oral sex and scrotal lesion

[nervousbc84]

Hello Doctors,

First, thank you for all the good work that you do.  I try to read other threads and search them using your internal search engine so that I don't take up extra valuable resources/time.

I am male, and this morning I performed oral sex on another male.  I am hiv negative (tested a month ago), and I asked him whether he was hiv negative, he said that he is hiv negative and that he usually has sex with women.  He also performed oral sex on me.  I had one previous encounter with this man before.  The previous time (two months ago) I used a condom.  Both times, I noticed that he had a little red mark on his glans, and he said that he's always had that, some sort of birth mark or something.  I also noticed that he had some scrotal lesion this time.  He said that he shaved his scrotum two days ago.  I have similar scrotal lesions sometimes when I get itchy and scratch myself really hard, the skin of the scrotum puffs up and feels a bit hard and swollen.  His scrotum (more like the base of his penis) felt like this.

He did not ejaculate in my mouth.  Everytime I tasted precum I spat it out on his penis and continued.  At most I had his penis in my mouth for about a minute to two minutes.  I did not suck his testicles, but the scrotal lesion was close to the base of his penis.  I understand that performing oral sex is low risk, but I'm worried about his scrotal lesion.

Dr. Hook in the thread below mentioned that risk is increased with lesions on scrotum.
http://www.medhelp.org/posts/HIV-Prevention/condoms-and-oral-sex/show/1013673

I asked him if he had stds/hiv, he said he did not.  The scrotal lesion looked like the kind when you scratch for a while and the skin puffs up and gets a bit hard.  He said that he shaved down there two days ago, and that might have been from that.  In your opinion, am I at risk, should I get tested?  Thank you so much.  I'm a bit nervous right now, so if I am not clear, let me know and I'll provide more info.

[Edward W Hook, MD]

Welcome to our Forum.  The exposure you describe remains zero risk for HIV.  I think that you may have misunderstood the thread you refer to.  Further the context in that situation ( an open sore) was different than the sort of lesion you refer to. the lesion you are referring to was red an swollen but not open and resembled something that you had seen on this partner before.  As I understand the exposure you describe, I see the presence of his scrotal lesion as not changing your risk for HIV which is, as you know, essentially zero.  EWH

[Edward W Hook, MD]

I will only say NO RISK one last time.  You must realize that we VERY frequently get questions asking if different types of exposures or prevention measures are 100% effective.  The answer to that is that this is scientifically impossible.  For a variety of complex mathematical reasons far too complex to go into here, all one can do with well conducted scientific studies is estimate probabilities.  By definition, any estimate, cannot be 100% certain.  On the other hand, when Dr. Handsfield or I say that something is essentially zero, very close to no risk or of minimal risk, or use any other term to indicate a very small risk, that means "close to zero" in a world where zero cannot be attained.

You need to get a grip on your anxieties.  Decisions about testing are yours and yours alone.  EWH

[nervousbc84]

Thanks again for your reply.  Sorry just one more follow up.  

With respect to the birthmark, should I be concerned at all?  I haven't seen that many penises, mine doesn't have any marks.  Did your "essentially zero" opinion take account of this??

I understand your advice on testing.  I just went through a tough few months where I was tested for something else over a few months and just got cleared by my doctor.  Could you confirm whether my exposure with your "essentially zero" risk opinion even warrant testing???  It would feel a lot better if I knew any test that I might get in the future is solely to ease my mind and not really warranted for hiv given the essentially zero risk.  Many thanks again!

[Edward W Hook, MD]

I understood your explanation. theis lesion does not bring to mind any STD or change my opinion related to HIV risk.

As far as your being nervous about testing, this is a bit silly.  Testing does not give a person HIV but it does give them the power to know what is going on and whether or not they have the infection.  Most tests are negative and if you were so unfortunate as to have HIV, the test would allow you to seek treatment sooner.  There is no reason to fear, delay or avoid HIV testing.  EWH

[nervousbc84]

Hi Dr. Hook,

Thank you for your response.  Perhaps I should clarify a little bit.  There were two things that I noticed about him, the first was a reddish mark on the head of his penis, the size of a small mole, he said it's just a birth mark and that he's always had it.  I noticed this mark the previous time.  Since he said it was a birth mark, I didn't think about it too much.  Should I be worried about this?

The second thing that I noticed (for the first time this morning) was that the upper part of his scrotum, close to the base of his penis, was swollen, a bit hard, and puffy.  The hard/swollen part was the size a bit bigger than a quarter.  I've never seen this on him before, but I've seen it on myself when it's been really hot and sweaty and I get itchy and scratch really hard, which leads to the scrotum swelling up, becoming a bit hard the next day, sometimes weeping a little bit of clear liquid.  His swelling was dry, was not weeping anything, and resembled the swelling that I would have when I scratch.  He attributed this to shaving his scrotum two days before.  I did not lick his scrotum because of this, but I did perform oral sex on him and my lips when performing might have been close to touching the swollen part.  Just to confirm then, this type of swelling/lesion is not of concern with respect to increasing the risk of hiv?

I know you advocate getting tested in order to ease minds, but getting tested makes me even more nervous.  Given the situation that I'm in, would you think testing is necessary?  If it is not, then I'll just defer to your expertise and move on.  Thanks again.