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A Texas woman may have acquired HIV through sex with another woman, according to the CDC. The 46-year-old woman attempted to sell her plasma in April 2012, and a routine test of a sample came back positive for the HIV virus.

The same test had been negative when she donated plasma the month before. The woman was also negative on an EIA test 10 days after the March donation, when she went to an emergency department with sore throat, fever, vomiting, decreased appetite, pain on swallowing, dry cough, frequent diarrhea, and muscle cramps.

Although such cases have previously been reported, they tend to be difficult to isolate to sexual contact, the agency said in the March 14 issue of Morbidity and Mortality Weekly Report.

“Past confirmation of HIV transmission during female-to-female sexual contact has been difficult because other risk factors almost always are present or cannot be ruled out,” according to the CDC report.

But other risk factors in this particular case, such as injection drug use, tattoos, heterosexual sex, or other higher-risk activities were ruled out. Additionally, both women had HIV that was almost genetically identical when three genes were sequenced, the CDC report said.

Cases of HIV transmission via sex in lesbian couples are rare, as such transmission is considered to be extremely rare.

The woman at the center of this current case had been in a monogamous relationship for six months with a 43-year-old woman, who had been diagnosed with HIV in 2008 but who had stopped treatment two years later.

After the second woman was diagnosed as HIV-positive, the couple reported routinely having unprotected oral and vaginal contact, including sharing sex toys. They also reported that their sexual contact was occasionally “rough to the point of inducing bleeding,” the agency report said. If there was genital inflammation or abrasions, infected blood might also have carried the virus from one woman to the other.

Experts say that this case demonstrates the need for continued treatment for anyone carrying the HIV virus, not only for their health, but to help prevent the virus from being spread to others.