Possible opening on the penis - Risk of BBV ?

[ghart23]

Good evening Doctor
I'm a 23 year old heterosexual male and circumcised. All my life, I've had an area of skin over my penis. It is parallel to the penis with two openings, on top and bottom (like a cylinder). The skin is 0.7cm in length. When I try to turn this skin inside out and explore whats on the under side of this skin, I notice a light yellow/white thick discharge exactly like the discharge of a blackhead. After this discharge is totally expectorated from both openings (top and botton), I notice a mucosal lining with a red appearance due to tiny amounts of blood. I touched it to confirm that it is blood, if only a tiny amount. I'm worried about this is because 16 days ago I received unprotected fellatio from an Asian escort for less than 5 minutes. No symptoms whatsoever until now luckily. I'm aware of all bacterial STDs (by reading your forums) that I have a small risk of. What bothers me most is hepatitis C. My situation is strange in the sense I have this abnormal anatomy described above. I didn't notice any blood during the act, either mine or the escort's but only saliva yet I can't be sure. Am I at risk of any blood borne virus here (hepatitis C, HIV)? I had a HIV/HEP C test done earlier this month which was negative. No other risky activities before this. Please let me know. I'd be extremely grateful if you could shed some of your wisdom here. Many thanks!

[Edward W Hook, MD]

Welcome to the Forum,  I will try to help although it is difficult for me to understand precisely where this extra skin is on your penis.  There are a number of inconsequential variations in the appearance of the urethra which occur in men, perhaps this is one of them.  Many represent variations on the way the urethra is formed during grow prior to birth.  If so and, most likely, even if it is not, there is no reason for concern.  Irrespective of what this may be however and whether or not this is a cutaneous or mucosal abnormality, I am confident that the recent exposure that you mention did not put you at any risk for HIV or hepatitis (B or C).  Irrespective of the presence of anatomic variation and irrespective of the presence or absence of genital lesions, cuts or sores or person to person anatomical variation, there are no instances in which any of these infections have been demonstrated to be acquired as the result of receipt of unprotected oral sex.  I am confident that you will not be the first.

As far as the small amount of blood you noticed, I suspect this is more likely to be a consequence of your examination of the surface than anything else.  Any closed off or covered area of the anatomy, including the penile skin under the foreskin of uncircumcised men, should be cleaned and dried regularly with a mild soap.  

As to precisely what this is or how to best manage it, you may wish to discuss this with a urologist.

I hope these comments are helpful to you. EWH

[Edward W Hook, MD]

This is a new question and not part of your original question.  I will provide a brief answer but new questions should be started as new questions within the guidelines of our site (2 questions in any 6 month period).  Your risk for HSV and HPV with condom protected sex is low but not zero.  For both infections condoms are the most effective protective measures there are and are highly recommended.  For HSV it you have not had symptoms you should not worry and there is no need for testing.  HPV is more complex and I have posted links to several prior explanations of this situation below.

http://www.medhelp.org/posts/STDs/HPV-Transmission/show/1522088

http://www.medhelp.org/posts/STDs/HPV-without-sex/show/1799277

This will now end this thread. There will be no further answers.  If you wish to learn more about these or other STIs, there is excellent, highly informative information available at the web site run by the American Sexual Health Association.  (Disclosure. Dr. Handsfield and I have both been associated with ASHA.  I am the former Chair of their Board of Directors and Dr. Handsfield is currently a member of the ASHA Board of Directors.) EWH

[ghart23]

Hello Dr Hook. I hope you're well. I'm sorry for posting again here. After your earlier reply to my first question above, I was genuinely reassured and felt happy. So the next time I made sure I indulged in safe sex. So 1 week previously I had protected vaginal intercourse with someone who gets checked monthly and said is 'very clean' and does not have HIV. For some reason, I came across an article saying HPV and HSV2 can cause lesions to unprotected parts such as the scrotum and groin. I've only had vaginal intercourse three times in my life which were all protected with no condom splitting. Likewise I received unprotected fellatio three times. Do I have much of a chance of catching HPV or Herpes. I'm getting tested in 2 weeks time for the above mentioned episode. Many thanks doctor

[Edward W Hook, MD]

Thanks for your thanks.  I'm pleased that my comments were helpful to you. EWH

[ghart23]

Morning Dr Hook.

Many many thanks for your advice here. When you said that any anatomical abnormality, blood, sores etc does not change things in this scenario, it really has given me a lot of peace of mind! As you mentioned, no documented case of HIV/HEPC by insertive oral sex so far. All I wanted to know was that I wouldn't be an exception to this conclusion because of the strange anatomy I have. Also, there must have been many people may or may not have had blood, sores etc in all these studies/trials. Anyway, many thanks again. I won't ask any further questions. For reassurance, I will reread your above response. Many thanks again!