Few patients of a sexual health clinic in London had penile wetness, according to a report in the June edition of Sexually Transmitted Diseases. Penile wetness causes inflammation that can leave cells more vulnerable to HIV infection. The findings of this study may suggest that neither penile washing nor circumcision would have a significant impact on HIV transmission in a low prevalence country, such as the UK.
Poor genital hygiene has been associated with the spread of chancroid, a sexually transmitted infection characterised by a painful sore on the genitals. Although, little is known about penile hygiene and other sexually transmitted infections, a recent study conducted in Durban, South Africa, found that penile wetness was independently associated with an increased risk of HIV infection. The Durban study also found that the protective effect of a dry penis against infection with HIV was similar to that of circumcision. In settings where circumcision is not ethically or logistically possible, encouraging penile hygiene could, it has been suggested, enhance HIV prevention efforts.
Penile wetness prevalence in the UK, where approximately 4% of men are circumcised, has not been examined. Investigators at the Ealing Hospital sexual health clinic in West London therefore conducted a study to determine the prevalence of penile wetness amongst men presenting with a new complaint. The investigators recorded whether or not a man was circumcised, obtained demographic data, and conducted a genital examination to determine if penile wetness was present. They also recorded if the man was diagnosed with a sexually transmitted infection.
The investigators defined penile wetness as a level of moisture over the head of the penis and the under the bulbous groove between the head and shaft of the penis. Men with evidence of inflammation of the foreskin or head of the penis (balanitis) were provided with appropriate treatment.
A total of 480 were included in the analysis. Most of these men were white (244), 109 were Asian, 102 were black, and 25 were of other ethnicities. Almost three-quarters of the men (73%) were uncircumcised, and 48 men were gay.
Penile wetness was observed in 6% of men. This included 8% of uncircumcised men and 1% of circumcised men, a statistically significant difference (p = 0.001).
Balanitis was the condition most associated with penile wetness (41%), but 5% of men diagnosed with non-specific urethritis and 5% of men diagnosed with ‘other’ infections were also assessed as having penile wetness.
Heterosexual and homosexual men were equally likely to have penile wetness (both 6%), and although Asian men were the racial group most likely to present with penile wetness (9%), the difference with white men (7%) and black men (3%) was no statistically significant.
“We found a prevalence of penile wetness of 6.3% in this population of routine STI clinic attendees…this prevalence is much lower than that reported from a population of pretreated black STI clinic attendees in Durban, South Africa, where 49% had penile wetness”, write the investigators.
The investigators believe that penile wetness is a marker for poor genital hygiene. Secretions from the prostate, blisters and urethral discharge are thought to be the reasons for the penile wetness observed in the Ealing study.
“The evidence for the protective effect of male circumcision in protecting against HIV in heterosexuals is now compelling”, write the investigators. “One of the mechanisms by which circumcision might reduce HIV transmission is thought to be through improved hygiene,” therefore, suggest the investigators, “improving male genital hygiene could provide some HIV risk reduction benefit in the way that circumcision might.”
But the investigators suggest that circumcision may be a more viable HIV prevention strategy. Circumcision is a one-off procedure (albeit a procedure that can be extremely painful and take weeks to heal if carried out in adulthood), whereas the investigators suggest that “long-term efforts would probably be required to bring about and sustain genital hygiene.”
The investigators believe that further studies of male penile hygiene are warranted in settings with both a low and high HIV prevalence.
O'Farrell N et al. Low prevalence of penile wetness among male sexually transmitted infection clinic attendees. Sexually Transmitted Diseases 33: 408 - 409, 2007.