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HIV Transmission from blood when undetectable??
Sep 13, 2011

G'day from Australia, Dr Bob!

I'm panicking here!! So is my (female!) wife!

I am poz, she is neg.

We have made the decision that we are comfortable with unprotected vaginal sex and have done a lot of research. ie It was an informed decision made by both of us.

I am on Atripla and never miss a dose. I have been undetectable for more than 3 years at every routine test.

Last night, my wife was on top and being quite vigorous. At one point she moved and I felt my cock bend the wrong way and felt pain there. It wasn't major so we kept on going. Then about a minute later I noticed quite a bit of blood on my cock. It's was not time for her period, so I can only think that I popped a blood vessel when she was riding and my cock bent in the wrong direction. (My cock feels fine today and no issue with that).

However we are both really worried about transmission risk from my blood. Yes, we made a choice based on research that we are comfortable with unprotected sex together and I never cum inside her. But this last eposide was one we never considered!

I know undetectable means no virus can be detected in the blood, but could still be there. (My tests go down to measuring a level of 40 copies).

Based on the fact I've been undetectable for more than 3 years, no other STI's and we stopped about a minute after my cock got bent the wrong way, and she went and showered and cleaned herself immediately, is her risk for exposure high do you think?

I know this is a weird situation... But I guess on this forum you're used to that!

Thanks if you can offer some thoughts. Cheers!

Response from Dr. Frascino

Hello, Oz Magnetic Couple.

Unprotected sex, even with an undetectable viral load, still carries some degree of risk for HIV transmission/acquisition. That risk would be increased if fresh HIV-tainted blood was involved, or alternatively if your wife had some type of bleeding wound or was menstruating. Either way, a course of nPEP (nonoccupational post-exposure prophylaxis) would be warranted, if it could be started as soon as possible and no later than 72 hours after the incident.

Good luck.

Dr. Bob



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