[Question #4714] HIV and menstruation

28 months ago
I’m a 25 year old male, I am currently on a business trip and had 2-3 unprotected sexual intercourse with a 24 year old female in Jakarta. The first night we had sex, it was her first day of menstruation, thus, there was blood. 2 days later, we did it again, unprotected, there was more blood.

I don’t know if I should take PEP since it would cost approximately $400 back home.

What are the odds that I would have contracted STI, primarily HIV, considering that Jakarta is a low income country and she was on her menstruation. 

When I asked her if she has HIV, she said no, but she only mentioned that she has never gotten tested. It worries me because she seems promiscuous and wasn’t concerned at all that the sex was unprotected, thus implying that she could be HIV positive. 

Should I be worried?
Edward W. Hook M.D.
Edward W. Hook M.D.
28 months ago
Welcome to the Forum.  There are several dimensions to your questions.  I'll try to help.  

Sex during menstruation.  There is a common misconception that sex with an infected persons during menstruation heightens risk for HIV, I suppose because of the perceived exposure to blood.  Actually however, among untreated, infected persons, there is just as much HIV in non-bloody genital secretions as there is in blood (menstrual or otherwise).  Thus the fact that your partner was having her period does not change your risk for infection.

You don't mention is your partner was a commercial sex worker or not but the fact that you sense that she had not been tested does make her somewhat higher risk for being infected with one or another STI, gonorrhea and chlamydia being much, much more likely than HIV.  Despite that however, most people do not have STIs and most exposures to infected partners do not lead to infection so your overall risk for infection is low.  Having said that, testing is the only way to be 100% sure..  If you acquired an STI such as gonorrhea or chlamydia you would be more likely than not to develop symptoms in the week or so after acquiring infection (burning on urination or penile discharge) although some persons do not develop discharge.  In the future, at some point, even if symptoms do not develop it would probably be a good idea to get tested.

finally, with respect to PEP.  PEP works best when it is taken soon after sex.  PEP is thought to have no effect if taken more than 3 days (72 hours) after exposure so if it has been three days or more, there is little benefit to taking PEP.  My sense is that it may have been more than 3 days.  If this is the case, there would be no benefit from taking it.

In the future, I recommend condoms as the best way to avoid risk and worry as condoms are highly effective in preventing acquisition of all STIs while pep is only effective against HIV.

I hope these comments have been helpful.  If there are additional questions or clarification, please feel free to use your up to two follow-up questions.  EWH
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28 months ago
My partner is not a commercial sex worker and my window for PEP would end in approximately 24 hours (it hasn’t been 72 hours since my first encounter) 

1) would it make sense to spend $400 on PEP, would this decision be anxiety fuelled and irrational? 

2) would the odds of me contracting HIV be similar if she wasn’t menstruating which is 1 in 2500? (A lot of STI articles mentioned that menstruation increases the likelihood of HIV transmission) 

3) physically she doesn’t have any visible symptoms of STI even though she mentioned that she has a headache today; considering she hasn’t gotten tested, are the chances favourable that she doesn’t have any STI? 

4) would you worry about contracting incurable viral STIs such as HIV and HSV1/2 if you were me? 


Edward W. Hook M.D.
Edward W. Hook M.D.
28 months ago
1.  Decisions about PEP are personal and hard to give.  I can provide a few more facts which may be helpful t you.  If your partner has HIV (statistically unlikely I suspect) then your risk for infection is 1 infection for every 1200 acts of unprotected vaginal intercourse.  Three episodes of sex makes the risk about 1 in 400, IF she was infected.  If she can be tested today and is negative, there is no realistic risk for HIV.  Rapid HIV tests are available in most countries.

2.  See above regarding risk during menstruation.  The idea that sex during menstruation increases HIV transmission suggests a poor understanding of how the infection is transmitted.

3.  Most people do not have STIs.  When women have STIs however they are more often asymptomatic than not

4.  Probably not.

Bottom line, your risk for HIV is somewhat related to your partner's characteristics and what you know of her.  It sounds as though you are not too worried.  I think that is probably reasonable.  Similarly, the idea of PEP is related to your concern about your partner and your level of anxiety.  Far fewer than 1% of persons in your circumstance will get HIV, you have decide how you feel about that.  EWH

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28 months ago
Doctor Hook, I don't know how I am able to write here, but could you please respond to my question-- i will appreciate it greatly! 
28 months ago
Thank you for addressing my concerns Doctor Hook, I will wrap things up with 3 more questions

1) since you mentioned that more often than not, females have asymptomatic STI symptoms, would it be reasonable to take it as a good sign nonetheless, since viruses like HSV is relatively high in transmission when the sores are present 

2) I understand that by the off chance I contracted HIV or any STI, the symptoms may be asymptomatic; however, what symptoms should I keep an eye for and if there are no visible symptoms, which day mark after my last sexual encounter would allow me to be considered ‘out of the woods’ 

3) would you get tested if you were me? Getting tested in my home country is expensive and I would rather make rational and not emotionally fuelled decisions 

4) how long should I wait before I get tested for HIV? 



Edward W. Hook M.D.
Edward W. Hook M.D.
28 months ago
1.  Yes, it is better to not have symptoms than to have them.
2.  About half of people who acquire HIV experience the Acute Retroviral syndrome which is a flu-like illness typically occurring 2-3 weeks after acquisition of infection with sore throat, high fever, sever muscle ache.  As for other STIs, when symptomatic in men, STIs like gonorrhea or chlamydia typically cause urethral burning on urination and/or a penile discharge.  Person who acquire herpes or syphilis develop genital ulcerations at the site of sexual contact.
3.  As a matter of personal protection, we recommend annual testing for anyone who has had two or more sex partners in the past year (we consider this to be health maintenance- we also recommend you get your blood pressure and cholesterol checked regularly.  It sounds as though you qualify.  You do not mention what country you are from but most countries have genitourinary medicine/STD//sexual health clinics at which testing can be gotten relatively inexpensively.  
4.  Testing with currently available tests for HIV is typically conclusive for any test that is done more than six weeks after an exposure.

I hope this helps.  As per Forum Guidelines, this thread will be closed shortly without further replies.  Take care.  EWH
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