hiv risk with protected sex +hsv2

[zackw945]

Hello,

I recently came down with what I thought was an hsv1 infection on my lips a few months ago. It turned out to be hsv2 after 16 weeks.  for the first time, around month 4,, I had a small hsv lesion appear at the base of my penis shaft. 1 month later,  about 2 weeks ago , I had a second time.

I recently had protected sex with a woman of unknown Hiv status. however the place where the lesion appeared both times is just out of reach by the condom. probably at or right past where it stops covering.

I live in the philippines, the girl is my neighbour, works as an exotic dancer(a CSW), and we both got off work and had been drinking heavily on the roof of our condo building.

It has been about 1 week since the lesion healed. I am concerned with the following:

1) at the start, she attempted to frot me or have unprotected sex. she was giving me oral sex, then proceeded to climb on top of me and put my penis inside of her (or rub against). my penis touched her vagina or entered her slightly. it lasted no more than 3 seconds. I got up and soaped and watered immediately after. what is the hiv risk if any?


2) what is my HIV risk with protected sex, given that I have herpes 2 on an area is not covered by a condom. we had sex 3 times during the night, each time was with a condom and lubricant, properly used. I washed with soap and water afterwards. Due to intoxication I was unable to ejaculate the first 2 times. I'm unsure to the total time having sex.

3) I felt pain in my skin around the base of my penis while having sex, not in same place as lesion, I think b/c the condom was pulling on my pubic hair. (I don't think i had a cut).. is this a  concern?

4) should I be tested for this? should I take PEP if it is available to me?

[zackw945]

Heh, thank you for re assuring me doctor :)

I'm just trying to make sure I understand all the risks, so I know the how to proceed in the future.

Thanks for your time sir

[Edward W Hook, MD]

I think you are being a worry wort.  Her negative DUO test assures you that she could not have infected you.  Further, there is no reason for concern related to her "squirting", if that is what it was while you were in bed together.  EWH

[zackw945]

Hello,

I went and did monthly hiv (a bit of a routine, worthwhile I feel since its 8 bucks for a DUO test, why not?)

I dragged her down 6 days after, she tested negative as well.

Do you think I have anything to worry about given that this wouldn't cover the window period fully?

I'm not trying to be a worry wort, but  could you answer one last thing for me?

I had slept with 5 days later (the 6th day I dragged her to the hospital), we didn't have sex, but when I woke up, my king size bed was completely soaked through, with what I presume to be sweat from her. I don't think it was urine, it didn't smell like it but my backside was also soaked straight through my sweats and shirt. this was the second time she was sweating profusely.

as I understand, there is no hiv risk from urine or sweat, however if it was from her squirting, then there could be correct? since my HSV infected skin was literally soaked in contact with the sweat for some time, I could have a concern potentially.

I don't think it was her squirting, but she was very wet the night before, and dripping ... I've had some experience with squirters , they are quite capable of drenching the bed in its entirety. She also claimed she doesn't squirt.

We DID drink a lot, but I wouldn't call it excessive… Is this anything hiv related that you think i should worry about, or am I clear?

[Edward W Hook, MD]

Souds to me as though you have a good plan.  Take care.  I lok forward to hearing your friend's follow-up test results - I anticipatethey will be negative.  EWH

[zackw945]

Doctor,

sorry, had a lack of internet for a day...thanks for your help. I'll try to find a place to examine them if / when they show up again.

I appreciate your help. My friend also agreed to an hiv test. so while its too late for pep (if it were necessary to begin with), at least I can put my mind at rest in any case.

[Edward W Hook, MD]

You'll need to speak with a dermatologist about your regular doctor to explore alternate diagnoses.  It will be hard to tell unless your lesions can be examined.  EWH

[zackw945]

Thanks doctor, my mind is much more at ease... I think I will still change my lifestyle while they finish up a therapeutic vaccine for this junk.

So essentially, protected sex with hsv2 is still more or less protected sex and it's far more likely I'll have a broken condom cause a risk as opposed to getting hiv from infected skin?

Re: hsv, if it turns out not to be hsv, do u know of any illness that presents like herpes but isn't?

[Edward W Hook, MD]

For a person with genital herpes who was exposed to a person with untreated, active HIV (which is, in itself unlikely), the risk for acquiring HIV would still be less than 1 in 100,000 and probably closer to 1 in a million.  Not something to be worried about.

