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Risk assessment
Hello Doctors,
I am a 35 y/o white heterosexual female who made a stupid drunken mistake and had unprotected vaginal and oral sex with a white male that I just met (neither of us has ever used IV drugs). We had vaginal sex for a couple of hours, but he did not ejaculate. He and I both have HSV (neither of us know which type exactly, but both of us have it genitally). As it turns out, he came down with an outbreak the following day. He tells me he believes that there's no chance he has HIV, but he hasn't been tested recently. He says he has had very few sexual partners outside of long term relationships with women but I can't be sure if he's telling the truth since I don't know him well. I also have a *VERY* strong suspicion that he is bisexual even though he states that he is hetero.
So, I am concerned about the possibility of contracting a different strain of HSV (depending on the type I already have), either orally or genitally. But I am even more concerned about HIV risk given the fact that we both have HSV and the fact that I am pretty certain that he "swings both ways."
I am going to get an HIV test tomorrow to be certain that I am clear from two previous unprotected encounters that occurred months ago (I believe the risk to be very low for those encounters), and I'm also going to get tested in 3-4 weeks to get the clear on this most recent unprotected encounter that is concerning me. Hoping I can get a little peace of mind from you on this.
Thank you!
I am a 35 y/o white heterosexual female who made a stupid drunken mistake and had unprotected vaginal and oral sex with a white male that I just met (neither of us has ever used IV drugs). We had vaginal sex for a couple of hours, but he did not ejaculate. He and I both have HSV (neither of us know which type exactly, but both of us have it genitally). As it turns out, he came down with an outbreak the following day. He tells me he believes that there's no chance he has HIV, but he hasn't been tested recently. He says he has had very few sexual partners outside of long term relationships with women but I can't be sure if he's telling the truth since I don't know him well. I also have a *VERY* strong suspicion that he is bisexual even though he states that he is hetero.
So, I am concerned about the possibility of contracting a different strain of HSV (depending on the type I already have), either orally or genitally. But I am even more concerned about HIV risk given the fact that we both have HSV and the fact that I am pretty certain that he "swings both ways."
I am going to get an HIV test tomorrow to be certain that I am clear from two previous unprotected encounters that occurred months ago (I believe the risk to be very low for those encounters), and I'm also going to get tested in 3-4 weeks to get the clear on this most recent unprotected encounter that is concerning me. Hoping I can get a little peace of mind from you on this.
Thank you!
MEDICAL PROFESSIONAL
If your partner indeed had a new genital herpes outbreak the next day, you could have caught oral herpes by the oral sex contact. But just as for genital, not if you previously have been infected with the same virus type to which you were exposed.
Herpes is not spread by quick, casual, social kissing, and also not likely to be transmitted even before a new infection starts causing symptoms. Your friend's daughter is not at significant risk, even if you should turn out to have new oral herpes.
Please follow the advice I recommended above. But there's nothing else this forum can offer. Feel free to let me know how this turns out after you have been professionally evaluated and tested -- but until then I won't have any further comments or advice.
Herpes is not spread by quick, casual, social kissing, and also not likely to be transmitted even before a new infection starts causing symptoms. Your friend's daughter is not at significant risk, even if you should turn out to have new oral herpes.
Please follow the advice I recommended above. But there's nothing else this forum can offer. Feel free to let me know how this turns out after you have been professionally evaluated and tested -- but until then I won't have any further comments or advice.
Thank you so much, Dr. Handsfield. I really appreciate your insight and expertise.
I have one more question - am I at risk for an oral HSV infection since I performed oral sex on this partner (and would I be contagious within 3-5 days of days of contracting a new infection)? I am feeling really paranoid right now...my best friend's little daughter came up today and gave me a kiss before I had time to think about it or stop her, and now I'm freaking out that I could have possibly passed something on.
Thanks again!
