HIV incresed risk with other SDT present

[Hopefulforhelp]

I'd like to thank you for all the wonderful information on this site and the work you do. I had been diagnosed HSV2 via a +HerpesSelect, IgG 4.51. I never had an outbreak. I have been told by several specialists that I do not have herpes, more so I've been exposed at some point. Is that IgG high? Can it be determined by an IgG when the virus was encountered? And do I or don't I have it based on a blood test? I know oral HSV2 is rare, yet how rare? And is it only rare because most people have already been infected with type 1 and the two can't reside in the same local? Is it because traditional recurrences of HSV2 don't happen orally and if that's the case, how frequent would shedding occur? Also, is it possible that a cause of TN is due to HSV2? I never had type 1.

A close friend of mine that I've known for ~6yrs is HIV+ ~11 years. He occasionally misses a dose on the anti-retroviral meds yet doing well. Recently, completely innocent intentions of cuddling escalated. We shared an open mouth kiss for a few moments and he performed oral sex on me for all of a minute. I've long since read HIV is not transferable via kissing unless both parties have open sores, yet today I read sores/ cuts to pass HIV can be very small and not readily noticeable.

In regards to the oral sex, I truly had no idea he was heading that direction. He states that my receiving oral sex from him carries no risk. He also states he would never put me at risk and I believe him give n the friendship we have. It would appear what had occurred carries a very low risk, if any... I do apologize for asking a 'low risk' question, yet I am concerned for the additional factors that exsist in our case. My concern is for 'any' risk. What's most concerning to me is I've also read that having HSV2 can increase the risk of transmission by 50%. Is this true without visible sores ever being present?

Some more questions I have... Although presumable only exposed to his saliva, how much blood (if any) would be required to transmit the virus? If his saliva entered an unnoticable sore in my mouth/ vagina, would this cause infection? What stage of HIV is most contagious? Is he more infectious by missing a dose? I have also read that HSV2 can be very pronounced in a patient with HIV. What are his risks, presuming I have it? I've read that it's rare to catch it orally if performing oral sex, how rare? Much like type 1 being passed via a kiss, can type 2 also be passed as easily given it's rarity?

I began suffering a sore throat that has lasted almost a week now to varying degrees. I have also been extremely tired yet no fever or chills.  I do plan to get tested after 3wks & again in 3mn, but I wonder if I should go for viral load testing? I am curious in regards to ARS, how soon do symptoms apear? If symptoms do apear do they all show up, only a few, or even only one. How long do symptoms last if/ when present? Do please advise! Thank you!

[H. Hunter Handsfield, M.D.]

monkeyflower, an STD forum regular, has already responded (below) with completely accurate information.  As she said, there is no such thing as being exposed to HSV-2 but not infected.  Your positive blood test means you have HSV-2, regardless of what symptoms you might notice.  In theory your infection could be oral, but genital (or anal) is far more likely.  From here on out, you need to tell any potential sex partner that you have genital herpes.

The risk of catching HIV by oral sex is low no matter what.  Your being positive for HSV-2 increases the risk, probably by about double--but 2 times a near-zero risk still is near zero.  The fact that your friend is on antiviral therapy also is very reassuring; he probably is not highly infectious.  Missing a single dose now and then is not likely to make much difference.

To answer all your questions in detail would require a couple pages of writing.  The bottom lines are that HIV transmission by kissing is not known to occur, and receiving fellatio has a risk around 1 in 10,000 as cited by monkeyflower; the risk by cunnilingus probably is even lower.

As I have said many times on this forum, symptoms never are a reliable indicator that someone does or does not have early HIV infection, even when the symptoms are typical for acute retroviral syndrome (ARS)--which yours are not.  You definitely should not have an HIV RNA (viral load) test.  If you want to be assured you aren't infected, just have a standard antibody test 4-6 weeks after your exposure.

Finally, read up on genital herpes, then be on the lookout for genital or anal area lesions.  People with positive blood tests for HSV-2 usually come to recognize at least mild symptoms, even if entirely asymptomatic before they were aware of the diagnosis.  You can start with the herpes article in the link STD Quick Facts and Articles on this forum's home page.

Best wishes---  HHH, MD

[monkeyflower]

You do have herpes. There's no such thing as being exposed and developing antibodies, yet not infected (although obviously you can be exposed and not contract it, you know what I mean). Most people are like you (and me) and are either asymptomatic or have unrecognizable outbreaks. But you definitely have it. The actual number doesn't matter, just that it's over 1 (or whatever the cutoff is).