Values for the HerpeSelect test vary from person to person and typically fluctuate when the same, unifected person is tested repeatedly.  In some persons who acquire HSV-2 the levels climb slowly while in others with equivocal tests such as yours persons can be transiently falsely positive.  I would suggest that you repeat the test a few weeks after your last test.  If the result is negative, your prior test was falsely positive and you do not have HSV, if it is above 3.0 then you have acquired herpes, if it is between 0.9 and 2.9, you need a confirmatory test with a different test such as a Western Bot perfromed at the University of Washington or a diffent herpes test such a the Biokit test.  EWH

[zackw945]

Am I overly worrying about this? I just don't know the risks for this situation and I prefer to be as informed as possible

[zackw945]

Hmm, do u have an idea what the odds of acquiring hiv are with a condom + hsv would be?

Also, do u have any idea what it could be if not hsv2? I should also say the initial value of hsv2 was .34 for every test but the last 2, .86 and then 1.6

[Edward W Hook, MD]

thanks for the additional information.  It makes me doubtful that you have HSV at all.  Our research shows that in well over half of people with HerpeSelect blood test values for HSV-2 of 1.5-2.0, these results are falsely positive and, in fact, the "positive" tests are falsely positive.  I am skeptical that you have HSV at all.  

If you do happen to have herpes, your overall risk for HIV, as well as your risk for giving herpes to others, is low.  the single best thing you could do is use condoms for all sexual encounters.  Having HSV is certainly not a reason to take PrEP.  EWH

[zackw945]

oops, I also meant to add, Hospitals and clinics here don't do cultures or swabbing for herpes. I can press this issue  next time something shows up, but I only had the initial OB on my lip. and then 4 months later I had one on my penis. I would not have not even noticed on my penis, except I woke up one morning and scratched myself, and noticed a 'wet spot' where my nail popped the blister , the second time only lasted 2 days, before it was just red.

I suppose I can try to grab a flight to singapore at the first time something shows up, I'm not sure I can book a flight and get there in time tho.

[zackw945]

Hello Dr. Hook,

Thank you for the prompt reply, I appreciate it very much.

Due to my initial oral presentation and lack of genital presentation, and since my Ex girlfriends mouth was full of sores but claimed nothing presented on her genitals as well, I thought it was likely hsv1. however in the most recent test at month 4, the Igg came back 1.6 for hsv2 , and no hsv1.

re: std testing. I regularly test for STDs, including hiv.I have none except for hsv2. As u have guessed, I'm paranoid. then again, I feel its warranted given the locale where I live.

with regards to her being a CSW, I am certain she is, b/c I have visited her  place of work and seen her working there (she told me about it). the way these places work is anyone can go in and 'bar fine' and take out the girl or just do their business in the back.

The reason I am paranoid living here, is b/c a significant percentage of the girls living in manila, work in bars. or barring that, free lance to supplement their daily wage (about 10 bucks), do the college thing, whatever.

Can I ask, is it even safe for someone to have protected sex anymore with hsv2 lesions that present outside of an area covered by the condom? I read this, and it has me a little unsettled:

http://www.nih.gov/news/health/aug2009/niaid-02.htm

Are there any pointers you can give me, outside the basics ? wear a condom, take a shower etc? would taking a PREP for hiv minimise my risk? or is it unnecessary you think?


Thank you,

[Edward W Hook, MD]

Welcome to the Forum.  I will try to help however, like Terri, I am not entirely sure that you have HSV-1 or HSV-2.  If you got HSV on your lips (cold sores are nearly always HSV-1) then it is not clear how you would have gotten HSV-2.  It is certainly unusual for a person to get both HSV-1 and HSV-2 at about the same time.  Do you have positive cultures or PCR from either of your possible sites of infection?

Even if you have HSV in either location, you would not be in a group for who PEP is recommended, nor are you at particularly high risk for acquiring HIV.  It is unlikely that your partner has HIV, even if she is a CSW and even if she does, following three sex acts, protected or unprotected, your risk for having gotten HIV even if she was infected would be less than 1 in 100.  When exposed (and you probably were not) the presence of genital HSV is estimated to increase the risk for infection about three-fold, increasing the risk from about 1 infection per 1000-2000 sex acts to about 1 infections for 300-600 sex acts.

My advice to you is for you to be tested for bacterial STIs such as chlamydia and gonorrhea for which your risk of infection is far higher than your risk for HIV and then to see of your partner/neighbor would be willing to test.  If her test is negative there is virtually no risk that you were exposed to HIV and therefore no reason for concern.

I hope these comments are helpful to you.  EWH