I have had a sexual encounter with a friend who does work a high escorting job often, we have a friendship with benefits kind of relationship. I have had several sexual encounters with her over the past year, some of which weren't protected, I have tested myself as I do regularly after some of them and had nothing. She also tells me that she tests regularly and have nothing, also, she told me that she doesn't have unprotected intercourse with clients, she mentioned that the only times she had unprotected sexual interactions were with her past boyfriends. Anyhow, I recently had an encounter with her where I had unprotected vaginal intercourse for probably 6 minutes before I realized there was a lot of period blood, afterwards, we both thought it would be better to use protection. Urinating afterwards, I realized there was a lot of blood coming out from my urethra and some were like clotted blobs. I'm not necessarily overconcerned with this as I trust her and have spent a lot of time with her but if I assume that she might be in a higher risk because of her job, should I be concerned with this event in terms of STDs transmission. 

I'm sorry for the long story, and thank you in advance.

I really wouldn't be very worried. From your description, your friend-with-benefits partners seems to be a typical high-end escort. Such women have exactly the attitudes and approaches to sexual safety she has described to you -- clients generally at low risk, consistent condom use, frequent testing, etc; and I see no reason not to trust that she has been tested recently and negative. As for risks from the exposure described, sex with HIV infected women during menstruation is no more risky for HIV, or only minimally so, that at other times. It makes sense, because the amount of virus in blood is no higher than in vaginal fluids. It's sort of interesting that some of her vaginal secretions, including blood, made their way into your urethra. I'm not a sufficient expert in the mechanics of sex to know whether or not this is common, or unique to your anatomy, the details of this particular contact, etc. But I don't see it as significantly elevating the low overall risk of this event.

What to do now? Maybe nothing. Or you could have a valid urine gonorrhea/chlamydia test, any time more than 3-4 days after the event. Or, since your partner is a friend, perhaps she would understand your concerns and agree to have a fresh round of STI/HIV testing. If negative for HIV, syphilis, gonorrhea and chlamydia, nothing more need be done. In fact, you both could be tested:  she has just as much cause to be concerned that you could have transmitted an STI to her as her to you (depending in part, of course, on other sexual risks you may have had). If for some reason she isn't keen in being retested, then in addition to a prompt gonorrhea/chlamydia test, you could be tested for HIV and syphilis in a few weeks. Of course this assumes you do not develop typical STI symptoms (urethral discharge, painful urination, penile ulcers or sores) in the next couple of weeks, but I doubt that will happen.

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

HHH, MD

Thank you so much for your response. I certainly won't test unless I develop some kind of symptoms because i would test anyway in 6 months which is my regular routine check. In regards to the blood in urethra, I think it has to do mainly with the position. Since you mentioned that the HIV virus in blood isn't much higher than in vaginal secretions, does that mean the likelihood of transmission is similar to unprotected sex, which I believe is somewhere around 1 in a 1000 ? 

Thank you again Doctor, this will be my last question.