understanding of it) is ridiculous. Apparently you have forgotten (or didn't carefully read?) my opening comment in response to your question: "there has never been a proved case of HIV transmission oral to penis", which your doctor seems not to know. If such transmission occurs, it is extremely rare: CDC calculates the chance at 1 in 20,000, which is equivalent to getting BJ's by infected partners once daily for 55 years before transmission might be likely. That's why PEP is rarely if ever recommended following oral sex exposures.
That completes this thread. I hope the discussion has been helpful. Best wishes and stay safe.
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