[Question #9581] Do non-bleeding cuts on my scrotum and penis base increase my HIV risks?

31 months ago

Dear Doctors,

Thanks very much for running such a great forum. I learned a lot from reading your answers!

I live in London. I have just started to explore a non-monogamous lifestyle. I had protected oral and vaginal sex with a CSW a week ago. The CSW was by appointment and was 350£ for an hour. During the entire process, the condoms were intact. However, I had burning and itching sensations on my scrotum and penis base after sex. I couldn't find any visible or obvious cuts on my testicles, and I am sure even if there were very small cuts, no blood was present. But I do have scrotal sebaceous glands, and they sometimes cause itching and burning sensations.

1. Do non-bleeding, very small cuts on my scrotum and penis base (that may not be covered entirely during sex) increase my HIV risk during sex? I worry that her vaginal fluids were on my testicles during sex.

2. Do scrotal sebaceous glands increase the risk of HIV?

3. Do you recommend HIV testing? Personally, I plan to have occasional meetings with sex workers (like once a month), and I would like to follow your annual testing advice which I saw in a lot of other posts. So, I don't want to pursue testing after individual exposures, and I plan not to test after this exposure. Do you agree with my plan?

By the way, I am uncircumcised.

Thanks very much for your time.

31 months ago

To be more precise: I started to have burning and itching sensations between 2 and 5 hours after my exposure. I couldn't find any obvious or visible cuts at that time and until now.

31 months ago

I still have occasional burning and itching sensations now.

31 months ago

I'm sorry but I need to clarify: by scrotal sebaceous glands I mean scrotal eczema and Fordyce spots.

Edward W. Hook M.D.

31 months ago

Welcome to our Forum and thanks for your thanks. I'm pleased that you have been able to learn from posts on the site- we leave them there in order to allow others to learn from our replies. Your exposure a week ago was low risk. Your partner was a professional for whom STIs and HIV would be bad for business. Your use of a condom makes your exposure virtually no risk. Further, it is my sense that your scrotal burning, which is not a typical sign of STI occurred too soon after the exposure to reflect even an unusal manifestation of an STI- STI symptoms typically take at least 2-3 days to begin and then tend to worsen, not resolve. In answer to your specific questions:

1. Do non-bleeding, very small cuts on my scrotum and penis base (that may not be covered entirely during sex) increase my HIV risk during sex? I worry that her vaginal fluids were on my testicles during sex.

No. Contact of genital, including vaginal secretions from an infected person would not put you at risk for HIV. For infection to occur there MUST be either penetration to injection of infected material DEEP into tissue.

2. Do scrotal sebaceous glands increase the risk of HIV?

Absolutely not.

While testing is always a personal choice, I see no medical need for testing related to the encounter that you describe. It was low risk and protected. Out of an abundance of caution, we do recommend periodic screening (testing even in the absence of symptoms) for persons with multiple partners every 6-12 months, depending on the partner number and your sense of there relative risk (for instance, screening can certainly be done less commonly if you use condoms' correctly (from beginning to end of all exposures), consistently, and they do not break (which occurs about 1% of the time). Remember- most people, even most CSWs do not have STIs including HIV and most exposures to infected partners do not result in infection).

I hope this perspective is helpful. I certainly endorse your plan and your apparent commitment to safe sex. EWH

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31 months ago

Thank you! Your comments are very clear. I have a follow-up question that will help me choose partners in the future.

I was wrong when I said the price of the CSW was 350£ per hour. It was actually 320£ per hour. I booked the CSW online through an agency. I saw comments in other posts that escorts are low risk partners. Dr HHH defined escorts as expensive female sex workers.

My question is: do you consider my partner (320£ for an hour) as an escort? Is there a relationship between price and risk? Do you have any more general advice for choosing a partner?

Edward W. Hook M.D.

31 months ago

I’m pleased that my comments were helpful.

I really don’t have a scale to rank CSW prices but I would consider greater than 300 pounds to be higher tier. When we refer to lower cost CSWs we’re referring to inexpensive street walkers. CSWs that work by appointment or those who worker professionally in brothels where sex work is legal tend to be less likely to be infected

Hope that this comment helps. EWH

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31 months ago

Thank you for your reply. I have one more clarification to make. In my initial post, I asked about scrotal sebaceous glands, and I actually meant to say scrotal eczema and Fordyce spots. So I have a final question:

Do scrotal eczema and Fordyce spots on my penis and scrotum increase the risk of HIV during sex?

You can close the thread after answering this question. I thank you again for your valuable advice.

31 months ago

I am sorry. My question is:

Do scrotal eczema, penis eczema and Fordyce spots on my penis and scrotum increase the risk of HIV during sex?

Edward W. Hook M.D.

31 months ago

You are worrying all too much. Neither eczema in any location nor Fordyce spots are associated with increased risk for acquisition of HIV.

Please don’t worry. EWH

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