[Question #4539] Blood present during sex with escort

81 months ago

Hello Doctors
Hoping you can please offer me some advice. I am a male and recently had vaginal sex with a female escort. After around ten minutes of sex, the girl started bleeding and there was blood on the sheets and all over the condom afterwards. I took the condom off using tissues and do not believe blood ended up on the penis head but could have. I then washed my penis in the shower and some blood did end up on the skin of the penis shaft, presumably from taking the condom off. After showering after washing hands, I had hand relief using both her hands and my hands. She may have touched herself during the hand relief before touching me so blood may have been present on her hands. Please could you advise if I am at risk of HIV, Hep C or anything else from this encounter. Thank you!

H. Hunter Handsfield, MD

81 months ago

Welcome back to the forum. Thanks for your question and your continued confidence in our services.

First, as in your last question, congratulations for using a condom. Second, the expert consensus is that HIV is rare in escorts (expective female sex workers by appointment, as opposed to brothel workers, bar pick-ups, etc); in general they know the score about HIV and ohter STDs, generally have low risk clients (men like you), use condoms regularly, and are tested frequently. Third, blood exposure per se isn't an issue except by direct exposure by injection or injury, not from contact with the skin. And in HIV infected persons, the concentration of HIV -- and hence potential for transmission -- often is no higher in blood than in sexual fluids.

So all things considered, there is little or no risk of blood borne infections from this event. Assuming you have occasional sex with escorts, even condom protected, it would make sense to have occasional (e.g. yearly) blood tests for HIV and syphilis, and urine for gonorrhea and chlamydia. If you haven't been tested recently, this might be a good time, when it's on your mind. But definitely not because of this particular event.

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

HHH, MD

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81 months ago

Thanks very much for the response and reassurance Dr HHH. One quick follow up question if possible please - there is a chance that some of the blood from the condom may have come in contact with my penis head and the mucus membrane there, when I was removing the condom as there was quite a bit of blood. I am uncircumcised if it makes any difference. Would this be a risk? I am not sure how long it takes air to kill HIV/Hep C. The girl said she sometimes bleeds during the few days leading up to her period. Thanks again for your advice. Always much appreciated.

H. Hunter Handsfield, MD

81 months ago

You're a better judge than I am about whether blood could have gotten down inside the condom, or whether you had significant contact with blood when removing the condom. But please note the other things I said; there are other strong reasons that you were not likely at risk for HIV or other blood borne infections. Also, even with a known infected female partner, the risk of HIV transmission for any single episode of unprotected vaginal sex is around 1 in 2,500. (Many spouses of infected persons never catch HIV, which perhaps you didn't know.)

How long HIV or HCV can survive in air, or when drying, really isn't important. If the blood was wet, it's fair to assume these viruses were still viable. But the fact is that no such exposure has ever been reported to result in transmission. Since it happens rarely or never, the biological reasons don't much matter.

Another approach to deal with your anxiety is to contact her partner for a) further reassurence she doesn't have HIV, i.e. tested recently; or b) to be retested now. If negative, you'll know you could not have been exposed. If you go this route, do it diplomatically and respectfully.

And by the way, HCV has been oversold as an STD. The only proved sexual transmission scenario is among men having potentiallly traumatic rectal exposure to other men. The heterosexual partners of HCV infected persons have no higher rate of catching HCV than anyone else. And a recently published research analysis calculates the transmission rate by unprotected vaginal sex at one chance in 185,000 (or maybe it was 1 in 195,000, I don't recall). That's equivalent to sex with infected women once daily for 500 years before transmission might be likely. In other words, zero for all practical purposes.

So all is well. Don't overthink it. You're fine.

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81 months ago

Thanks Dr HHH - that all makes sense. I was mainly concerned as I understand uncircumcised men, such as myself, can be more prone to HIV infection. I also read somewhere ages ago that washing after sex can increase the likelihood of HIV infection. Obviously with blood on my actual penis below the area covered by the condom, my initial reaction was to wash. Hopefully the dirty water didn’t come in touch with the penis head and mucus membrane.

Thanks again for your help.

H. Hunter Handsfield, MD

81 months ago

Be careful what you read, and put it in context. Even technically accurate information can be misleading. For example, not being circumcised roughly doubles the risk of HIV if sexually exposed. "Double" sounds like a big deal and at a national or societal level it is: double the number of new HIV cases per year. But for any particular exposure, it means that instead of 1 chance in 2,500 for unprotected vaginal sex with an HIV infected women, it becomes 1 in 1,250. That's equivalent to daily sex with infected partners for 3.4 years before infection might be likely. Assume 99% protection from using a condom, and the odds become 1 in 125,000 per exposure.

As for washing after sex, that was the outcome of a single study in Africa 20 or more years ago, which got a lot of publicity because it was surprising and counterintuitive. Later studies have not confirmed it.

New HIV infections are exceedingly rare in men with your lifestyle, i.e. occasional sexual exposures with relatively low risk partners like escorts. I would guess fewer than 10 such men acquire HIV in the US per year. Your Powerball odds are higher. The large majority of heterosexual HIV transmissions in industrialized countries occur in the regular partners of infected persons who are in the dark about their partners' HIV status -- not in one-off exposures. I'm not suggesting you become cavalier, and certainly you should continue to use condoms in this setting.

That completes the two follow-ups and replies included with each question and so ends this thread. I hope the discussion has been useful.

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