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.

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 

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.  

 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

Again I know that she doesn’t test regularly for HIV and has regular unprotected encounters with different men.   

I have one week before I can take a PCR test.   

Even with multiple casual partners, the statistical  likelihood that she has HIV is substantially less than 1%.

again, apologies for having missed your earlier folow-up.  I presume that your testing was negative in the interval.  EWH