[Question #9862] HIV and STI risk from cut on penis

28 months ago

Hi,

I am uncircumcised,

Have a cut on the foreskin of my penis,it doesn’t bleed but hurts if touched.

I had unprotected oral sex with a female SW, what would be my exposure risk assuming she was hiv positive and bleeding from her gums

H. Hunter Handsfield, MD

28 months ago

Welcome to the forum. Thank you for your confidence in our services.

Nobody has ever been scientifically confirmed as having acquired HIV by receiving oral sex. HIV transmission doesn't occur from mouth to penis, or so rarely that the possibility can be ignored. The large majority of female sex workers do not have HIV, although this depends a lot on the type of sex worker (expensive escort versus brothel worker, for example), where the event occurred (higher risk in some countries or cities), and so on. But even if she had untreated HIV, and even with bleeding gums, and despite a "cut" on your penis, I would judge this as a nearly zero risk event. And since your "cut" isn't bleeding, probably it could not be infected with HIV even if blood with the virus came in direct contact with it.

What caused the genital cut? Since it's on your foreskin, it's not a shaving cut, right? If there is no obvious cause that you can think of, you might need evaluation for genital herpes, the most common cause of otherwise unexplained genital sores. If you have genital herpes caused by HSV2, you are at increased risk of HIV if sexually exposed -- but still very low risk.

Can I guarantee that you didn't catch HIV? No; there's a first time for everything. But if you think about it, there have been many millions (or billions) of oral sex events by persons with HIV, and penile skin problems and bleeding gums are quite common. Therefore, there must have been millions of such events in the presence of these problems -- and still no known transmissions of HIV.

The risks of other STDs from oral-penile contact is a lot higher than for HIV, although this also depends the details about your partner just discussed. If high risk or uncertain, you might consider a urine test for gonorrhea and, after a few weeks, a blood test for syphilis. You also could include a blood test for HIV if you remain concerned about it. But in the meantime, I really don't think you need to be very worried about HIV.

I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD

---
---

28 months ago

Thank you for the reply doctor. I believe the “cut” maybe because of the tightness of the foreskin but to my knowledge it isn’t and didn’t actively bleed during the interaction. What test do you recommend for hiv and how soon?

H. Hunter Handsfield, MD

28 months ago

This doesn't change my advice about HIV. You don't need to be tested at all. If you feel you must do for reassurance from the negative result have an HIV AgAb blood test ("4th generation" test) 3-4 weeks after the event for nearly conclusive result, and a final test at 6 weeks for 100% assurance. You could do only the 6 week test, but you might not want to wait that long for preliminary reassurance.

You definitely need evaluation for genital herpes. "Tight foreskin" is often one of those presumed possibilities infected men think about when they have genital lesions of unknown cause. Another common one is "I must have caught it in my zipper", or a tooth wound from oral sex. Herpes often turns out to be the explanation cases like this. You should find a physician who understands STD; assuming the penile lesion has healed by the time you are seen, an HSV type 1 and 2 IgG antibody test usually is the place to start. (Don't have or ignore the result if an IgM test is done.) Regardless of that result, if an when another similar sore appears, get seen within 48 hours for a swab test from the lesion for HSV PCR to detect the virus.

You're probably getting more than you bargained for in asking these questions. But I hope you find this information useful.

---

28 months ago

Dear Doctor,

My guilt may be getting the better of me here but I had one more question. If I somehow had say 2-3 ml of the workers vaginal fluid on me and used it to masturbate would my risk increase. Yes it was by appointment and not a brothel. London to be specific

28 months ago

Specifically I may have touched her and then masturbated to get erect to put a condom on before I decided to not risk penetrating

H. Hunter Handsfield, MD

28 months ago

Female escorts (expensive, by appointment) generally have low STD/HIV rates. Most are health conscious, have relatively low risk clients (men like you), and are tested frequently. HIV in particular is rare in UK female sex workers, as I understand the data from such agencies as Public Health England. Still, in the even of similar experiences in the future, I strongly recommend condoms!

Hand-genital contact and hand contact with genital fluids are very low risk for any STD. So this information does not at all change my evaluation and advice. I remain somewhat concerned that your penile "cut" could have been herpes, although probably not from the event described.

In summary, if you feel you need negative lab tests for reassurance -- not because of actual risk -- consider blood tests for HIV and syphilis when you reach 6 weeks after the exposure. Be clear: this doesn't mean I really believe you were at significant risk; I do not. But anxious persons often are more reassured by negative test results than by professional opinion, no matter how expert.

That completes the two follow-up exchanges included with each original question and so ends this thread. I hope the discussion has been useful.

---