[Question #12618] Blood on condom during sex

6 months ago

Hello,

I’d appreciate a professional opinion on my recent exposure and whether PEP is warranted in my case. Here’s the situation:

• I had protected vaginal intercourse with a female partner (escort in Dubai).

• She was riding me, and during the act, she started bleeding (she mentioned her period had just ended, and she believed my size caused the bleeding).

• When she pulled off, the condom remained entirely inside her—it did not break.

• I noticed some blood on my lower pelvic area (above the penis) and possibly on the base of my penis (the area not fully covered by the condom).

• No known open wounds or sores on my penis at the time.

• She later provided me with an STD PCR test panel, showing she was negative for chlamydia, gonorrhea, syphilis, herpes (HSV1 & HSV2), mycoplasma, ureaplasma, and other common STIs.

• However, her test did not include HIV—I’m unsure if she has tested for that separately.

6 months ago

I should correct that the condom remained intact, not inside her. There was exposure to blood on the pelvic area and the lower part of the penis where the condom didn't cover it. She tested for HIV over a year ago when she was granted residency. I asked her to test for it and said maybe next week.

H. Hunter Handsfield, MD

6 months ago

Welcome back to the forum. In preparing to reply, I scanned your previous thread a few months ago. My first reaction now is to congratulate you for using a condom -- which was a lapse in the exposure you described last time. Good show.

Despite the menstrual bleeding (which is far more likely than an injury from you), you can be sure the condom did its job and you are at no significant risk of HIV. Blood contains no more virus than vaginal fluid does; and the condom remained in place and was intact. Skin to skin contact with vaginal fluids occurs normally during condom-protected sex, and because the amount of virus exposure is no greater with blood, there is nothing in this event that significantly elevates your risk of HIV.

In addition, it is statistically unlikely your partner has HIV -- in your previous thread, Dr. Hook described the infrequency of HIV in Dubai sex workers.In addition, "escort" usually means expensive female sex workers by appointment, and such women (world wide) are believed to have low frequencies of HIV and STIs. They often are educated, they understand the risks and take steps to protect their health (condoms, regular testing), and their clients generally are themselves unlikely to have HIV (men like you!).

That said, I agree it would be reassuring if she is tested at this time with a negative result. In the meantime, you are at little or no risk of HIV even in the unlikely event she turns out to be HIV positive.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

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6 months ago

Thank you, doctor. I'm 100% sure that there are no sores or wounds on my penis/groin area. Though, to be honest, I've been vigorously masturbating with soap daily, and my penis has been kind of sensitive/irritated.

Would masturbation result in micro tears that I can't see with the naked eye at the penis base could pose risk from this encounter?

And, finally, would you recommend PEP in my case? It's hard to get in Dubai and would raise eyebrows, so my best bet is to catch a flight to a nearby European country. Would it be reasonable/worth it to do so?

H. Hunter Handsfield, MD

6 months ago

There are no known cases of HIV resulting from exposure of visibly intact skin. This makes no difference. Some experts might advise PEP in this situation, but I would not; nor would I suggest travel to another country for that purpose. PEP needs to be started within 72 hours of exposure and ideally is started within 24 hours; and there would be a good chance that whatever provider you found there would advise against it anyway. Also think about a downside of PEP that's often forgotten: it delays the time to conclusive testing by a few weeks, prolonging the potential duration of anxiety over the event.---

5 months ago

Thank you, doctor, for your time and insights—I truly appreciate it. I have one final follow-up question regarding general sexual health risks.

I’d like to better understand the potential risks of contracting non-HIV STIs, such as gonorrhea, HPV, syphilis, and chlamydia, when engaging with female escorts, as the internet is rife with anxiety-inducing information that leads me to considering celibacy. If there are no visible symptoms present, what steps can I take to ensure a safer experience for both parties?

Additionally, how do activities like giving or receiving oral stimulation or performing rimming compare in terms of risk if condoms or barriers are not used?

I appreciate your guidance on this matter. Thank you.

H. Hunter Handsfield, MD

5 months ago

The opportunity for follow-up comments is for clarification or other questions about the initial question and our replies. That will have to conclude this thread, which was due for closure soon in any case (automatic after a month). Thanks for your understanding.---