[Question #12724] Escort bleeding during intercourse
5 months ago
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Two weeks ago I saw an escort, aged 25, who came from Kazakhstan (I myself reside in an East Asian country). During condom protected intercourse, while changing positions, I noticed that there was blood mostly situated near the head of the penis on the condom. She mentioned that the reason is because she did not have sex for a long time and she was very apologetic. She had just arrived in the city the day before, so I believe I was her first customer during her stay here. She also says she gets tested regularly in Kazakhstan.
As mentioned, it has been two weeks now, and I have not noticed any obvious symptoms that would normally be associated with STIs. The condom stayed on the whole time and at least covered the head of my penis. I mention this because the condom did not completely cover the entire penis (it kept rolling up half way for some reason, perhaps it was too small or she put it on reverse for me by mistake).
Appreciate if you could answer the following:
1. What is your assessment of the situation in terms of risks of STIs and whether I need to get tested for this exposure?
2. Is it possible and common for there to be vaginal bleeding during intercourse as a result of abstinence for some time? Is this due to tightness? I could not find a definitive answer online.
3. If I do choose to get tested, when should I get tested and which tests should I do?
Thank you doctor, your services on this website are always so helpful and appreciated.
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H. Hunter Handsfield, MD
5 months ago
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Welcome back to the forum. Thank you for your continued confidence in our services.
Some questions can be answered based only on the title of the question. The amount of HIV in blood is no higher than in vaginal fluids. Sex during menstruation, or exposure to a partner's blood during sex, is no higher risk for HIV than in absence bleeding. The same is true of other STIs as well. And in any case, you describe a partner who cares about her health, gets tested regularly, and therefore almost certainly does not have HIV or any other of the main STIs. In addition, condoms often roll up during sex; and the penis can slide inside the condom during sex. Probably neither situation significantly raises the risk of HIV or any STI.
1. Those comments pretty well cover your first uesiton.
2. Not having sex, or frequency of sex, is not known to increase the chance of vaginal bleeding during sex. It's more likely something else was the cause -- an irregular menstrual period or any or other several possible causes.
3. I would not advise testing on account of this exposure or the bleeding. On the other hand, based on this and your previous questions going back a few years, it is apparent you have at least occasional commercial sex exposures. "Escorts" -- those who usually are expensive and work by appointment (as opposed to brothel workers etc) -- tend to have low rates of active STIs. On the other hand, the risk isn't zero, and it makes sense to be tested from time to time for common STIs, or after several such exposures. Generally that means testing only for gonorrhea, chlamydia, syphilis and HIV. If you haven't been tested recently, you might consider it now. But not necessarily because of this particular exposure.
I hope these comments are helpful. Let me know if anything isn't clear.
HHH, MD
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5 months ago
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Thank you for your prompt answers Dr. Handfield. I had a few follow up questions if you would be so kind as to comment on:
1. I know that there is a lot of misinformation online so I just wanted to clarify. I am a bit concerned that the bleeding may have been caused by an STI as I have read that vaginal bleeding can be caused by chlamydia or another STI. Alternatively, could it have been a more benign cause, i.e. vaginismus which was exacerbated by a period of abstinence resulting in bleeding? Appreciate your comments.
2. If I decide to test and I want the test to cover this recent exposure, should I wait another two weeks (for a total of four weeks post exposure) to conduct the four types of tests you mentioned?
3. I am also considering getting the HPV vaccine gardasil. However, I am in my late 30s and I have already had about 20-30 commercial sex exposures over the years. Is getting the vaccine still recommended and of any benefit in this case?
Thank you again in advance.
5 months ago
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Just a reminder on this because I think my above response may have been missed.
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H. Hunter Handsfield, MD
5 months ago
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My apologies -- I missed the automated email heads-up when follow-up comments are posted.
1. The vaginal bleeding with chlamydia etc is usually just a bit of spotting, not as much blood as seems to be the case for your escort partner. I'd not a gynecologist, but I am unaware of data that vaginismus or sex after a period of abstinence cause vaginal bleeding. I doubt it.
2. You can be tested at any time for gonorrhea and chlamydia; those tests are valid after 4-5 days. HIV and syphilis blood tests detect almost all infections at 4 weeks, but need to be at 6 weeks for 100% certainty.
3. At your age, and on the basis of your sexual history, you probably have already been infected with most of the nine, four or two of the HPV types covered by the three available vaccines and therefore would not benefit. That's why HPV vaccination usually is not advised after age 26. That said, vaccination wouldn't hurt anything if the cost isn't a barrier for you. If you do it, get the 9-strain type of vaccine (Gardasil-9).
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4 months ago
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Thanks Dr. Hansfield. Since enough time has passed, I plan to get tested for HIV, syphillis, chlamydia and gonorrhea as you suggested.
However, I read online that being sick with a common illness such as a cold or the flu could lead to false positive results for HIV and syphillis because the antibodies the body produces to fight those common illnesses may resemble the antibodies used to fight HIV or syphillis which may be detected by the tests. Is there any truth in this? From my understanding the clinic uses a treponema pallidum test for syphillis although I am not completely sure.
If having a cold/flu may lead to false positives, how long after the cold/flu goes away should I wait until getting tested?
Since this is the last follow up question I just wanted to also take the opportunity to thank you for your answers to all the above.
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H. Hunter Handsfield, MD
4 months ago
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You found misinformation or mis-read what you found: there are no data that common illnesses have any effect on reliability or timing of any tests for syphilis or HIV. In fact, there are NO known medical conditions that do this, except for anti-HIV drugs affecting HIV testing. You do not need to delay testing on account of these conditions and can fully trust the results.
Thanks of the thanks. I'm glad to have helped. Best wishes and stay safe.
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