Giving Cunnilingus - Potential Blood Exposure

[bluefrost78]

I have been seeing a woman (white, 29 years old) who claims to have been tested before by her gynecologist; so I was more comfortable having sexual relations with her.  I have known her for about half a year and have never seen her sick or lose weight.

I performed cunnilingus on her (despite having a small sore/tender spot behind my two front teeth, which was not open/exposed).  After performing oral sex, we had a few minutes of protected intercourse, but we stopped.  She proceeded to give me oral sex and used spit to put her finger inside my anus.  After this experience, we noticed blood on the bedroom sheets (not a lot, but definitely some streaks).  She was not having her period, and she claims that she had had bleeding occur during previous intercourse with people in the past. She said that last time this happened she went to the gynecologist, who treated her (she claimed it wasn't bacterial/viral in nature last time it occurred).  I freaked out thinking that it was some potential STD like Chlamydia or Gonorrhea, which would make it more likely for her to contract HIV.  She also had a bisexual boyfriend in the past but claims they were in a committed relationship for four years (until she found him cheating on her with another woman).  That also heightened my anxiety.

My concern is as follows:  Theoretically, if she had already been bleeding while I was performing cunnilingus on her, what are the odds that I could have been infected with HIV if she indeed was positive?  Also, what about the potential exposure via "anal fingering" with spit as lubricant?

Does my experience warrant PEP? My window of opportunity is closing.  

Thank you for your time.

- Concerned

[Edward W Hook, MD]

The "scare" tactics result form over a hundred years of stigmatization of persons with and at risk for STDs. while this is clearly inappropriate and, in my mind, a hindrance to STD control efforts. The same thinking is active in other nations as well but things seem to be more intense here in the U.S. than elsewhere.  Wish that were not the case.  EWH

[bluefrost78]

First. Thank you for your well thought out and prompt reply.  My nerves have been significantly calmed.  A rhetorical question (so no response necessary) . . . why are so many unnecessary scare tactics employed regarding disease transmission?  Looking at literature online, one is exposed to so much fear-mongering that I feel as if some in the medical community (and those who have no place giving any medical opinion whatsoever, such as social workers) are causing people to endure mass panic.  I feel that you and your colleague represent a much more rational tone with respect to disease transmission than what is generally available for public consumption.  Thanks again.

[Edward W Hook, MD]

Welcome to our Forum.  Before we deal with your specific risks related to the exposures you describe, let me remind you that your partner, whom you have no reason to distrust has told you she was tested an her test was negative.  Presumably, this was since to her breakup with her bisexual BF as well. This most likely being the case, there is really no reason to even think that she might have HIV. That said and realizing the this really is a bit of a "what if" question, let's review your questions:

1.  Oral sex.  . The quoted figure for HIV risk, if one has oral sex (giving or receiving) with an infected partner is less than 1 in 10,000 and, in my estimation that is too high. Some experts state there is no risk at all from oral sex.  Neither of us on this site have ever seen or reading the medical literature of a convincing instance in which HIV was passed by oral sex.  This includes by all of the people who had gum disease, etc as well as performing oral sex on a partner who might have vaginal bleeding, irrespective of the source.  

2.  Saliva and anal masturbation. HIV is not spread through masturbation, irrespective of what is use for lubrication, including saliva.  This is true even though it is usual for persons engaged in mutual masturbation to get each others' genital secretions on one another in the course of mutual masturbation. Saliva is also not infectious adding yet another reason not to worry about her use of saliva to lubricate her finger.

Her ulcerative colitis in no way changes this statement.

There is no reason for you to worry about HIV and probably no goo medical reason related to this exposure to test, much less to consider PEP.  In my mind, for a health care provider to prescribe PEP after an exposure of the sort you describe is irresponsible.

I hope these comments are helpful to you.  EWH

[bluefrost78]

I also forgot to mention that this woman has ulcerative colitis and is thus predisposed to autoimmune disease.