The human immunodeficiency virus (HIV) targets and weakens the body’s immune system. This article covers how HIV can impact the genital area, including manifestations, transmission, prevention, and testing.
How HIV Can Affect the Genital Area
Initial HIV infection can cause a flu-like illness, acute retroviral syndrome, in 40% to 90% of individuals within weeks after exposure. This phase may include a rash anywhere on the body, including the genital area. These rashes often appear as flat, red or purple patches with small bumps, and may be itchy or painful.
HIV can also increase susceptibility to other sexually transmitted infections (STIs) that cause genital lesions. Conditions like herpes simplex virus, syphilis, and human papillomavirus (HPV), which leads to genital warts, can manifest more severely or atypically in individuals with a weakened immune system. For example, STIs causing genital ulcers, such as syphilis or herpes, can create openings in the skin or mucous membranes, potentially increasing the risk of HIV entry.
Less common direct manifestations of HIV itself on the genitals can also occur. Molluscum contagiosum, a viral skin infection, can cause numerous pink or flesh-colored bumps, sometimes exceeding 100 lesions, particularly in individuals with advanced immunosuppression. Fungal infections and certain rashes, like eosinophilic folliculitis or severe psoriasis, may also be more prevalent or pronounced in people living with HIV. Many people with HIV, especially in early stages, may not have any symptoms, and genital symptoms are not exclusive to HIV, requiring medical evaluation for an accurate diagnosis.
Transmission Pathways
HIV is transmitted primarily through direct contact with specific bodily fluids from a person who has a detectable viral load. These fluids include blood, semen, pre-seminal fluid, rectal fluids, vaginal fluids, and breast milk. For transmission to occur, these fluids must enter the bloodstream of an HIV-negative person, typically through mucous membranes in the rectum, vagina, mouth, or tip of the penis, or through open cuts or sores.
Sexual transmission, particularly through anal and vaginal sex, is the most common route. During anal sex, the delicate mucous membranes of the rectum are highly susceptible to HIV entry. Vaginal sex also carries a risk, as the virus in vaginal secretions can enter through the skin of the penis or the vagina. Oral sex carries a very low risk, though it is possible if oral ulcers, bleeding gums, or genital sores are present.
Sharing needles, syringes, or other drug injection equipment is another significant transmission route. These items can contain residual blood from an infected person, directly introducing the virus into another individual’s bloodstream. HIV is not transmitted through casual contact, such as kissing without open sores, hugging, shaking hands, sharing toilets, food, or utensils. The virus does not survive long outside the human body and cannot be transmitted through air, water, or insect bites.
Preventing Transmission
Effective strategies prevent HIV transmission, especially during sexual activity. Consistent and correct use of condoms, both external and internal, creates a physical barrier preventing bodily fluid exchange. Using water- or silicone-based lubricants with condoms helps prevent breakage.
Pre-Exposure Prophylaxis (PrEP) is a medication for HIV-negative individuals at risk. Taken as prescribed, PrEP reduces sexually acquired HIV infection risk by about 99% by blocking viral replication if exposure occurs. Treatment as Prevention (TasP) is another strategy: people with HIV who adhere to antiretroviral treatment achieve and maintain an undetectable viral load. An undetectable viral load means the virus in their blood is immeasurable, and they cannot sexually transmit HIV.
Regular STI testing and prompt treatment are important for HIV prevention. Other STIs can increase HIV acquisition and transmission risk by causing inflammation or open sores in the genital area. Harm reduction strategies for injection drug use, such as sterile needles and syringes, significantly reduce HIV transmission among people who inject drugs.
Testing and Diagnosis
HIV testing is the only way to determine one’s HIV status; early diagnosis benefits effective treatment and management. Different HIV tests exist, each with a “window period”—the time between exposure and when the test can accurately detect the virus. Nucleic acid tests (NATs) are the earliest detectors, identifying HIV infection 10 to 33 days after exposure.
Antigen/antibody tests, often from a vein, detect HIV infection 18 to 45 days after exposure. Rapid antigen/antibody tests using a finger prick may take longer, from 18 to 90 days. Antibody tests, common for rapid tests and self-tests, detect HIV 23 to 90 days after exposure. If a test is negative during the window period, retesting after this period is recommended to confirm the result.
HIV testing services are widely available. Individuals can access testing through healthcare providers, community health clinics, sexual health clinics, and local health departments. Home test kits are also available at pharmacies or online, providing a convenient, private option for initial screening. Knowing one’s HIV status allows timely access to care, leading to a long and healthy life.