vaginal bleeding

[unlucky28]

Dear doc, like anyone here I made a big mistake. I’m well known with all dangers and transmission rates. So, I'm dating a girl for several weeks and last night we had unprotected sex for the first time, when I withdrew I saw there was blood from her on my penis and urethra.

Ofcourse this totally freaked me out. I was so stupid to mathematically calculate the chance of infection (which I know is about 1:1000) on forehand, but with the presence of blood this will probably increase highly. I will get tested (and ask her to test also), but in the meantime I would like to know what my chance of infection could be when she is HIV+ (she has not done any recent testing). Do you think 1-5%?

Thank you, and let this be a warning for everyone not to rely on mathematically low-risk…

[H. Hunter Handsfield, M.D.]

Sex during menstruation roughly doubles the risk of HIV transmission by vaginal sex.  The average risk by vaginal sex, from female to male is around 1 in 2,000.  So your risk might have risen to 1 in 1,000 -- nowhere near 1-5%.  But the odds are strong that your partner didn't have HIV, in which case your risk is zero, blood or no blood.

You have a very inflated view of overall HIV frequency in women and the risk of transmission.  Let's do a quick mathematical odds calculation.  Let's say there's a 1 in 1,000 chance your partner had HIV; that's the average in American women.  Then assume a 1 in 1,000 chance you caught it, if she had HIV.  The chance you have HIV comes to 0.001 x 0.001 = 0.000001, or 1 in a million.  

To that into perspective:  If you live in the US, your chance of dying within the next 12 months of some accident is 1 in 1,756, according to the National Safety Council.  That means the chance you caught HIV is 570 times lower than the chance you're going to die of an accident in the next year.  Your "warning" to other forum users is irrelevant and meangingless.

Bottom line:  You don't need HIV testing on account of this event, but it's fine with me if this reassurance doesn't erase your fears.  In the meantime, don't forget your seat belt.

Regards--  HHH, MD

[unlucky28]

Thanks doc, I like that last sentence ;) A last respond if you would allow this: considering her social 'high class' status the risk she is infected is indeed low, probably lower than average. I know I might overreact, but apart from that I am interested in the statistical chance of 1:1000.

The reason I took the 1-5% chance is because when having anal sex with a female, the chance of infection is about 1:100/200. I thought the odds are that much higher than with vaginal intercouse, because with anal intercourse bleeding can occur (and blood having a higher viral load then body fluids causing the higher risk). But bleedings during anal sex do probably not always occur; so if bleeding does occur the chance should be higher, like 1:50. In the case of vaginal bleeding, muscous membranes/the urethra have come into touch with blood; in my view the chances of infection should therefore be higher than 1:100/200. I'm really curieus at the theoretical support.

[H. Hunter Handsfield, M.D.]

I missed that you had anal sex.  That increases the risk, but probably to around 1 chance in 500, not 1 in 100-200.  (The latter is the risk for the receptive partner; the risk for the insertive partner is lower.)  On the other hand, as you suggest, higher educational attainment, income, and social status generally are associated with lower HIV risks, so the chance your partner has HIV is probably under 1 in 1000.

I have to say that I see a disconnect in your thinking.  If you are so concerned about the HIV risks, why didn't you sort out your partner's HIV status before having sex at all?  Whether or not you have anal sex or sex during menstruation are minor considerations compared with a decision to have sex at all, and compared with a partner's actual infection status.  This doesn't imply I think you really were at risk; I do not.  But you are reacting emotionally after the fact of these exposures, when it would have made more sense for you and your partner to just be tested together before you became sexually active.

Anyway, stop calculating the odds, which is over-thinking the situation.  None of these odds means squat if neither of you has HIV.  So just get tested (both of you) then forget about it.

[unlucky28]

Thank you doc, you do not need to reply to this. I just want to clarify that I did not have anal sex; what I wanted to say is that in my view the risk of vaginal intercourse with vaginal bleeding present should be more like the risk as having anal sex, rather than a doubling risk rate of 'normal' vaginal intercourse.

But I stop calculating the odds. I fully agree with your argumentation (which is in line with my view on sex, but humans and mistakes...). Btw, the bleeding was not due to menstruation, she said that happenes more often during sex.

[H. Hunter Handsfield, M.D.]

Now you raise an entirely new issue.  Bleeding triggered by sex can be sign of STD (e.g., chlamydia, gonorrhea, herpes of the cervix).  If she has had that symptom checked out and all is well, then don't worry about it.  If not, it sounds like she needs to see her primary health care provider or gynegologist about it.

That will need to be the end of this thread.  Best wishes--  HHH, MD