[Question #13747] Need reassurance

29 days ago

Good evening doctors:

Thank you for all the guidance you’ve provided me on this site. I feel like I have an understanding of the HIV risk for my situation, based on past answers you’ve provided. However, this last encounter rattled me a bit and I’d appreciate some reassurance, if you’d be so kind:

I recently had sex with a woman at an Asian massage parlor in NJ, USA. She mounted me on the table shower and rubbed our bare genitals together with no penetration. She also performed a bare blow job. We went back to the massage room and proceeded to have vaginal intercourse with a condom, when I noticed she had (or recently got) her period. When I pulled my penis out of her, the condom seemed intact, though it was only half way up the shaft (still covering the head) by that point, but I had blood all over my genital area including my thighs, upper shaft and scrotum.

I know you mention that menstrual blood is no more infectious than vaginal fluid, but I’d like some reassurance on the HIV risk and if testing is warranted:

1. I shaved my genital area a day or two prior to this encounter and nicked myself in a few spots with the razor. Given everything I just described, is there a realistic risk of contracting hiv assuming she had it?

2. Once we realized she had her period, we washed the area (genitals and hands) in the shower with body wash then I proceeded to use her mouth and hands, and my hands to reach climax. Could this in anyway have increased the risk if I missed any spots of blood and somehow massaged it into the tissue?

Again, my thought is “no” but I’d like to have an expert opinion to consider.

Thank you for your guidance and apologies if this is a waste of your time.

H. Hunter Handsfield, MD

29 days ago

Welcome back, but sorry you found it necessary. For the future, please just accept that without unprotected penile insertion, you can consider yourself to not be at risk for HIV. Even without condoms, heterosexually transmitted HIV remains exceedingly rare in the United States.

In this case, genital apposition without penetration is zero risk for HIV or close to it; and unprotected oral sex also is very low risk. (One calculation is one chance in 10,000 if the oral partner has untreated HIV, which is equivalent to receiving unprotected BJs once daily for 27 years before infection might be likely. And statistically it also is very unlikely a partner like this one has untreated HIV. You also are correct that blood is no more likely to transmit HIV than vaginal fluids. To your specific questions:

1. Shaving with micrscopic trauma to exposed skin is often described as risky by various online sources, but it's an urban myth. Theory only, with no know cases that HIV ever was transmitted in this manner.

2. HIV is instantaneously killed by soap. Washing with soap and water undoubtedly eliminated any small theoretical risk that existed. And even without washing, hand-genital contact is not a risk for HIV, even if genital fluids are used for lubrication.

In summary, your thought of "no" is correct. You were not at significant risk for HIV and do not need testing. If you have a regular partner, you can safely continue your usual sexual practices without risk.

I hope these comments are helpful. Best wishes and stay safe.

HHH, MD

---

29 days ago

This is comforting and thank you gor your reply. So even her blood got on the tip of my penis, where the glans are, while rubbing our bare genitals together before penetration is still no risk? Im curious why the risk is lower here vs penetration, if the blood is present in each scenario? To be clear: i trust your judgement and guidance, this is more for my own understanding and education.

Thanks again!

H. Hunter Handsfield, MD

29 days ago

There's no science to answer the precise reasons for various levels of risk. But with penetration, typically the penis is in the vagina for at least a couple of minutes; thrusting might increase risk by rubbing the virus into tissues, especially in uncircumcised men, and by massaging secretions into the urethra; also in uncircumcised men, exposure to vaginal secretions (or menstrual blood) is more prolonged by retention under the foreskin; and maybe more. No research on any of these but they are logical guesses to explain the clear fact that busy HIV/AIDS clinics rarely see patients with sexually acquired infection who only had non-penetrating contact of various types.

Even with several minutes of vaginal sex to completion, if the female partner has HIV, the risk to her male partner is estimated at roughly one chance in 2,000 of becoming infected. You can safely assume that other kinds of contact therefore have far lower risks. And as already discussed, the chance your partner had HIV probably also is near zero.

The chance you acquired HIV isn't zero, but the chance all these individual factors would all go the wrong way probably is under one chance in several million.

---
---

29 days ago

Thank you for your reply and guidance, as always.

H. Hunter Handsfield, MD

29 days ago

Thanks for the thanks. I'm glad to have helped; that's why we're here. That completes the two follow-up comments and replies included with each question and so ends this thread. Best wishes and stay safe.

---