[Question #5717] Am I at HIV risk from this contact with menstrual blood?

73 months ago

Dear Doctor,

Last week I had an encounter with a CSW. I am currently living in a north African country. She provided a condom (but she asked if I want to use it, which is worrisome). We used this condom. It was too tight and quickly I decided to change it (the condom was intact) and put my own one which was more comfortable. After we finished I saw a lot of blood on the condom and on the base of my penis (not protected and on which I have small genital warts, I treated in the past but are still coming back). She was just starting to have her periods as the first condom was intact from blood. Also when I removed the condom carefully to avoid that blood enter in contact with the head of my penis, I had some of it on a cut on my thumb I had that morning which was still stinging but not bleeding.
According to you, am I at risk for HIV from this event? My concerns are from the warts and the cut in contact with possibly contaminated blood.

I am particularly concerned since I read this study (http://www.bumc.bu.edu/busm/2018/08/21/untreated-genital-warts-may-increase-risk-of-hiv-transmission/) . It is said that "compared to normal tissue from the same patient, anogenital warts had a significantly higher density of HIV-target cells. Of the anogenital wart samples studied, approximately half had high concentrations of these cells in the outermost layer of skin (the one most likely to be contacted during sexual intercourse)"

Should I wait 4 or 6 weeks before testing and resuming unprotected sex with my regular partner?
Thanks much for your help

H. Hunter Handsfield, MD

73 months ago

Welcome to the forum. Thanks for your question.

My first response is to congratulate you for using a condom. Good move.

My understanding is that the frequency of HIV in CSWs in northern Africa is low, so it is statistically unlikely your partner had HIV. But even if she did, condom-protected sex is safe. Menstrual blood has no ligher amounts of HIV than genital fluids, and unprotected sex during menstruation is no more risky than at other times in a woman't cycle.

STDs in general raise the risk of HIV if exposed, but warts do so less than most other STDs. In any case, when the risk is almost zero anyway, any increased risk is meaningless. For example, if we estimate you had one chance in a million of catching HIV, and if your warts doubled that risk, the chance you caught the virus would rise to 1 chance in 500,000 -- still low enough to ignore. Whether or not your warts had increased HIV target cells makes no known difference. Also, healing cuts are not a risk even when exposed to HIV infected blood.

For these reasons, testing is optional in this situation. If somehow it were me instead of you, I would not be tested and would continue sex with my wife without worry. However, some people are more reassured by negative testing than by professional opinion, no matter how expert the source. If you would feel better having a negative test, seek an antigen antibody (AgAb, 4th generation) HIV blood test at 6 weeks. (A prelminary test at 4 weeks would be 98% conclusive, but 6 weeks is needed for 100%.) But the risk is low enough that you probably should continue sex with your regular partner in the meantime. (In 14 years of this and a previous forum, with thousands of questions, there has not yet been a single person who was worried about HIV who turned out to be infected. You won't be the first!)

Another approach is to contact the CSW and ask her to be tested. If currently negative for HIV, you will know you were not at any risk at all.

I hope these comments are helpful. Best wishes-- HHH, MD

---