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Female-to-female sexual transmission likely caused HIV in Texas woman
A Texas woman with HIV likely acquired the infection through female sexual contact, according to the CDC.
The 46-year-old woman who acquired HIV had a history of heterosexual intercourse, but not within 10 years before the infection. She also reported no injection drug use, tattoos, acupuncture, transfusion, transplants or other HIV risk behavior. She reported three female sexual partners in the preceding 5 years. The woman tested negative for HIV by HIV-1/2 enzyme immunoassay (EIA) serology screening after donating plasma in March 2012.
Ten days after donating plasma, the woman presented to the ED with a sore throat, fever, vomiting, decreased appetite, pain on swallowing, dry cough, frequent diarrhea and muscle cramps. The EIA test was negative at that time and she received treatment for a presumed upper respiratory infection. The woman again attempted to sell plasma 18 days later, when her EIA serology and Western blot test were positive for HIV.
The woman had a virus that was almost genetically identical to her female partner’s virus. The partner had been previously diagnosed with HIV and stopped receiving antiretroviral therapy in 2010. During the 6-month monogamous relationship, the couple had not received any preventive counseling. They reported routinely having unprotected oral and vaginal contact and sharing sex toys. They also described rough sex to the point of bleeding and unprotected sex during menses.
“All persons at risk for HIV, including all discordant couples, should receive information regarding the prevention of HIV and sexually transmitted infections to prevent the HIV-negative partner from acquiring the infection,” the CDC investigators wrote. “Furthermore, all persons identified as infected with HIV should be linked to and retained in medical care. Control of HIV infection with suppression of viral load can result in better health outcomes and a reduced chance of transmitting HIV to partners.”
Perspective
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HIV virions are present in blood and probably all other fluids in the body. In the absence of effective HIV suppression through antiretroviral therapy, blood and other fluids, particularly semen and general secretions, can transmit the infection if introduced in sufficient quantities in another person. Sexual HIV transmission between women has been rarely reported. Reasons for this may include a small volume exchanged compared to ejaculated semen and more effective barriers in the vagina compared to the rectum. In this report, the additional possible risk of blood exposure due to “rough” sex may be an issue. This case, as do all cases of HIV transmission, underscore the need for HIV case finding leading to prompt HIV care and effective antiretroviral therapy. Each new case of infection, regardless of the sex of the source or recipient, is a failure of applying well established prevention methods and reason to make sure that case finding includes women as well as men.