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Menstrual Blood Question
Dear Doctors,
Here are the facts.
This morning, I met with a CSW in the Louisville, Kentucky area. She was 23 years old and bi-racial. We had unprotected cunnilingus and fellatio and protected vaginal intercourse. I also penetrated her with my fingers for several minutes prior to vaginal intercourse.
The protected vaginal intercourse lasted approximately 10 minutes. When I withdrew my penis from her I noticed that there was blood all over the condom. It was somewhat dark, so I went into the bathroom to carefully remove the condom. At that point I noticed there was a very large amount of blood all over my pubic region. Clearly, she had started menstruating. What perplexes me is the fact that there was also blood INSIDE the condom (mostly at the base, but also up where the condom covers the shaft and some near the head).
About halfway through the vaginal intercourse the condom slid down my penis. I moved it back to the base, but I'm wondering if some of the blood may have worked its way into the condom. I removed the condom but I was quite panicked at the amount of blood. I can't be certain if any got into my urethra or if I may have rubbed some of the blood onto the tip of my penis when I was examining myself. There was clearly blood smeared all over my penis though.
She was embarrassed by the incident. She stated that she is negative and that she tests frequently. For what it's worth she seemed quite educated and was a somewhat "high class" escort.
All of this said, I have a few questions:
1) If she was HIV + would these circumstances put me at a high risk for transmission?
2) Should I seek PEP, given that blood was involved (a large amount of blood!)
3) If you were in my shoes would you be worried, and do you see a need for testing from a medical standpoint?
I searched the forum for other similar experiences, but couldn't find any instances where blood actually made its way into the condom. Thank you for your help -
Here are the facts.
This morning, I met with a CSW in the Louisville, Kentucky area. She was 23 years old and bi-racial. We had unprotected cunnilingus and fellatio and protected vaginal intercourse. I also penetrated her with my fingers for several minutes prior to vaginal intercourse.
The protected vaginal intercourse lasted approximately 10 minutes. When I withdrew my penis from her I noticed that there was blood all over the condom. It was somewhat dark, so I went into the bathroom to carefully remove the condom. At that point I noticed there was a very large amount of blood all over my pubic region. Clearly, she had started menstruating. What perplexes me is the fact that there was also blood INSIDE the condom (mostly at the base, but also up where the condom covers the shaft and some near the head).
About halfway through the vaginal intercourse the condom slid down my penis. I moved it back to the base, but I'm wondering if some of the blood may have worked its way into the condom. I removed the condom but I was quite panicked at the amount of blood. I can't be certain if any got into my urethra or if I may have rubbed some of the blood onto the tip of my penis when I was examining myself. There was clearly blood smeared all over my penis though.
She was embarrassed by the incident. She stated that she is negative and that she tests frequently. For what it's worth she seemed quite educated and was a somewhat "high class" escort.
All of this said, I have a few questions:
1) If she was HIV + would these circumstances put me at a high risk for transmission?
2) Should I seek PEP, given that blood was involved (a large amount of blood!)
3) If you were in my shoes would you be worried, and do you see a need for testing from a medical standpoint?
I searched the forum for other similar experiences, but couldn't find any instances where blood actually made its way into the condom. Thank you for your help -
Hi Dr. HHH,
Thanks very much for your initial reply. I took an OraQuick test today and the results were Negative at 32 days post "incident". Would you test again at 3 months or move on? Thanks so much -
Thanks very much for your initial reply. I took an OraQuick test today and the results were Negative at 32 days post "incident". Would you test again at 3 months or move on? Thanks so much -
MEDICAL PROFESSIONAL
That result should be highly reassuring and confirms you were not infected. However, you were tested a bit early for 100% reliable results, which come at 6-8 weeks for antibody tests like Oraquick. But don't necessarily need to wait as long as 3 months for a definitive result see the thread linked below:
http://www.medhelp.org/posts/show/1704700
http://www.medhelp.org/posts/show/1704700
MEDICAL PROFESSIONAL
Welcome to the forum. Thanks for your question.
I wouldn't be worried about HIV. First, it is statistically unlikely your partner had HIV. The risk tends to be especially low in higher class CSWs, and most people don't lie about HIV status when asked directly. Second, even with entirely unprotected sex, menstruation raises the transmission risk modestly if at all, compared with exposure to vaginal fluids without blood.
Third, as you have experienced, genital secretions probably work their way under a condom qutie frequently; the blood made it more noticeable, but this sort of thing probably is common. Undoubtedly this is part of the reason that condoms are less effective protection against STDs transmitted by skin to skin contact (e.g., herpes, HPV) than those that require urethral exposure (gonorrhea, chlamydia, etc). Protection against HIV is considered complete as long as the head of the penis and urethral opening are covered.
To your specific questions:
1) She probably doesn't have HIV, but even if she does, the transmission risk is virtually zero from the exposure described.
2) I would not recommend PEP, and we would not prescribe it in these circumstances in my STD clinic. However, local standards vary; you could check with the Louisville or KY public health departments for their recommendations. But I imagine they would agree with me on this.
3) If I were in your circumstances, I certainly would not take PEP, and I would not feel a need for HIV testing -- and I would continue unprotected sex with my wife without fear of putting her at risk.
Nevertheless, I recommend you be tested for reassurance purposes. You wouldn't be on the forum if you weren't worried, and negative testing is likely to be important in resolving your anxiety about it (in addition to this advice). But try to stay mellow in the meantime. In the 8+ years of this forum, nobody actually caught HIV from an exposure they asked about -- and with a low risk exposure like this one, you aren't going to be the first!
I hope this has helped. Best wishes-- HHH, MD
I wouldn't be worried about HIV. First, it is statistically unlikely your partner had HIV. The risk tends to be especially low in higher class CSWs, and most people don't lie about HIV status when asked directly. Second, even with entirely unprotected sex, menstruation raises the transmission risk modestly if at all, compared with exposure to vaginal fluids without blood.
Third, as you have experienced, genital secretions probably work their way under a condom qutie frequently; the blood made it more noticeable, but this sort of thing probably is common. Undoubtedly this is part of the reason that condoms are less effective protection against STDs transmitted by skin to skin contact (e.g., herpes, HPV) than those that require urethral exposure (gonorrhea, chlamydia, etc). Protection against HIV is considered complete as long as the head of the penis and urethral opening are covered.
To your specific questions:
1) She probably doesn't have HIV, but even if she does, the transmission risk is virtually zero from the exposure described.
2) I would not recommend PEP, and we would not prescribe it in these circumstances in my STD clinic. However, local standards vary; you could check with the Louisville or KY public health departments for their recommendations. But I imagine they would agree with me on this.
3) If I were in your circumstances, I certainly would not take PEP, and I would not feel a need for HIV testing -- and I would continue unprotected sex with my wife without fear of putting her at risk.
Nevertheless, I recommend you be tested for reassurance purposes. You wouldn't be on the forum if you weren't worried, and negative testing is likely to be important in resolving your anxiety about it (in addition to this advice). But try to stay mellow in the meantime. In the 8+ years of this forum, nobody actually caught HIV from an exposure they asked about -- and with a low risk exposure like this one, you aren't going to be the first!
I hope this has helped. Best wishes-- HHH, MD
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