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A Texas woman recently diagnosed with HIV apparently contracted the virus from another woman, the Center for Disease Control says.

The woman diagnosed with HIV is 46-years-old and the CDC says she had a history of heterosexual intercourse, but not in ten years. According to the investigation, she “reported three female sexual partners in the preceding five years, but said she had no IDU, receipt of tattoos, acupuncture, transfusions, transplants, or any other recognized HIV risk behavior.” A female-to-female HIV transmission “has been reported rarely and is difficult to ascertain.”

The case was first reported to the CDC by the Houston Department of Health in August of 2012, after the infected woman visited the emergency room ten days after donating plasma, complaining of a sore throat, fever, vomiting, decreased appetite, pain on swallowing, dry cough, frequent diarrhea, and muscle cramps—all symptoms of the HIV virus. Initially, she tested negative, but tested positive 18 days later when attempting to sell more plasma. Reports say that the woman’s 43-year-old partner, who had tested positive for HIV in September of 2008, was the likely infector, as she was her only sexual partner in the six months before she tested positive.

The couple reported that they were “routinely having unprotected (using no barrier precautions) oral and vaginal contact and using insertive sex toys that were shared between them but were not shared with any other persons.” They also said their sex was sometimes “rough to the point of inducing bleeding in either woman,” and reported having sex while either woman was menstruating.