[Question #1432] Oral sex with csw having menstruation

45 months ago
Dear Doctors, here the fact: 3 days ago i had sex with a csw, russian girl, here in Italy. I did protected vaginal intercourse and not protected cunnilingus excslusively on her clitoris, not on the lips and absolutely not inside.  After vaginal intercourse i found blood on the top of the condom and a small blood spot on my finger i used to finger her. She told me only in that moment that she had menstruation. I am sure i did not feel any taste of blood in my mouth, my mouth has perfect conditions, no cuts inside or similar. I can not know if she was HIV+, she told me "don't worry". I am really worried now, what is the risk to have been infected, should i test for HIV? please help me.
Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago

Welcome to our Forum.   I'll be pleased to comment.  This was essentially a no risk event despite the rather high risk nature of your partner. Most commercial sex workers do not have HIV and even if your partner did, your vaginal sex was condom protected and acquisition of STIs of any sort, including HIV from cunnilingus is nearly unheard of.  There are VERY rare cases in which person have acquired gonorrhea of the throat from performing cunnilingus but this is extraordinarily rare.  There are no known cases in which HIV has been acquired through cunnilingus, even when the recipient is menstruating.  Personally, I would not worry at all about this exposure however if you desire to test to be 100% sure that no STI was acquired, the only STI that I would recommend from a medical perspective is a throat test for gonorrhea.  There is no medical reason for blood tests for HIV, hepatitis or syphilis and no reason for penile testing for other STIs. 

I hope this comment is helpful.  EWH

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45 months ago
Dear Doctor,  thank You for Your answer that has removed all my anxiety.
Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago
Great, glad my comments were helpful.  EWH
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45 months ago
Dear Doctor here i am again, nothing has changed from my last request, just some irrational anxiety. The question is, would something changes, in the case the csw had a high viral load and i swallowed some blood, i mean also undetectable blood because i am sure i did not feel any taste of blood. In this worst case scenario, is it again a no risk event? Because the cunnilingus was only external and on the clitoris, may the contact with the air and the saliva inacetivated the virus, if high loaded and if present? Still no reason to get tested under this scenario?
Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago
I understand your concerns but you do not need to worry.  Even if the very unlikely circumstance that your partner had HIV with a high viral load and was bleeding and swallowed some of her blood, this would still be a no risk event.  there is no scientific data to suggest that HIV can be acquired by swallowing the blood of an infected person.  EWH
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45 months ago
Dear doctor, from last friday (14 days after the exposure) to Monday morning, i have experienced the following symptoms: nose congestion and discharge, very fast laringitis, no typical sore throat like pharyngitis, but due to the mucos discharge that caused me also hoarse, two episodes of mild night sweating, but in a case as you probably will understand i was very anxious for the situation and in the second case probably it was also due to paracetamol I have taken before to sleep. No fever, only one episode with temperature at 37,5 on Sunday afternoon, but in the evening was normal around 36,5. No swollen linph nodes and no rash. Starting from the no risk exposure you told me in the first answer and confirmed after my second question, i consider this episode as not linked to the exposure, but a common mild cold due only to the cold weather here in Italy. I just ask Your   opinion and I think you probably will confirm my considerations, in order I can definitively move on supported by your statistics and probabilities. Thank You.

Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago

Our Forum Guidelines allow up to three replies to a client’s questions.  This will be my third and therefore final rely.  I hope my comments and the information I have provided has been helpful.

The symptoms you describe are not suggestive of the ARS which typically presents with high fever, severe muscle aches and sore throat and sometimes diarrhea or a rash.  Your symptoms do not suggest the ARS to me and are more compatible with an everyday "cold" or URI which coincidentally occurred following the exposure you described.  Give the nature of your reported activities, I would not be at all concerned about the possibility of HIV and rather would urge you to move forward without concern.  Take care.  EWH

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