[Question #13588] Unprotected vaginal during menstruation

1 days ago

Hello Dr. HHH and Hook,

I’ve been following your forums for quite some time. Approximately 37 hours ago, I had insertive unprotected vaginal with someone I’ve known for a while. I’m circumcised. We’ve never had unprotected intercourse as I believe in being as safe as possible. Neither of us had a condom, and I had a few drinks so decided to proceed. Started off with cunnilingus. As soon as we started intercourse, she started bleeding pretty heavily. We had sex about 5-10 minutes I’d say. I then rinsed off.

My concerns are that she is very promiscuous, is currently a tattoo artist and used to be involved in the sex industry, she informed me. She doesn’t believe that vaginal sex is a cause for concern for HIV, and prefers unprotected sex. When I asked her if she tests she said she’s not worried and that we all have to go somehow….very strange response.

I’m still in the window to begin PEP and actually went to urgent care yesterday to discuss. The physician thought that although fairly low risk, they said it was ultimately my decision. I’m a little concerned about the side effects of taking this regimen. I haven’t filled the medication yet.

What are your thoughts regarding my overall risk exposure?

Thanks for all you do here.

1 days ago

I asked if tested for Hep C and HIv and she said that she has to for her job. I didn’t get any details on last time tested or additional info.

Edward W. Hook M.D.

1 days ago

Welcome to our forum thank you for your questions. I’ll be glad to comment. Overall the encounter you described was relatively low risk. Most people even persons who live somewhat riskier lifestyles do not have HIV and your partner has already been tested for other blood-borne infections such as hepatitis.(FYI, often when people are tested for hepatitis they are tested for HIV at the same time.).

Even in the unlikely situation that your partner had untreated HIV, the risk of infection from cunnilingus is no higher than 1 infection per 10,000 exposures ( I.e. there is a 99.99% likelihood you would NOT be infected) and the estimated risk from unprotected vaginal sex, on average, is less than 1 infection per more than 2000 exposures). Since the amount of virus present in vaginal secretions is about the same as in blood, there presence of blood makes no difference.

I agree with the physician you spoke with and personally would not take PEP although testing for more common STIs like gonorrhea and chlamydia is reasonable. Taking PEP is a personal decision however. If you start PEP that would add at least 30 days to the time when you can test.

I hope that this information is helpful. EWH

---

1 days ago

Thank you for the prompt response Dr. Hook. I’m an extremely anxious person with a serious phobia of HIV in particular, so I’m not sure that I could handle waiting the additional time to test if going the PeP route. I figure the PCR RNA test at around the twelfth day would be the best way to ease my worry.

My concern with the blood is that it definitely got into my urethra I’m sure due to the quantity and vigorous intercourse. Another forum states that when a woman is on her cycle, the viral load is higher at that time. This freaked me out quite a bit.

So in summary, you feel that my odds are very good for coming out of this okay when I do test?

Have you seen an encounter such as mine produce a reactive result? I’m just trying to make sure that I don’t miss the PEP opportunity if indeed it may be necessary.

Edward W. Hook M.D.

1 days ago

Thanks for acknowledging your concerns, but my assessment and advice is unchanged. I’ve never seen or heard of someone who acquired HIV in your situation

You are correct that an HIV RNA PCR test anytime at 11 or more days would rule out the possibility of infection. Please don’t worry.EWH

---