[Question #5818] Advice needed

21 months ago

Hi Docs, 

Have used other questions as a baseline for my questions but hope you could advise. I'm a straight  British 30 y/o male who is checked before / after any new relationship and had all clear for hiv (my main concern)  - last test was May 2019 and no partners since. 

I recently entered into a mutualy monogamous relationship with a girl from Brazil. She was tested twice in last 2 years before moving to the UK but hasnt been tested in about 9 months and has had 2 partners since. 

Last might we had protected (!) vaginal intercourse for the first time. What we didnt realise was that she was still bleeding on her period and after about 5 minutes of penetrative sex I saw my pelvis/base of condom covered in quite a bit of blood.  Some of the blood also managed to get underneath the base of the condom (as we were using water based lubricant) and had a bit around the inside of the condom - it is possible it got quite near the top  and tip of my penis but I am not sure. I got blood on my hands and possible trace on a recent but closed paper cut. We had planned to get lab tested but I actually had home antibody 2nd gen kits from a previous relationship - they are called Biosure and are even given out by our own National Health Service. I explained my anxiety to her and we both did them together. Both were negative. Her last sexual partner was about roughly 7 weeks ago but unsure of specifics.  I got a bit nervous as she said she had been quite I'll about 4 weeks ago with a fever and was in bed for a few days - sounded like ARS though I know these are nonspecific. 

1) Should I be concerned about blood getting inside the condom and possibly mechanically being pushed around?

2) even though a 2nd gen antibody only - what is the accuracy after about 7 weeks for a test like this? 

3) if her "flu"a month ago was due to ars - would the antibody test have been positive? I think I read this was the case. 

4) should I consider PEP in this situation as it is 24 hours on now?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
21 months ago
Welcome. Thanks for your confidence in the forum and for reviewing questions similar to yours before asking your own.

First, with only two partners since last tested and the low rate of HIV transmission heterosexually (averge roughly 1 chance in a thousand, male to female through unprotected vaginal sex) it is extremely unlikely your partner has HIV. And even if she does, the risk in the other direction (female to male) averages 1 in 2,500 per exposure; and your risk was a hundred flold lower than that, since you used a condom. To your questions:

1) The blood exposure makes no difference. The amount of HIV in blood is not signficantly higher than in vaginal fluid, and unprotected sex during menstruation does not significantly raise the risk of HIV in exposed men.

2) The second generation HIV antibody tests detect around 90-95% of infections by 7 weeks.

3) You are correct, her test would have been positive. HIV antibody is always detectable within 7 days after onset of ARS. And for any person with otherwise unexplained fever, probably under one in thousands has ARS.

4) For sure no need for PEP. You probably could not find an ethical doctor or clinic willing to prescribe it in this situation.

All factors considered, there is no chance you or your partner has HIV. Don't worry about it and stop testing!

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

HHH, MD
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21 months ago
All clear* and understood. Thanks for getting back to me so quickly. 

*Just for clarity: the blood that managed to slip inside the condom around the place was what worried me most but I guess I should just forget about it? 

Cheers 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
21 months ago
Of course you "should just forget about it". You noticed it because blood is so visible, but genital fluids probably often get inside the upper part of condoms during normal use. That's probably one reason condoms are less protective against skin-to-skin transmission (e.g. herpes, HPV, syphilis) than for STDs transmitted through fluids (e.g. HIV, gonorrhea, chlamydia). And as I already said, blood is little more infectious than genital fluids. And we already discussed the impossibility your partner has HIV. Let it go -- don't make sex and romance such a chore!---
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