Hypospadias and its effect on exposure risk

[sir_oz_alot]

G’day Doctor,

Let me congratulate you on this wonderful forum. Not only is this great resource for information, I imagine it also provides people with the reassurance they can take to the bank …accept for the paranoids who need not go to the bank, but to the Doctor for testing.

The way I guess my ‘similar questions’ differ to everyone else’s is that the issue of Hypospadias is at hand, and I have not seen a similar post.

I had the corrective surgery at the usual age (for those of you reading this I will let the Doctor describe this condition if he wishes, but this is a common thing with baby boys (probably 1 in every 200) I would say.

With this in mind (and keeping in mind I have a slightly larger than normal urethral opening and some scar tissue around where I was circumcised (for the surgery), please assess my risk

Brief history: I am an Australian 25 year old heterosexual male (non injecting drug user) living in Sydney. A few weeks ago my new GF and I are considering commencing unprotected intercourse. So these questions are to reassure against HIV based on that I guess.

1. In the past year, I have had about 10 protected vaginal sexual encounters. 8 were escorts (Australian sex workers) and 2 were one night stands with random females. Oral sex was involved sporadically with or without protection.

Is it reasonable to assume I do not need testing for any of these encounters as it was either protected sex? Or oral, which is close to zero either way?

2. In the same year there were 2 questionable encounters. The first was with an Australian brothel worker, in which the condom broke whilst I was inserting so there was probably about 20 seconds of total exposure before I withdrew and changed the condom.  What is the risk here? Would I need testing?  ..one thing to mention here is that I did come down with a bad cough/infection 2 weeks later however I guess the fever and sore throat could be attributed to this and it was just coincidence? The fever and throat only lasted a day.

The second was another one night stand with a lovely but drunk 28 year old female Sydneysider, in which we just simply did not use a condom for vaginal sex at all for about 10 minutes without finishing. I rang her the next day and she said I had nothing to worry about as she recently had her ‘women check” and everything was OK…she used the term “I am clean” ...but who knows?

The thing which worries me about her is she was not at all concerned about asking ME about my HIV status. You would think she would want to know at least?



Please assess my risk; keeping the corrective surgery in mind (my thinking is that if I have a larger opening, meaning larger surface area and scar tissue which may be an easier route through… I would be at more risk?

The point of this is that I believe my risks are low and I could take it to the bank that I can commence steady unprotected sex with my now GF, this is just to have a second (more valued opinion : )

[H. Hunter Handsfield, M.D.]

Hypospadias might slightly increase the risk of some STDs, such as gonorrhea or chlamydia.  This has never been studied, but if there is an effect, it probably is minor.  Hypospadias almost certainly increases the risk of other (non-STD) infections, including non-sexually acquired urethritis due to vaginal, oral, or anal bacteria.  The symptoms may mimic STDs.  To the extent that any inflammation increases the risk of HIV in an exposed person, I imagine that people with hypospadias-related infections might be at somewhat increased risk for HIV.  This also has not been studied, but if there is such an effect, it  surely is too small to worry about.  Select your partners with care and use condoms consistently, then don't worry about HIV.

I cannot predict the likelihood that one or more of your partners was at HIV, regardless of whether the last one didn't ask you about your HIV status.

Although your overall HIV risk is low, anybody with your sort of sexual lifestyle should have routine STD and HIV tests from time to time, such as once a year.  Since you probably haven't been tested in a while and are about to start a new (committed?) relationship, this would be an excellent time for you to visit a sexual health centre.  Collectively, Australia's SHCs probably are the world's best STD clinic system.  (If you go to the Adelaide, Melbourne, or Sydney SHC, give them my personal greetings.)

Best wishes---   HHH, MD

[sir_oz_alot]

Hi there again,

Thanks for the info, I hope it was informative to other males who may have had this procedure.


Q: I had the 6 week test in March of this year which was negative. Would I still need a test before I start this relationship though?

I am planning to have another one in March eitherway of next year, if you don't advise testing before I start unprotected, and yes, monogamous intercourse with my new partner.

By the way,  When I go I will be visiting the SHC at the Royal North Shore Hospital if that rings a bell.

[H. Hunter Handsfield, M.D.]

A negative HIV test result 6 weeks after possible exposure, especially a low risk exposure like yours, is completely reliable.

I'm not familiar with that hospital.  Sorry!

[sir_oz_alot]

Hi Doc,

I should have been more succinct with my follow up question. \

The 6 week test in March ‘06 was a routine test. Most of the protected exposures and the two questionable ones happened well after that test, the one night stand (unprotected) being 3 weeks ago.

So based on that, would I still need a test before I start this relationship?

… if I’m a lucky chap it will begin this weekend I would imagine!  

…or would I need testing before my usual March annual?
I guess this is more like one of those “…this is what I have done, is it safe to resume sex with my wife…” type questions you seem to get.

Sorry about the confusion!

[H. Hunter Handsfield, M.D.]

Sorry I misunderstood, but I don't have more to add at this point.  In view of your sexual lifestyle, I see no reason for HIV testing more than once a year, regardless of specific exposures (unless you learn for sure that a partner had HIV).  But if you will sleep better having another negative result, it's fine with me to be retested 6 weeks after your last exposure.

[sir_oz_alot]

Many thanks