ASK InSite: Rewriting answers to take out the anti-foreskin bias

[Ask InSite is a feature of the University of California San Francisco’s HIV InSite. The site touts itself as  providing “Comprehensive, up-to-date information on HIV/AIDS treatment, prevention, and policy from the University of California San Francisco.” And in nearly every sense, it does just that. I have a lot of respect for HIV InSite’s tireless work in the HIV/AIDS research and public information arena. But sometimes the site gets it wrong. The authors have a lot of ground to cover and sometimes they go with the flow instead of critically reviewing the evidence. So with that, here’s my rewrite of a recent question to Ask InSite.]

Blood on My Penis: Was I exposed to HIV?

May 11, 2007

Answered by Mark Vogel, MA, HIV InSite Prevention Editor, anti-foreskin bias corrected by David Wilton, Blog Editor, Male Circumcision and HIV

Question

One month ago, I had protected sex with my girlfriend, who has some experience as a sex worker. When removing the condom, I must have touched my penis rim accidentally. I saw stains of blood on my penis. I wiped off the blood with a tissue immediately. I had no bruise at all. I was disturbed, but my girlfriend told me that she has not had sex without a condom for the past 4 years and she always carries condoms whenever she is working. She has also taken several tests before and after our encounter because of the nature of her work. She has always tested negative. She is ready to take another test. My worry is whether
I was exposed to HIV. I am really worried because I have a wife.

Answer

This sounds low risk: you used a condom during the encounter, and your girlfriend sounds as though she is very careful to use condoms during her other sexual encounters. Theoretically, if your penis came into contact with blood, it is possible that you were exposed to HIV.

Blood can enter the penis in one of two several ways: through the foreskin a cut or abrasion on your penis or through the urethra. Intact Uncircumcised men have an abundance of Langerhans cells in their foreskins that are known to “eat up” HIV. Where there are no cuts or abrasions, this may provide greater protection than if you are circumcised because circumcised men lack the abundance of Langerhans cells that intact men have and, it is believed, are prone to greater epithelial trauma due to the lack of movable skin. are more at risk because HIV can enter the body through cells on the foreskin. The reports of circumcised men being at greater risk for HIV were limited to a specific set of circumstances in Africa and are probably limited to that setting. Blood can also enter through the urethra, but that’s a less likely entry point more difficult for HIV to enter the body this way.

Having a sexually transmitted disease (STD) increases your risk of acquiring HIV as well. Nevertheless, from what you describe, it doesn’t sound like there was contact between her blood and the inside of your foreskin or urethra, where asymtomatic STDs can hide and provide a non-obvious opening or sore. Washing immediately after sex also greatly decreases your chances of being exposed. You stated you wiped the blood off immediately, which likely provided similar protection to washing.

If you are still concerned, the best thing to do is get tested. Get tested now to rule out possible existing HIV infection, then again after 1 month (by which point many people produce the antibodies that HIV tests detect) and again at 3 months (the point at which nearly everyone produces antibodies to HIV). You might find some comfort if your girlfriend’s test result comes back negative. If she is, indeed, negative there is no chance of HIV transmission from her to you. That said, it’s generally a bad idea to determine your own HIV status based on that of your sexual partners.

[Editor’s Note: Strike-throughs and italics are editor’s corrections.]

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