As for the risks of receiving oral from a known HIV positive partner, I wish I could remember the exact statistic (1 in 10,000?), but it translates to one chance in like 27 years of daily blowjobs from a known infected partner. You most definitely have nothing to worry about; the risk is so low, having herpes means little/nothing. Kissing is no risk at all.

I'd assume that being HIV positive would increase his risk of contracting herpes, as well as increase the severity of possible outbreaks. I don't know how much, though, since it'd be HSV2 orally... I'd be interested to know the answer to this myself, since I have a very good friend and occasional partner who is undergoing chemo and obviously immunocompromised.

[Hopefulforhelp]

A response from the Doctor and MonkeyFlower! I have been all over the Internet (mostly .org and .gov pages) for the past six months and I find the STD and HIV forums on this site among the best! I really appreciate your expeditious responses! Thank you!!!
In regards to my possible HIV exposure, I pretty much 'knew' the no risk/ extremely low risk based on my reading. Yet, I like everyone else, thinks my personal situation is so unique. I have learned my 'fears' are simple nickel and dime psychology, a displacement of anxiety from the real issues occurring in my life. The only concerns that will still send me scampering for an HIV test is if, yet unlikely, there was any blood present in his mouth and if infected saliva entered directly into an unnoticable cut could cause transmission?!? Now day 15 post exposure my sore throat has gotten worse with small lumps in the tonsil area (prolly sinuses), my fatigue has increased (prolly sleep deprivation due to life circumstances) and the diarrhea has kicked in (prolly the near raw hunk of steak for dinner) So, I know, I'm beating a dead horse on this ; ) I'll test when it's time and keep you posted that I'm well!
I am more concerned for my HIV pos pals risk of getting HSV2. Since my diagnosis, I've had one partner that I intended to be with, yes I told him. We were careful and he didn't care. My friend I'm currently concerned for, I did not tell as we never had that type of relationship and it really did take me by surprise. This is why the encounter was so incredibly brief, I pulled him away, not so much for fear for myself, more so for him. We held each other and talked. I immediately told him of the HSV2 and reassured him my stopping had little to do with his HIV status (aside from me wanting to learn more safe practices if we chose to engage in that sort of relationship). To date he is showing no signs of HSV. It's my understanding, if symptoms were to occur, which would be likely in his case, it would happen within a months time, correct? Although I was told I don't need to by the clinics, for fear of passing it on, I am also taking Valtrex as prescribed by PPH. This would decrease the chances of transmission even if only via shedding, correct? or even better, does Valtrex suppress shedding too?  
Despite being told by the specialists I visited (ID & STD clinics telling me I've merely been exposed and don't need to tell anyone; and PPH stating it's no big deal that with the new tests out probably half the population will be found to have it). I have believed I have HSV2 since the test. I was shocked, horrified and all the emotional roller coaster it came with, so I 'wanted' to believe them. I was (still am) so distressed, I actually called Spotswood Spruance at home. He extended his sympathy on the diagnosis, yet reassured me that, though he can't be 100% sure given a phone call, it's unlikely I have it orally. Not that I disbelieve him or anyone regarding the rarity of the fact, yet I had noted some oral symptoms just prior to the test (which is what sent me for it) and some rather severe issues shortly after. Anxiety? Perhaps, yet I dread I am among the few that do have it orally.
I have since run to the clinics for every oddity I've noticed (below the waist) and all cultures remain negative. I have a bunch of 'theories' that I'd love to share, yet given this is the HIV forum, I'll post the details in the STD forum soon. I look forward to hearing back from you both!

[confused516]

The actual risk that is posted is .5 per 10000 with a KNOWN person to be positive.  Even this number is probably to high since it is basically just a guess because there have been no documented cases in 25 years.  Many experts say that the risk for Deep kissing and recieving oral sex are the same.  Zero or so close to it that it would be an extremly rare thing worldwide.

[confused516]

I am sorry I meant the last post to be to you guys

[grbala]

Hello Hopefulforhelp & Monkeyflower,

I too had a similar encounter with a friend who is HIV postive and homosexual.

One day we both masturbated on the bed using our own hands. It was not MUTUAL. I did for myself and he did for himself. Before that he did touch my genitials with dry hands. Also he has licked my neck. I had a sore in my neck and I had shaved 4 hours before that.

We were neither involved in oral, anal or not even a deep kiss.

