I had an incident where I was involved in unprotected cunnilingus and protected (somewhat) sex with a female CSW. 

I had sex for 1-2 minutes and then saw blood all over my condom. At that time my condom was still covered. I panicked and asked her about that. She said she has been menstruating since yesterday. It was too much blood. I started to worry even more because I gave her cunnilingus before the sex. I wiped my lips and nose with a tissue and saw blood even in the tissue paper. It was not a small amount for sure. I stopped then but forgot to wash my penis and mouth and rushed back home. 

I came home and did a water test on the condom. I saw water leaking immediately from the condom through a cut which was  approximately 0.3 cm and clearly visible. It was not in the front but slightly above where my foreskin would have been exposed if that cut were present before I penetrated. She gave me a blowjob in the same condom and may be her teeth would have damaged it. My condom didn’t burst or wide open during the act which is the only thing I am clear off. 

I am extremely worried now because I might have been exposed to her menstrual blood if the cut in the condom was present just before I penetrated. I visited the doctor and started the PEP. I would like to get you assessment on my case as I am suffering mental breakdown. 

Please help. 

Before I even read the question itself, looking only at the title you chose:  In persons with HIV, the amount of virus is pretty much the same in both blood and genital fluids. Therefore, sexual exposure is no more risky during menstruation.

Now having read the rest, you are not at risk for HIV. Nobody has ever been known to catch HIV by cunnilingus (oral-vaginal contact), so that aspect of the sexual event wasn't wiry. And it sounds like the vaginal sex was condom protected:  the small condom defect did not significantly raise the risk.

Is there a reason to suspect your partner actually has HIV? is she a sex worker? IV drug user? If not, I would have strongly advised against PEP in this situation. Another option is to speak with your partner and ask her to be tested for HIV now. (You should pay for it.) If she tests negative, you will know for sure there was no risk. You might ask your doctor whether or not to continue PEP. You definitely should stop it if your partner tests negative.

With or without her being tested, you really needn't be worried at all. You might also like to know this:  in the 21 years of this and our preceding forum, with thousands of questions from persons worried about HIV after a sexual experience, none has yet turned out to test positive. You will not be the first. If and when it finally happens, I'm sure it will be a genuine high risk exposure (maybe something like unprotected anal sex between men), and certainly not a virtually zero risk event like yours.

I hope these comments are helpful and you'll be able to relax. Let me know if anything isn't clear.

HHH, MD

I thought I will put my event to rest and move on but what really bothers me is that,  I had a brief sex with her say for 2-3 minutes, wouldn’t the infectious vaginal fluid and blood pass through the  tear reach my urethra or urethral mucosa? Isn’t that scenario is as same having an unprotected sex? 

While the condom didn’t burst open or slipped, my foreskin and urethral mucosa was still exposed to the vaginal fluid. Can you consider this situation as well  and provide your assessment ? 

I reached out to her but she blocked me everywhere. She behaved and looked very promiscuous. She is a prostitute and had many customers according to her. Hence I had to assume the worst in this case. 

Thanks

It's up to you and your doctor whether you decide to continue PEP or stop it. There's a downside to PEP you might not have thought about. Without PEP, you can have conclusive HIV testing (with the PCR RNA test) 11 days after exposure. With PEP, it will be 6 weeks until conclusive testing, i.e. 2 weeks after the last dose of drug. Are you prepared to wait and wonder that long? 

Just that the person with whom I had contact has been avoiding me since then. She is an expat from Vietnam if that helps in anyway in terms of risk assessment. This incident occurred in Singapore. 

1. I've told you my assessment; it would be the same for a patient in person as in this forum.

2. Yes. That's what I assumed and the main reason the small condom hole did not seriously raise your risk.

3. We don't examine posted photos. When uploaded, we delete them without looking at them.

That completes the two follow-up comments and replies included with each question and so ends this thread. I hope the discussion has been helpful. Don't worry:  In the 21 years of this and our previous forum, with thousands of questions from persons worried about HIV after an exposure, nobody has yet turned out to be infected. You won't be the first; if and when it finally happens, it will be a truly high risk exposure, not a minor risk event like yours.

Best wishes and stay safe.