Phimosis and STD Risks: Your Questions Answered - Urology

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Phimosis, excessive pre-ejaculatory fluid, oral sex without a condom for one minute followed by wiping with a wet tissue, risk of HIV?


Hello, Doctor.
I have phimosis, and after retracting the foreskin, about one-fifth of the glans is exposed.
I previously asked about the issue of unprotected oral sex for about a minute followed by wiping with a wet tissue, but I realized I forgot to add some details.
Here is my previous question: "The second time I had intercourse with a sex worker was on April 7th of this year (last Saturday).
During oral sex, there was unprotected contact for less than a minute, after which I immediately wiped clean with a wet tissue (the state of my foreskin only exposed a little bit of the glans, approximately one-seventh to one-sixth of the glans).
I then immediately used a condom for oral sex, followed by condom-protected vaginal intercourse.
During this time, there was kissing (only lip-to-lip contact), and finally, after the partner helped me with manual stimulation while wearing a condom, I ejaculated." Before the oral sex, I had a significant amount of bulbourethral gland secretion (it was more than usual, forming a small transparent colorless ball; I compared it with pictures and believe it was bulbourethral gland fluid).
I read on Wikipedia that "studies have shown that the human immunodeficiency virus (HIV) is present in the bulbourethral gland secretions of most infected individuals, and infection with HIV can lead to acquired immunodeficiency syndrome (AIDS)."
1.
Is this true?
2.
Does this mean that having more secretion increases the risk of sexually transmitted infections (STIs) or HIV?
3.
Recently, I have been worried about STIs and have been retracting my foreskin to the coronal sulcus (I have phimosis, so it is somewhat difficult to retract, and I can say it is forcibly retracted).
For the past two days, I have felt discomfort and slight itching when wearing underwear, possibly due to the seams of the underwear.
Could this be caused by the hot weather and wearing tight pants for too long (at least six hours), or is it due to my anxiety about STIs making me overly sensitive? Or could it be related to using a small amount of soap while washing my genitals and groin recently? When referring to genital itching, does it mean feeling itchy when not wearing underwear?
4.
After the second sexual encounter with the sex worker, I felt very regretful and worried about contracting STIs, which caused me to be anxious and unable to sleep well.
For the next two to three days, I experienced loss of appetite, poor sleep, weakness in my limbs, swelling and pain in my right calf, and trembling fingertips when my palms were flat.
However, after reading an article from the Red Ribbon Foundation, I thought, "If I really contracted something, I would have to accept it; life must go on, and the testing date is not yet due, so there is no need to worry too much." This thought eased my mind significantly, and the weakness in my limbs, swelling and pain in my right calf, trembling fingertips, sleep issues, and loss of appetite improved a lot.
Doctor, is this anxiety about contracting STIs causing my symptoms, or could they be early symptoms of certain STIs or HIV (though I think the incubation period hasn't passed yet, so it shouldn't be)? I apologize for asking so many questions, but I would appreciate your responses to each one, as I am really worried.

Yu, 10~19 year old female. Ask Date: 2018/04/15

Dr. Du Shixi reply Urology


Hello: 1) It should be correct.
2) There is no such thing; it is unsafe sexual behavior.
3) There is an itching sensation; whether or not wearing clothing, there will be an itching sensation.
Keep clean and dry, and prefer loose-fitting underwear.
4) Both HIV and syphilis are difficult to diagnose; the symptoms are not very typical and may sometimes resemble those of other diseases.
Therefore, blood tests are necessary for diagnosis.
It is recommended to have a sexually transmitted infection (STI) screening every three months.
Wishing you good health.

Reply Date: 2018/04/15

More Info


Understanding phimosis and the associated risks of sexually transmitted diseases (STDs) is crucial for maintaining sexual health. Phimosis, a condition where the foreskin cannot be easily retracted over the glans (the head of the penis), can lead to various complications, including increased risk of infections and STDs.
1. HIV and Urethral Bulbourethral Gland Secretions: It is true that studies have shown the presence of the Human Immunodeficiency Virus (HIV) in the secretions of the bulbourethral glands (also known as Cowper's glands). These glands produce a pre-ejaculatory fluid that can contain the virus if the individual is infected. This means that engaging in sexual activities, even without penetration, can pose a risk of transmission if bodily fluids are exchanged.
2. Increased Risk of STDs: The presence of more pre-ejaculatory fluid does not necessarily increase the likelihood of contracting an STD or HIV, but it does indicate that there is a higher volume of potentially infectious fluid. The risk of transmission is influenced by various factors, including the viral load of the infected partner, the type of sexual activity, and the presence of any cuts or abrasions on the skin. Therefore, while more fluid may suggest a higher risk, it is not a direct correlation.

3. Discomfort and Sensitivity: The discomfort you are experiencing after attempting to retract the foreskin could be due to several factors. It might be a result of irritation from tight clothing, excessive friction, or even anxiety about potential infections. Anxiety can manifest physically, leading to heightened sensitivity and discomfort. Additionally, using soap in sensitive areas can cause irritation, especially if not rinsed thoroughly. If the itching persists, it may be worth consulting a healthcare provider to rule out any infections or skin conditions.

4. Anxiety and Physical Symptoms: The symptoms you describe—poor appetite, sleep disturbances, fatigue, and localized pain—can indeed be linked to anxiety and stress. The fear of contracting an STD can lead to psychosomatic symptoms, where anxiety manifests as physical discomfort. While it is essential to be vigilant about potential infections, it is equally important to manage anxiety. If these symptoms improve with a more relaxed mindset, it suggests that anxiety may have played a significant role.

In conclusion, while phimosis can complicate sexual health and increase the risk of infections, understanding the nature of these risks and managing anxiety is crucial. It is advisable to seek medical advice for both the physical discomfort related to phimosis and for STD testing, especially if there are concerns about exposure. Regular check-ups and open communication with healthcare providers can help alleviate fears and ensure better sexual health management.

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