1. What are the chances of HIV infection as he licked my neck where I had shaved and also had a open pimple?
2. Should I get tested?

I know the answers as I have read enough amount of information in the internet; however its hard to control the anxiousness?

Wish you the best too!

[who_is_this]

1) Zero
2) No

I doubt anyone will say anything different.  Read the archives.

[Hopefulforhelp]

Hi grbala, As you (and I) said, we already knew the answers. I think the wonderful thing about this site is the ability to get our own stories out there and answered by the professionals and people who have been there. It's not like we can talk to Mom about these things!

That said, a big fat no worries to you ; ) As who_is_this says and in my opinion, your risk is completely zero. If you need further reassurance check out this link http://www.thebody.com/sowadsky/faqs/faq1.html
"For cuts, once a scab forms (usually within a few hours), this would no longer give access to the bloodstream, preventing HIV from entering." Don't worry another second about that lil ole shaving cut!

I am no psychologist, but my life is filled with external issues outside my control. Sometimes when I can't (or don't want to) deal with something, my mind will race. That said, as far as your anxiety, are you an anxious person to begin with? If so, I'd stay away from any activities that might even remotely send you questioning. If not, ask yourself what you're really worried about... It shouldn't, by any means, be HIV based on your encounter.

My risk is soo near zero, it's not worth thinking about. Nevertheless, there I was, ugg! As Dr H says, symptoms are never a reliable indicator. As it turns out, mine were not caused by anxiety. I dragged myself to the ER last night (Not freaking that I had ARS, just cux I felt like ****) and it turns out I have sinusitis, baaaad. So, my only concerns that remain are for my HIV pos pal and my own questions on HSV2... something I actually have.

No worries my friend! Take care!

[grbala]

Thanks guys for the reply. Wish you the best.

[Hopefulforhelp]

Ok, herrre we go. Apparently, my pos pal and I can not stay away from eachother. Whenever I'm 'alone with my thoughts' I think 'this shouldn't happen'. We've been good friends for sometime, yet lately it's been magnetic. I really enjoy the comfort we give each other, Sooo, we had sex last night. No worries... kissing, cuddling, all the foreplay and completely protected intercourse. No, I am not TOO worried about getting HIV from this encounter as we were 100% safe, so I think. Based on my reading I believe the following to be true. Can I get a big ole yes confirmation on the 'safety' issues...

1) protected is protected and so long as the condom doesn't fail, break, or fall off there is no risk, be it oral, vaginal or anal sex.
2) There is no risk whatsoever so long as his blood or seman do not come in contact with any open wounds or mucosal membranes of mine.
3) The CDC recommends against 'french kissing' a partner 'known' to be infected, yet there has only been one case and blood was involved. Is kissing truly an absolute no risk or is the CDC imploring a CYA principle?
4) Previously, you've stated 'fellatio rarely transmits HIV; and cunnilingus never does' Is that HIV+ giving and HIV- recieving? I've read that lesbians have passed it, although extremely rare.
5) How long should I wait to get tested since our oral encounter? I'm assuming 4-6 weeks.
6) We will continue to be completely safe if/when together again, do I need to continuously get tested?

I imagine, dispite my willingness to give this a go and desire to be with him... given the apparent anxiety about this, I should seriously consider leaving it as friends only... I guess I'm looking for reassurance on 'safe' and testing for a final decision. Afterall, it's a virus and viruses can be elusive.


In regards to my HSV2...
I would not let him perform oral for the risk of transmitting HSV2 to him. There is so little information on oral HSV2, I really don't know what to think. My questions...

1) Assuming I have it orally (which I know is rare), given I do have tingling on my lips, do I have to forever be worried I will pass HSV2 by kissing?!? Not knowing this is rather distressful. Especially as HSV2 could be severe for him if aquired.
2) Obviously not in this case, yet future partners that test HIV/ STD negative, can I pass HSV2 by giving oral sex?
3) Assuming I have it vaginally, given that how rare having it orally is, can he catch HSV2 by performing oral sex on me?

I have yet to make time to post my theories and more questions in the STD forum, yet if you can answers these burning ones, I'd surely appreciate it! Thanks for being there!!!

