[Question #5726] Unprotected oral & protected vaginal sex during unexpected period

21 months ago
I am very scared because of two separate situations. The first situation is that today I had sex with a woman here in Japan who did not realize she is on her period because there was no obvious bleeding at first, but I gave her lots of oral and may have swallowed some blood and I do have bleeding gums sometimes. I also noticed later that there was dried blood on my finger and I have some small cuticle cuts. Finally, and most concerning, was that once we started having sex (protected) before we realized she was on her period, there was lots of blood on the condom, the sheet and on my lower penis area so she must have been bleeding pretty heavily at that point. 

She didn’t know so when I did the oral at first there is no way we could have known about the blood. She is a great person and we are likely going to start dating more seriously, but her ex cheated a lot and that is what makes me nervous. 

1. Was this a risk for hiv?

2. Was this a risk for other STD’s? She had no visible sores and I had just finished a zpak for a sinus infection, which seems to happen every July. 


The second situation happened last week also in Japan. I had anal sex for the first time (it was with a woman and protected), but  the condom slipped a bit. The head and at least a third of the shaft were covered at all times. She had no visible sores, but I didn’t see her anus in great detail. I have never had anal sex before and read some scary stuff online, but also some information that said protected is basically no serious risk for anything unless there are visible sores. I am not sure what to think. 

1. Was this risky?

Thank you for the amazing service! Perhaps if things go well relationship wise with the person from the first question I won’t be bothering you with questions after this one.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
21 months ago
Welcome back to the forum.

Reacting first to the title you created for your question before reading anything else:  Sex during menstruation is no more risky for STDs, including HIV, than in in non-menstruating women. And oral sex is pretty safe sex even wtihout a condom:  the risk is far lower for all STDs than unprotected vaginal or anal sex, and virtually zero risk for some, including HIV.

Now having read the details: My comments about the low risk of oral sex includes cunnilingus; and swallowing blood carries little risk, including HIV; and the odds any particular Japanese woman has HIV is low -- Japan is a low HIV incidence country. Bleeding gums has little or no risk in raising risk of HIV or other STDs. As for the second event, condom protected anal sex is entirely safe if the head of the penis and urethral opening remain covered.

I don't recommend testing for HIV or any other STD on account of these events. Of course you are free to be tested if the negative results will be more reassuring than my advice. If you decide to do that, you'll need a throat swab for gonorrhea, which is valid any time more than 2-3 days after exposure; and blood tests for HIV (AgAb, i.e. 4th generation) and syphilis at 6 weeks. Or you could speak with your partners and ask them to be tested. If negative, you'll know you were not exposed. However, if somehoow I were in your situation, I would not be tested nor would I ask my partners to do so.

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

HHH, MD
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21 months ago
Dr. Handsfield,

         Thank you! Your explanation is very clear. The only other question I have is whether the zpak I took for my sinus infection would have further lowered the already low risk of gonorrhea from cunnilingus or receiving fellatio? Given your clear explanation I am not concerned about hiv anymore, so gonorrhea is the only thing I am even remotely concerned about and if the already low risk was lowered even further I won’t be worried at all unless symptoms show up. 

           Thank you for the amazing work you do on this website. I have found Your, Dr. Hook, and Terri Warren’s answers to my and others’ question over the years to be a great source of knowledge on important health issues that sadly I, like too many people in the U.S., should know more about.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
21 months ago
Thank you for the kind words.

Sorry I forgot to comment on the azithromycin (Zpak). It for sure protected you against chlamydia, and is farily likely to have protected you from gonorrhea and syphilis. 20-40% of gonorrhea and syphilis is resistant to azithro, but both are so unlikely after the exposures you describe that it really makes no difference.  Bottom line (no pun intended):  no chance to my evaluation and advice.

That concludes this thread. You've had several questions on the forum, all of which imply a high level of STD anxiety that may not be warranted, based on the symptoms and exposures you have described. Rather than asking about every exposure or minor symptom, I would advise that if your sexual lifestyle continues as it has been, you just plan on yearly testing and disregard all individual exposures, unless particularly high risk (e.g. partner known to be infected) or clear symptoms of STD (genital sores, discharge from the penis, etc).

I hope the discussion has been helfpul.
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