Menstruation and HIV

[afraidbutstrong]

Hello,

I am concerned about a possible HIV transmission.  I am currently traveling in Brazil, and three weeks ago I had protected vaginal sex with a woman.  This woman is not a CSW to my knowledge; we met over a friendly drink at a bar by the beach. After about 10 minutes into the sexual encounter, she realized she was menstruating, and we immediately stopped.  I went into the bathroom and found that there was about a quarter teaspoon of blood on my scrotum and at the base of my penis.  I immediately washed myself completely as best I could.  I did not notice any cuts or breaks in the skin in the entire area, but I wasn’t using a magnifying glass either.

Right now I am having symptoms similar to ARS, which include swollen tonsils (one tonsil in particular is painful), fatigue, body aches, and a rash over most of my body.  The rash itches slightly.  The swollen tonsil has been there for a week, the fatigue for about 10 days, and the rash I just discovered two days ago.

This has me very worried.  I feel I took the proper precaution of using a condom and happen to have sex with someone who is menstruating.  But I guess the best protection is to not have sex at all.  I am not a person who has sex often.  My last encounter was in October of 2011.  I am here for another three weeks and I feel my vacation is ruined, and I don’t want to get tested here.  I’m very preoccupied with this.

Any insight you can give on this would be most appreciated.

Thanks.

[Edward W Hook, MD]

Just as an FYI. if this is early HIV (which is the only sort of HIV your symptoms could be due to), you can get an HIV PCR today or whenever convenient and expect an accurate answer. The 28 day recommendation is for the "DUO"  (combination HIV p24 antigen/HIV antibody) tests.  Thus you can seek a PCR as soon as is convenient.

Second and just as an fyi, because there are so many possible causes of your symptoms, about 25% of mononucleosis is caused by CMV, not EBV.  Thus, the odds remain in your favor.

Finally, if this is strep throat, the sooner you find out, the sooner you can be treated and get better.  

I look forward to hearing about your test results an wish you the best.  EWH

[afraidbutstrong]

Thank you doctor.  I have already had Epstein-Barr mono, so I don't think it'll be that.  I will have to wait about nine more days until the 28-day mark for a PCR test.  Until then, I will find a ID doctor here who can hopefully find some other cause for this recent illness.  Also, I will try to stay calm.  It's just troubling that while trying to do everything possible to be safe short of being abstinent, I could still have a major problem.

I will update you on the results of any tests I have.  Thanks again.

[Edward W Hook, MD]

Welcome to the Forum.  I'll try to help.  While the timing of your current illness, three weeks after the exposure you describe, and your symptoms are certainly suggestive of early HIV infection, the odds are still very much in your favor that this is not HIV.  Most women in Brasil do not have HIV, you used a condom, and surface contamination to menstrual blood of the sort you describe very, very rarely, if ever, transmits HIV.  When persons with the sort of symptoms you describe have been tested for HIV, less than 1% have HIV, the remainder having mononucleosis and other far more common, community acquired viral illnesses of the sort that most people get from time to time.  

Your situation brings to mind another recent post we had that had a happy ending.  Here's the link-  http://www.medhelp.org/posts/show/1733048  ;

So, what should be one. Fortunately, the medical care available in Brasil is quite good, Further, because your symptoms could be something like a strep throat that would benefit from treatment, I would suggest seeing a health care professional.  At the very least you need a test for strep throat.  You may also wish to be an HIV PCR test- if you are experiencing the ARS, it will be positive.  I doubt that it will be but it’s clear that you are concerned and I suspect a negative test will provide you with the peace of mind to permit you to enjoy the reminder of your vacation.  EWH