Help! I got semen in my eye. What do I do?

Maybe things got a little out of hand last night. You didn’t think much of it when it happened—but now you’re worried about that shot you took to the face. You got cum in your eye and are wondering about what chance you have of getting HIV, or another sexually transmitted infection from someone else’s semen. It’s actually a question I’ve gotten from clients before at Magnet, the sexual health clinic of San Francisco AIDS Foundation, so you should know you’re not alone. Here’s what you need to know.

Wash your eyes and face

I’m guessing you already did this. But if not—clean up! Semen—like other things that don’t belong in our eyes—can cause irritation. Flush your eyes with some lukewarm water. Take out your contacts carefully, if you wear them, and don’t put them back in unless your eyes look and feel normal. Make sure you cleanse the contact lenses with disinfecting solution before you put them back in.

Don’t fret about HIV!

The chance you’re going to become infected with HIV from semen is really, really low. Theoretically, it is possible for someone to get infected with HIV through mucous membranes—including their eye. But in reality, it just doesn’t happen.

Since the 1990s, possible HIV transmissions through the ocular membrane have been suspected in several occupational exposures such as lab researchers and nurses. However, there isn’t a single case of a person getting infected with HIV published in a reputable medical journal because they got semen from an HIV-positive person in their eye.

Do you need sexual health services—such as an HIV test, STI testing or treatment? Are you interested in learning more about the HIV-prevention strategy PrEP? Strut provides free sexual health care for gay, bisexual and transgender men who have sex with men in the San Francisco Bay Area. Learn more about Strut.

HIV transmission through the eye – what we know from research

Researchers have tried to estimate the risk of HIV transmission through the eye, and other mucocutaneous pathways (e.g., the skin inside the nose and mouth). It’s difficult, though, because there are so few cases, overall. A few studies have investigated this question by examining instances of documented occupational exposure to HIV (in other words, cases when doctors, nurses, researchers and others have been exposed to HIV-infected fluids at work).

A review article by Evans and colleagues, published in 1999, estimated that the risk of HIV infection through mucocutaneous exposure to be 0.03% (1 in 2910). (In other words, HIV infection that happens through the mucous membranes that line the mouth and nose.) We can interpret their estimate to mean that 99.97% of the time you are exposed to an HIV-infected bodily fluid through a mucous membrane, you won’t become infected with HIV. And, this estimate is based on exposure to blood—not semen—which likely carries an even lower risk for transmission.

Another study, by Henderson and colleagues, estimated that people who are exposed to HIV-infected blood at work, with needle sticks or other routes that go through the skin, have about a 0.3% risk of HIV infection per exposure. Risk associated with mucous membrane exposure, the authors say, “are likely to be substantially smaller.”

There is one documented case of a person who acquired HIV, when working in a hospital laboratory, by accidently getting HIV-infected blood serum in their eye. The case report said that, at the time of the accident, “he felt a droplet spill into his left eye, to which he reacted by blinking rapidly and not washing the eye.” The source of the infection—five weeks after it occurred—was traced back to a patient in the intensive care unit of the hospital, who received month-long care from the hospital following a severe traffic accident. The patient was not on ART, before being admitted to the hospital. Researchers were able to confirm the source of the infection by comparing the genetic sequences of the two different strains of HIV in the hospital staff member and the patient receiving care.

Keep in mind that risk for HIV infection through the eye is even lower (close to zero!) if the person who is HIV-positive is on treatment. We know from large clinical trials that people living with HIV who maintain an undetectable viral load are not likely to pass on an HIV infection to anyone else.

What about chlamydia and gonorrhea?

It is possible to get a chlamydia or gonorrhea infection in the eye (called ocular chlamydia or ocular gonorrhea). Again, this is probably not very likely after getting a partner’s semen in your eye. But, it is theoretically possible.

Ocular chlamydia or gonorrhea can stem from a genital infection—from either yourself or a sex partner. That means, if a sex partner has a chlamydia infection in their urethra (the tube of their penis), and they touch their penis and then touch their eye—they may transmit the chlamydia bacteria to your eye. Or, if you have a gonorrhea infection in your urethra—and touch your penis and then touch your eyes—you could spread the gonorrhea infection to your eyes. Most data on the prevalence of ocular chlamydia comes from neonatal cases of maternal transmission (when a mother transmits chlamydia to her baby when the baby is born). The CDC does not report data on the prevalence of adult ocular chlamydial infections—likely because it is uncommon.

Theoretically, semen with chlamydia bacteria in it could cause a chlamydia eye infection, or semen with gonorrhea bacteria could cause a gonorrhea eye infection.

Before you zero in the symptoms to look for, it is important not to panic. A case of “pink eye” (viral, bacterial or allergic conjunctivitis) is far more common and can share similar symptoms. If you are concerned, here’s what to look out for.

Symptoms and treatment of ocular gonorrhea

Although it is very rare, an eye infection of gonorrhea is considered a medical emergency, because it can cause vision loss. Symptoms of ocular gonorrhea can include eye redness, discharge, and inflammation. If it’s not treated right away, it can cause vision loss if it’s not treated, so it’s important to ask your doctor or health care provider if you do get symptoms. Treatment consists of eye drops in addition to oral and/or IV antibiotics, and it may require hospitalization.

Symptoms and treatment of ocular chlamydia

Symptoms of ocular chlamydia include mucous discharge from the eye, eyelid swelling, eye irritation, feeling like you have something stuck in your eye, or eye redness. Keep in mind these are the same symptoms you might get if you get semen in your eye (regardless of whether there’s chlamydia bacteria in the semen). Ocular chlamydia can be treated with antibiotics.

The take-away

Talk to your healthcare provider if you’re still worried, or you have any eye irritation occurring or persisting for several days after the “big event.” And remember, it’s a great idea to keep your HIV testing on a regular schedule (every three months) if you’re HIV-negative, and keep your treatment on track (i.e., take your medications every day) if you’re living with HIV.

If you’re not interested in wearing safety goggles during sex, and want to protect yourself and your health—you might want to consider PrEP (pre-exposure prophylaxis) for an additional layer of protection from HIV.

Sources

Abelson, M and Leung, S. The many faces of chlamydial infection. Review of Opthalmology, 2008.

Aboulafia, D. M. Occupational exposure to human immunodeficiency virus: What healthcare providers should know. Cancer Practice, 1998.

CDC. Frequently Asked Questions – Bloodborne Pathogens – Occupational Exposure.

Eberle, J. and others. HIV-1 infection transmitted by serum droplets into the eye: A case report. AIDS, 2000.

Evans, B. G. and Abiteboul, D. A summary of occupationally acquired HIV infections described in published reports to December 1997. Eurosurveillance, 1999.

Henderson, D. K. and others. Risk for occupational transmission of human immunodeficiency virus type 1 (HIV-1) associated with clinical exposures: A prospective evaluation. Annals of Internal Medicine, 1990.

Ippolito, G. and others. The risk of occupational human immunodeficiency virus infection in health care workers. Italian Multicenter Study. The Italian Study Group on Occupational Risk of HIV infection. Arch Intern Med, 1993.

Kumar, P. Gonorrhoea presenting as red eye: Rare case. Indian J Sex Transm Dis, 2012.

Medscape. Ophthalmologic manifestations of chlamydia. 2008.

Romea, S. and others. Risk for occupational transmission of HIV infection among health care workers. European Journal of Epidemiology, 1995.

Saltzman, D. and others. The surgeon and AIDS: Twenty years later. JAMA, 2005.