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19 September 2005
Ouch! Penis Wounds Need Speedy Attention
by George Atkinson

The current issue of the Dermatology Online Journal carries a sobering article about the treatment of bites to the penis. Penis injuries from biting are rarely reported and documented due to embarrassment, but the article provides a timely reminder that any wound to the penis is best treated as quickly as possible or serious complications can follow.

The article also looks in detail at the case of an elderly man who suffered lacerations to his penis after receiving oral sex from a prostitute. As it turns out, the lacerations were caused by dental braces scraping the glans of his penis. But the minor lacerations were only the beginning. After two days, the lacerations had turned into an extremely painful ulcer, covered with necrotic flesh. Laboratory analysis found that the wound had been colonized by aggressive bacteria that usually reside in the human mouth and throat.

Luckily for the patient, tests for HIV, syphilis and herpes all came back negative and after a course of intravenous and oral antibiotics, the man was back to health, despite some residual scarring on his penis.

The author of the article, Ted Rosen, MD, said bites involving the genitalia are particularly problematic because of the ease of debilitating physical damage to delicate tissue and because of the potentially destructive infection with oral bacteria. With or without infection, the wounds can result in serious physical damage to the glans, urethra, and internal structures of the shaft, leading to disfigurement and sexual dysfunction.

More worrying is the possibility of the transmission of infectious diseases, such as HIV, especially when the person inflicting the bite is a high-risk individual, such as a prostitute or intravenous drug user. Although infection via a genital bite has not yet been conclusively proven for many diseases, transmission of syphilis via a bite to the genitalia has been documented and transmission of HIV is considered biologically possible via a bite wound.

One of the problems facing physicians treating penile bite wounds is often the delay before the patient plucks up the courage to get treatment. Embarrassment often means the wound becomes more serious than it would be if treated quickly. "Prompt treatment of a human genital bite avoids complications," said Rosen. Adding that 42 different bacteria have been found in normal human saliva, and 192 types found in the mouth of a person with gingivitis or periodontitis.

In the case of the man who had the unfortunate encounter with the prostitute's braces, the wound became infected with the Eikenella corrodens bacterium. This particular organism - usually found in the mucous membranes of the mouth, respiratory tract and gastrointestinal tract - causes exceptionally painful and rapidly spreading necrotic lesions. As well as the local infection, it is also associated with abscesses of the abdominal cavity, head, and neck, meningitis, endocarditis and osteomyelitis.

While it is in the patient's own interests to seek help quickly, Rosen also underscored the importance of the physician understanding the circumstances behind the wound, and ascertaining the likelihood of infectious disease transmission.

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