I have one more question - am I at risk for an oral HSV infection since I performed oral sex on this partner (and would I be contagious within 3-5 days of days of contracting a new infection)? I am feeling really paranoid right now...my best friend's little daughter came up today and gave me a kiss before I had time to think about it or stop her, and now I'm freaking out that I could have possibly passed something on.
Thanks again!
MEDICAL PROFESSIONAL
Welcome to the forum. I'll address your two concerns, HIV and herpes, on at a time.
If your partner indeed has sex with men as well as women, the chance he has HIV would be elevated; and of course it would have been reassuring had he been tested recently. However, the chance remains low he has HIV. And even if he does, the transmission risk (male to female) for any single episode of vaginal sex averages around 1 in 1,000, so the risk is always pretty low for any particular event. If you have genital HSV-2 (but not if you have HSV-1), your risk is roughly doubled -- but I think you'll agree that 1 chance in 500 remains very strongly in your favor. To ease your concerns, I would recommend you have an HIV test in a few weeks. But you should stay relaxed in the meantime; all things considered, it is very unlikely you acquired HIV.
Going to herpes: It is important that you learn whether your genital herpes is caused by HSV-1 or HSV-2. The two types are very different in the frequency of recurrent outbreaks, potential for sexual transmission, association with increased HIV risk, and possible value of suppressive anti-HSV therapy (in each case, HSV-2 is much more a problem than HSV-1).
If both you and your partner's genital herpes are with the same HSV type (either HSV-1 or 2), then you are not at risk. People are immune (or at least highly resistant) to new infections with the type they already have. However, if your partner's HSV type is different than yours, then you would appear to be at very high risk for a new genital herpes infection. The potential for transmission probably is highest in the 24 hours just before onset of symptoms of a new outbreak. So you'll need to be on the lookout for new symptoms -- genital blisters, sores, etc . In most cases, onset is 3-5 days after exposure, but it can be as long as 10 days and rarely up to 3 weeks.
For these reasons, I recommend you have an HSV blood test in the next few days, which will tell which HSV type(s) you currently are infected with. Assuming a negative result for at least one type, if necessary you can be retested after a few weeks to make sure it didn't become positive.
I hope this has been helpful. Best wishes-- HHH, MD
If your partner indeed has sex with men as well as women, the chance he has HIV would be elevated; and of course it would have been reassuring had he been tested recently. However, the chance remains low he has HIV. And even if he does, the transmission risk (male to female) for any single episode of vaginal sex averages around 1 in 1,000, so the risk is always pretty low for any particular event. If you have genital HSV-2 (but not if you have HSV-1), your risk is roughly doubled -- but I think you'll agree that 1 chance in 500 remains very strongly in your favor. To ease your concerns, I would recommend you have an HIV test in a few weeks. But you should stay relaxed in the meantime; all things considered, it is very unlikely you acquired HIV.
Going to herpes: It is important that you learn whether your genital herpes is caused by HSV-1 or HSV-2. The two types are very different in the frequency of recurrent outbreaks, potential for sexual transmission, association with increased HIV risk, and possible value of suppressive anti-HSV therapy (in each case, HSV-2 is much more a problem than HSV-1).
If both you and your partner's genital herpes are with the same HSV type (either HSV-1 or 2), then you are not at risk. People are immune (or at least highly resistant) to new infections with the type they already have. However, if your partner's HSV type is different than yours, then you would appear to be at very high risk for a new genital herpes infection. The potential for transmission probably is highest in the 24 hours just before onset of symptoms of a new outbreak. So you'll need to be on the lookout for new symptoms -- genital blisters, sores, etc . In most cases, onset is 3-5 days after exposure, but it can be as long as 10 days and rarely up to 3 weeks.
For these reasons, I recommend you have an HSV blood test in the next few days, which will tell which HSV type(s) you currently are infected with. Assuming a negative result for at least one type, if necessary you can be retested after a few weeks to make sure it didn't become positive.
I hope this has been helpful. Best wishes-- HHH, MD
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