Likely Female-to-Female Sexual Transmission of HIV — Texas, 2012

In August 2012, the Houston Department of Health contacted CDC regarding the rare transmission of human immunodeficiency virus (HIV) likely by sexual contact between two women. The case was investigated, and laboratory testing confirmed that the woman with newly diagnosed HIV infection had a virus virtually identical to that of her female partner, who was diagnosed previously with HIV and who had stopped receiving antiretroviral treatment in 2010. This report describes this case of HIV infection, likely acquired by female-to-female sexual transmission during the 6-month monogamous relationship of the HIV-discordant couple (one negative, one positive). The woman with newly acquired infection did not report any other recognized risk factors for HIV infection, and the viruses infecting the two women had ≥98% sequence identity in three genes. The couple had not received any preventive counseling before acquisition of the virus by the woman who had tested negative for HIV. HIV-discordant couples should receive counseling regarding safer sex practices, and HIV-infected partners should be linked to and retained in medical care. Transmission of HIV between women who have sex with women (WSW) has been reported rarely and is difficult to ascertain. The potential for HIV transmission by femaleto-female sexual contact includes unprotected exposure to vaginal or other body fluids and to blood from menstruation, or to exposure to blood from trauma during rough sex. Other potential exposures associated with HIV transmission in WSW that must be ruled out include injection drug use (IDU), heterosexual sex, tattooing, acupuncture, piercing, use of shared sex toys between the partners and other persons, exposure to body fluids of others, and receipt of transplants or transfusion. Epidemiologic Findings The woman who acquired HIV was aged 46 years and had a history of heterosexual intercourse, but not in the 10 years before HIV infection. She reported three female sexual partners in the preceding 5 years but said she had no IDU, receipt of tattoos, acupuncture, transfusions, transplants, or any other recognized HIV risk behavior. The woman supplemented her income by selling her plasma and had tested negative for HIV by HIV-1/2 enzyme immunoassay (EIA) serology screening after donating plasma in March 2012. In April, 10 days after donating plasma, the woman went to an emergency department with a sore throat, fever, vomiting, decreased appetite, pain on swallowing, dry cough, frequent diarrhea, and muscle cramps. At that time, she was again tested for HIV by EIA serology screening, and the results were Likely Female-to-Female Sexual Transmission of HIV — Texas, 2012