By Hilary Bainemigisha

WASHING the penis immediately after sex does not protect a man from infection with HIV, Dr Fredrick Makumbi discovered. It actually puts you at a greater risk.

From a study he conducted in Rakai district, the PhD researcher from Makerere University Institute of Public Health said men who washed using soap, or a few minutes after intercourse, actually had the highest risk of infection with HIV.

These results surprised even the study team because most literature available calls for genital hygiene as one other way to prevent sexually transmitted infections.

Makumbi, who presented the study findings at the Fourth International AIDS Society Conference in Sydney, Australia last month, concluded that cleaning the penis after sex should not be taken as an alternative to circumcision.

Proponents of sexual hygiene as an HIV preventing method have been suggesting such methods as gargling, douching, soap and washing after sex and employing vinegar, lime, lemon or other mild disinfectants that kill HIV to complement condom use in preventing HIV infection.

Dr Toby Marotta, in his book, AIDS-Preventing Sexual Hygiene, summed it up as basic cleanliness.
Basing his findings on laboratory research which showed that soap and water kill HIV, the book advises that should you have unprotected sex or should the condom break or leak, douching with a solution of vinegar and water would lessen risk by reducing the amount of HIV left on penetrable skin-linings and susceptible cells.

“Using soap and water, vinegar, or some other mild disinfectant to wash a penis after intercourse can help keep HIV from reaching blood through any warts, sores, or skin breaks on it,” the book says.
In South Africa, the former vice-President, Jacob Zuma, said he rushed to the bathroom and washed his penis after having sex with a woman living with HIV.

His statement, while defending himself during a trial on the alleged rape, caused international uproar about HIV ignorance in some leaders.

But when Makumbi tested the recommendation in a trial, funded by the National Institute of Health, on 2,552 uncircumcised men in Rakai, he found that not only did washing the penis within three minutes of unprotected sex offer no protection to uncircumcised men, it also exposed them to a higher risk of infection.

Infection was higher in people who washed sooner after sex than in men who waited for at least 10 minutes after sex before cleaning. “Waiting 10 minutes before cleaning decreased the HIV incidence to less than 20% of that among men who washed right away”, the research noted.

“We found that consistent washing was not associated with a reduction in HIV incidence,” Makumbi said at the International AIDS Society Congress.
“In fact, the risk of catching the virus seemed to be higher in those men who used more water when washing”, he said.

Makumbi speculated that this could be because washing with soap and failure to dry resulted in wetness, increasing the chance of cells becoming inflamed and thus more vulnerable to infection with HIV. Makumbi also suggested that washing soon after sex could remove enzymes in vaginal fluid that help neutralise HIV.

“It appears that the use of water and immediate cleansing may facilitate viral survival and positive infection,” Makumbi said. “But this is just a possibility, we don’t really know.

But for now, circumcision and not hygiene, should be our HIV preventive priority.”

Makumbi’s findings resulted in such interest from the delegates at the Sydney conference that it was suggested that a larger sample size and longitudinal trial be done to confirm these findings.

The session moderator, Dr David Serwadda, added that the circumcision message should be carefully packaged not to generate false confidence that may undo some of the gains that have been attained with health education, condom use, abstinence and other preventive measures.

US epidemiologist Prof. Robert Bailey, a world authority on circumcision, added: “It would be nice if we found that better hygiene could help prevent HIV, but even then, the means of actually practising better hygiene are not practically available to people in the third world.”

A previous major study in circumcised men found that bathing could help lower HIV risk, but these men were circumcised so their risk was already lower.