Exposure to Sex Worker Menstrual Blood--Possible Skin Break

I have not seen this combination of factual circumstances in the archive, which prompts this posting and related questions.  About 4 years ago, I had protected vaginal intercourse with a sex worker of unknown status in the southwest region on the United States in 2002.  The woman was early 20s, caucasion, but HIV and drug use status is unknown, but drug use could be assumed based on younger age and working while menstruating.  She performed protected oral sex on me.  I did not perform oral sex on her.  After a couple minutes of intercourse with a properly placed condom, it seemed too wet for just vaginal secretions.  I stopped and observed that my condomed penis and uncovered testicles were smeared with a moderate amount of menstrual blood, which had been mixed in with vaginal secretions.  Of course, even a small amount of blood, especially if diluted with any liquid, appears copious.  I got up, carefully removed the condom, and washed the entire area for several minutes with body soap and water until any visible trace of the blood was gone and then splashed on some mouthwash, which demonstrates I was somewhat concerned with the blood exposure at the time.  The menstrual blood was on my skin for 3-5 minutes at most, but at least a couple minutes involved it being smeared around during intercourse before I noticed it.  Here is the kicker, so to speak, and what I have difficulty finding any information about on these archives or the web in general.  I had shaved the hair on my testicles and pubic area with a shaving razor earlier that day for that neatly groomed look.  This sometimes results in small razor cuts or scars much like a razor cut on the face.  These cuts dissappear quickly, but I have no doubt there were probably a few small razor cuts on my testicles before the encounter and these would have had a couple hours to close up.  There were no large lacerations or cuts, but there is a question whether the skin on my testicles was intact.  Ever since, I have had a nagging feeling that irorny almost demanded HIV transmission for the vanity of shaving ones testicles before seeing a prostitute.  I recognize that irony does not determine HIV transmission rates.  Although shaving of pubic hair is a fairly common practice, there is NO information on the effect of this practice on HIV transmission rates.  There is not much information on menstrual blood viral loads as compared to regular blood.  I guess the closest analogy is data from health care workers exposed to blood splashes.  I do recall a one night episode of fever, flu, chills and night sweats possibly within 4-8 weeks after the encounter, although it was much like any other one-day flus.  Otherwise, this is my one and only high risk activity since that time, and I remain healthy.  What are your thoughts about the possibility of HIV transmission from this episode?  Is testing recommended under these circumstances?  What about Hepatitis B or C from the blood exposure?  Thanks in advance.

[H. Hunter Handsfield, M.D.]

In theory, exposure to menstrual blood might slightly increase the risk of HIV transmission.  But the risk remains low for any single expsoure, and you wore a condom.  HIV is not transmitted through microscopic cuts on the skin.  For example, doctors and other health care workers never get HIV or viral hepatitis from just getting contaminated blood on the skin.

Anyway, it was 4 years ago.  Symptoms are NEVER a reliable indicator of HIV infection; never, nunca, nada, zilch, nichevo.  If you're worried, get tested--but I don't particularly recommend it unless you will sleep better knowing you have negative test results.

Good luck--  HHH, MD

[Escher1]

Thanks for the information.