We don't recommend the "water test" or any other close inspection of condoms after they are used. If it wasn't obviously ruptured wide open, then protection almost certainly is always complete. The notion of microscopic leaks that can allow transmission of HIV or other STD bacteria and viruses is an urban myth. There has never been a scientific report of HIV or other STD acquired through a condom with such small leaks.

Second and perhaps more important, your assumption probably is not correct. Unprotected vaginal sex with HIV infected women during menstruation appears to be no more risky than at other times. The main biological reason is that in infected persons, the concentration of HIV is just as high (or higher) in genital secretions than in blood. These issues have not been very carefully studied, but that's the general consensus of experts.

In general, we and other experts do not recommend testing after any single exposure unless particularly high risk. If you were to learn your partner definitely had HIV or another active STD, of course testing would be reasonable -- and I can understand why you might want to do it anyway. But you might glance back at your other thread, where I went into more detail about the inefficiency of HIV/STD transmission, even when one partner is known to be infected. In this case, there is the slight uncertainty of whether you used the condom or whether it failed, but the bottom line remains that the odds are strongly in your favor. If somehow I were in your situation, I would not be tested on account of this event. (Of course, if there have been other non-monogamous sexual exposures over the 2 years since your previous thread, perhaps testing would be a good idea now, if not done since then. But not because of this particular event.)

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

In any setting where HIV becomes especially common, and where most infected persons have not been diagnosed and therefore are not being treated, the proportion of the population with high level infection can be high, with markedly increased transmission risk, surely higher than 1 in 2,500. These same population groups also have especially high rates of other STDs, which further increase HIV transmission risk. Also, most heterosexual transmission occurs in people who are repeatedly and intensively exposed, for example the spouse of a partner not known to have HIV or maybe not even known to be at risk. Very few HIV infections occur from one-off exposures, such as men who occasionally (or even frequently) have commercial sex. Not long ago, someone on this forum asked a similar question and cited Magic Johnson, who apparently was heterosexually infected. But Johnson reports he probably had a couple of thousand ( ! ) sex partners, during a time when few infected persons had been tested and nobody was on anti-HIV treatment; he seems to be a very atypical outlier.