Human Immunodeficiency Virus, or HIV, is a virus that targets the body’s immune system. It attacks CD4 cells, a type of T cell that helps the body combat infections. Over time, HIV reduces the number of these cells, which weakens the immune system’s ability to fight off diseases and certain cancers. If left untreated, this can lead to Acquired Immunodeficiency Syndrome (AIDS), the most advanced stage of HIV infection, which is diagnosed when the CD4 cell count drops to a very low level.
Penile Symptoms Associated with HIV
HIV itself does not produce symptoms that are exclusively located on the penis. Instead, signs in the genital area result from the virus’s broader effect on the body. During the initial, acute stage of infection, which can occur two to four weeks after exposure, some individuals may develop a widespread rash. This rash can manifest anywhere, including on the shaft or glans of the penis.
More common penile signs are not from HIV directly but from other infections that take advantage of a compromised immune system. An immune system weakened by untreated HIV has a harder time controlling pathogens, so sores or ulcers on the penis may be caused by opportunistic infections. These can include more severe outbreaks of genital herpes or chancres from syphilis. While these sores are caused by separate sexually transmitted infections (STIs), their persistence or severity can indicate an underlying immune deficiency.
HIV Transmission and the Penis
The penis can be involved in both the transmission and acquisition of HIV during sexual activity. The virus is present in bodily fluids such as semen and pre-ejaculate of a person with a detectable viral load. When a person with HIV ejaculates, the virus can be passed to a partner if these fluids come into contact with mucous membranes or breaks in the skin.
HIV can also be acquired through the penis. The urethra, the tube that runs through the penis, is lined with a mucous membrane that is susceptible to viral entry. Small cuts, abrasions, or open sores on the penis provide another direct route for the virus to enter the bloodstream from a partner’s infectious fluids.
The risk of transmission varies with different sexual acts. Unprotected receptive anal sex carries the highest risk for HIV acquisition because the lining of the rectum is thin and prone to tearing. While the risk is lower, HIV can also be transmitted to the penis during unprotected insertive vaginal or anal sex. The presence of a foreskin may slightly increase the risk of acquiring HIV, as the area underneath can trap fluids and has a higher concentration of immune cells that HIV targets.
Distinguishing from Other Conditions
Many penile symptoms are not related to HIV and can be caused by other common conditions. Other STIs often present with more distinct penile manifestations, such as:
- Genital herpes, which appears as painful blisters or ulcers.
- Syphilis, which often begins with a single, painless, firm, and round sore called a chancre.
- Human Papillomavirus (HPV), which can cause genital warts that may be flat, raised, or have a cauliflower-like appearance.
- Fungal infections, which can lead to a red rash and itching on the penis, particularly under the foreskin.
Because these and other conditions can cause symptoms on the penis, self-diagnosis is unreliable. The only way to determine the cause of any genital lesion or rash is through a professional medical evaluation. A healthcare provider can perform the necessary tests to identify the specific pathogen and recommend the correct treatment.
Prevention and Next Steps
If you have concerns about HIV, getting tested is the only definitive way to know your HIV status. Modern tests are highly accurate, and a healthcare provider can advise on the appropriate timing for testing.
Using condoms consistently and correctly during sexual activity is a highly effective method for preventing the transmission of HIV and other STIs. Condoms act as a barrier, preventing the exchange of bodily fluids that can carry the virus. For individuals at higher risk of exposure, Pre-Exposure Prophylaxis (PrEP) is a medication that can be taken daily to significantly reduce the chance of acquiring HIV.
For people living with HIV, a major advance in prevention is the concept of Undetectable = Untransmittable (U=U). This means that by taking antiretroviral therapy (ART) daily as prescribed, the amount of HIV in the blood can be reduced to an undetectable level. A person with an undetectable viral load cannot transmit the virus to their sexual partners.