HSV-2 Complication

[JohnDoeGo]

Doc HHH,

     Sorry, should have known I needed to post as a new question (so this will be my 2nd of two new posts allowed per 6 months, if I have read the rules correctly)

     In my last post I described condom protected sex with a prostitute, followed by many (one could even say most) of the ARS symptoms), followed by negative gum swab oraquick advance tests at 6 weeks and 7 weeks 2 days.  You had said in my case the last test was conclusive and i didn't need to re-test.

    Now i realized that 2 weeks after sex with the prostitute, i tested negative for Herpes.  3 weeks 2 days after we ha sex i tested positive for HSV-2 (1.8 with normal <.9) an negative for HSV-1.  This seems to indicate i got Herpes from the prostitute, doesnt it?  The only other options would be condom protected vaginal sex and unprotected felatio with my ex-girlfriend (who I'm basically 100% sure didn't have HSV-2), or casual unprotected oral sex with a girl (not a prostitute) 7-8 weeks before the positive HSV-2 test.

If I did get HSV-2 from the prostitute, it was with condom protected vaginal an oral sex?  How could that happen?  There was some body rubbing unprotected, but very little with my penis and her vulva, if at all.  Perhaps there as something wrong with the condom, even though I took a quick glance and it looked okay?  The room was dim and I had a little trouble getting it on.

     Does this new information change your opinion that I can be certain I don't have HIV and don't need further testing beyond my 7 week 2 day negative?

thanks Doc

[H. Hunter Handsfield, M.D.]

It doesn't matter, makes no difference.

No further comments, please. This thread is over.

[JohnDoeGo]

So just to make sure I understand correctly so i can have a plan pf action:

1) i have had most ARS symptoms (including doctor confirmed nodes in groin and neck, muscle aches and pains, upset stomach / loss of appetite, etc.) lasting for 3.5 weeks plus

2) negative oraquick test at 6 weeks and 7 weeks 2 days

3) condom protected sex with commercial sex worker in NYC (high rate of HIV) from which I likely contracted HSV-2 based on a 3 week 2 day test - and any degree to which this would draw into question the effectiveness of that particular condom

A) You suggest another HSV-2 test four months after exposure
B) You consider my 7 week 2 day OraQuick test for HIV totally conclusive and dont suggest (or think i need) another test at 3 months

Thanks, have a good day Doc.

[JohnDoeGo]

I was reading about the accuracy of HIV antibody tests and it seems that the OraQuick Advance is only 2nd generation, which means it takes longer to detect antibodies.  One paper I read put the window period at 42 days for such rapid tests, as compared with 22 days for the most recent generation of lab tests (3rd or 4th generation, which detect IgM).  Do you still think that a 7 week 2 day OraQuick negative test, like the one I had, is 99% accurate, even though it is supposedly second generation?

[H. Hunter Handsfield, M.D.]

Both.

[eaglesfan3313]

Dr.HHH u were saying that "HSV-2 increases the risk if exposed" is this saying that if u acquired HSV-2 during an encounter u r at higher risk for HIV for the same encounter or for subsequent encounters?

sorry for the clarification questions just want to get my facts straight so i have a better understanding of these things so i am better prepared in the future

thank you this is a great resource especially for a young person like myself

[H. Hunter Handsfield, M.D.]

I understood all that information. Your symptoms make no difference in my judgment, although I disagree that your symptoms were particularly suspicious for HIV. You correctly interpreted my advice.

[JohnDoeGo]

this is of course the same incident with the same CSW i am concerned about, both for HIV and HSV.

[H. Hunter Handsfield, M.D.]

This should have been in the STD forum.  But no big deal.

The blood test results new HSV-2 infection. However, most positive results are stronger than yours, usually with an ELISA ratio over 3 or 3.5.  So you might consider repeat testing a couple of months later.  

If you are newly infected, the commercial sex exposure seems the best bet, despite condom use.  In about half of all patients with new HSV-2 infections, the HerpeSelect test (which I think is the one you had) becomes postive by 3 weeks, so the timing is OK.  Oral HSV-2 infections are rare, and it is very unlikely you acquired HSV-2 from receiving oral sex either from your regular partner or the other exposure you describe.

Condoms are not perfect in preventing HSV-2 transmission, not because the virus passes through latex, but because of potential skin contact above the condom coverage, or from genital apposition without penetration.

Although getting HSV-2 increases the risk of HIV if exposed, the odds are low that your commercial partner had HIV (it's pretty uncommon in North American CSWs); and in any case, does not change the reliability of HIV testing.  You can rely on the negative test result.  You could have another HIV test at 3 months if you remain nervous, but that also would be negative.

Bottom line:  Have another HSV-2 blood test ~4 months after the exposure.  In the meantime, keep on the lookout for herpes symptoms like genital blisters or sores (which can be mild and virtually painless).  If the positive result is confirmed by repeat testing, most likely you'll never know for sure when and where you got it, but the commercial exposure would be the best bet.

Good luck--  HHH, MD