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Protected sex with open sores from herpes outbreaks
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Protected sex with open sores from herpes outbreaks

Dear doctor,

I was diagnosed positive for both HSV 1 & 2 on July 14. My first genital outbreak started three months prior to these diagnosis, and it had been pretty frequent (every 2 weeks). The outbreaks are sometimes classical, while some other times, it appears like a small pimple. I never have an outbreak in my mouth, though. I tested negative for everything else, including HIV.

My stupidest mistake was made on July 23rd 2010. I went to a prostitute place in Indonesia (supposedly a high class "legal" prostitute) during a business trip. At the time, I was having an open sores from an outbreak, which I thought was  already healed. I put a condom on during the intercourse, and it stayed intact for the next 3 minutes. I could clearly see that the condom cover the outbreaks. It was a classical one, and there were no more white/yellow fuss on it. After I was done with the intercourse, I noticed that the sores were not dried yet. It appeared to be kind of bloody reddish - I think it's a result of from friction during the intercourse. The Outbreaks finally healed up the next 4 days.

A week after that, I was having another outbreak. Unlike the recurrences before, it came out in thee different places (usually it was just one place.) They look more like small pimple (white fuss on top) and it lasted longer than usual - although I already took valtrex the 5th day after the onset.

Note: The girl told me that they get tested every 3 months, and her vagina was checked every week. She urged me to wash my genital before we had sex, and she washed herself too after we're done. She performed oral on me with a condom on too. The reason she didn't see my sores at the time was because I covered it, and it located at the bottom of my penis. Now, I feel really bad of putting her at herpes risk.

Would you recommend me to get tested for HIV again? I've been so worried ever since. What's really my risk here with and without a condom (assuming she's HIV+).  













Tags: HIV
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300980_tn?1194933000
I have several comments.  Before I address your concerns, I would be remiss if I did not point out to you that for you to have sex with a partner who you do not know is infected (and despite the fact that she is a commercial sex worker, you do not know that she has HSV) is irresponsible, even if the sex is condom protected, and places her at risk and thereafter, should she get infected, increases risk for other,  future partners.  it is behavior like this that leads to the transmission of HIV.  I suspect you know this is the case, otherwise you would not have hidden your outbreak from her.  Your behavior saddens me.

Now for your question.  You had condom protected sex with a partner of unknown HIV status while you were having an outbreak of genital herpes.  Does the presence of the genital herpes outbreak increase your risk for infection?  No, condom protected sex is safe sex and the potential exposure did not put you at risk. Had your encounter been unprotected, your risk for getting HIV would have been about 3 times higher than if you did not have an outbreak but that risk is still statistically quite low.  

The outbreak that occurred after your exposure may have been a herpes outbreak or may have been something else, perhaps a secondary infection due to your exposure with open sores.  If is gone now, you need not be concerned about it.  There is no way to tell at this time what it might have been.  

As for your anxiety over HIV, it is now nearly 5 weeks since your exposure.  If you wish to be tested to relieve your anxiety, a test with a combination HIV p24. HIV antibody test (sometimes called the DUO test) will provide definitive evidence as to whether or not you were infected.  Statistically it is unlikely but if you wish to prove it to yourself, you could do this by testing as I have suggested.  A standard antibody test for HIV taken at this time would detect about 90-95% of infections at this time.

I hope this is helpful. EWH
10 Comments
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Avatar_m_tn
I realized it was totally a mistake - one of the biggest indeed. I didn't think that far (stupid, i know) all i thought was protected sex is safe sex. STUPID! I felt really bad afterward to the CSW. Thank you for your concern doc, this won't happen again. And I will definitely start to support the awareness for HIV in my area.

Just curious though, you said it's statistically unlikely, bus is it technically likely?

Also, you said that, although the risk is 3x higher, statistically it's still quite low. How could that be? I mean, an open sore is an easy getaway for virus to get in, right? Or is there a preference that the virus enter through through the urethra instead? Thank you very much, doctor!






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300980_tn?1194933000
Not, it is not likely.

An example, if your risk of HIV while using a condom is 1 chance out of 10 million (and this is a reasonable estimate), then your risk with gential (genital) ulcers (herpes) would increase about three times to 3 out of 10 million- still quite low.  The virus could gain entrance throught the sore.  EWH
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Avatar_m_tn
Dear doc,

it's passed 10 weeks since my last encounter. would a blood test at this time confirm my status? any specific test you recommend?

and one last question: if I experienced fever, body aching, feeling of run-down, etc when I was first infected with hsv, would I experience these kinds of ARS if i were infected with hiv?

thanks a lot doc!
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300980_tn?1194933000
At this time a negative blood test for HIV would be proof that you did not get infected through your encounter of concern.  The symptoms of the ARS do not occur in everyone who gets HIV and is a poor indicator of infection. If you want to know about your HIV status, please get tested, and do not waste your time worrying about the presence or absence of ARS Symptoms.  EWH
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Avatar_m_tn
thanks doctor. i'll have the test this weekend. i'm just so worried, because i've always had a frequent ob ever since i was diagnosed almost 3 months ago. and i dont know if this frequency is due to the hiv or a weak immune system.

do you still believe my result would come out negative? thanka doctor!
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300980_tn?1194933000
The odds remain in your favor.  EWH
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Avatar_m_tn
hi doc,

my test at 82nd day after last exposure comes out negative at COI 0.217.
this confirms my status rite? i dont need any further testing, do i?

thanks a lot docc!!!
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300980_tn?1194933000
You did not get HIV form the exposure you mentioned.  You do not need further testing.  EWH
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Avatar_m_tn
I am amazed, make that disgusted, at how very, very concerned you are for your own well being yet you gave not a rat's *** about the well being of the prostitute.

It is miserable-skin-cherishing 'people' like you who perpetuate the misery of stds.

Having spoke my mind (& quite possibly broken a MH rule) I am done here & it's time for me to move on.

P.S. Dr. Hook you are a truly great humanitarian.
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