[monkeyflower]

While you wait for Dr. Handsfield's response, you could consider protected oral, using a condom/dental dam/cut-open condom/plastic wrap. I actually very recently had my first experience with protected oral myself (I have HSV1 and 2, and my partner was concerned about contracting either one). From that experience I can tell you that 1. flavored condoms are gross AND made my lips go numb (disconcerting), and 2. receiving oral through plastic wrap, despite copious lube, is like receiving oral through a wetsuit. So yeah, it's far from perfect, but it still allows you to enjoy some of that closeness with your partner and alleviates the fear of contracting any STD.

The only risk associated with protected intercourse is a broken/slipped off condom. Still, it can't be that common. Granted, it's just my experience, but in all my years I've never personally experienced a broken condom and only had one slip off twice (which could have been easily avoided had either of us been more careful). I think condoms are more likely to break if there isn't adequate lubrication, so make sure you use plenty of waterbased lube, and a drop of lube inside the condom (increases his sensation, and decreases the risk of breakage).

I think the risk of deep kissing a HIV infected partner has to be virtually nil. I know Dr. Handsfield says otherwise, but I'm still more than a little skeptical of any information (particularly sex info!) from any govt agency these days. After all, Frist publicly claims that you can contract HIV through sweat and tears, federally funded sex ed programs in our schools are rife with outright lies, and our govt is funding programs both nationally and globally that assert condoms don't protect you from STDs (they actually mandate that verbiage). I could go on, but I'll spare you ;-)

Anyway, Dr. Handsfield just posted something about asymptomatic shedding of oral HSV2 on the STD forum, so hopefully he'll address these concerns as well. I personally think you're right to be concerned about transmitting HSV to him. I feel the same way about my friend undergoing chemo.

You sound like you have a really good and healthy approach to this relationship. I hope everything works out the way you'd like :-)

[H. Hunter Handsfield, M.D.]

I endorse monkeyflower's comments.

My main advice is that anyone who enters into a long-term sexual relationship with an HIV infected person should not rely on informal advice from the internet.  You and your partner should seek personal counseling and advice, perhaps starting with his HIV provider.  Depending on that person's knowledge, other sources may be needed.  But if s/he is good, perhaps s/he will become your joint provider, as a couple.

Everything you say is basically correct about HIV transmission risks.  But those risks are multiplied by repeated sexual contact, and mistakes occur, either because intended limits go by the wayside in the heat of passion (or with drugs or alcohol), and other mistakes can occur without being apparent.  Therefore, the regular sex partners of HIV infected people definitely are taking a risk of getting infected, except perhaps if they successfully limit their sex to mutual masturbation and not much more.  Nobody should start such a relationship without accepting the real possibility they will acquire HIV somewhere along the line.  Most likely not if you are careful, but there are no guarantees.

Your riskof HIV is elevated by your HSV-2 infection.  There are no data on whether you can lower the HIV risk by taking suppressive antiherpetic therapy, but you should ask your provider about it--under the basic notion that it can't hurt and might help.

Another important aspect of prevention is excellent control of your partner's HIV infection.  I don't recall what you said about his current stage of infection and treatment status; but being on treatment will markedly reduce your risk.  He must keep track of his viral load and CD4 count.

As far as your risk of transmitting herpes to your partner is concerned, the first step is for him to be tested for HSV-2.  Most (at least 50-70%) of HIV infected people already have HSV-2, so the odds are good that you needn't worry about infecting him.  (In general, people do not become reinfected with the same HSV type.)  If he is negative, then you can come back to the specifics of how to protect him.

I am not trying to discourage you from the relationship.  You are to be congratulated for being a caring enough person to even consider it; an awful lot of people (and probably most people who post questions on this forum) would say "sayonara" the minute they learned a potential partner had HIV.  However, I want you to go into it using your head as well as your heart.

Good luck--  HHH, MD

[Hopefulforhelp]

Hello again! I can't thank the two of you enough for your support and sound advise! First off, I went to get tested the other day 3+ wks from our first encounter... the only one I was concerned given the unprotected receptive oral. Of course, I was negative, whoohoo! I was feeling so crappy, I was convincing myself that I had ARS on top of the sinus issue... what an ***! Symptoms are MEANINGLESS!!! Sadly, because of my irrational fears, I don't think I can continue with a longterm relationship. Furthermore, I hear you loud and clear Doc, more exposure, more risk. I have no worries that we'd intentionally be safe. We talked for hours on the do's and don'ts, spoke with an HIV counselor, and he even joked about putting a check list above the bed... his humor is the bomb! (He also visualized me at the grocery store with a carriage full of condoms and cling wrap!) We don't do drugs or drink to the point of intoxication. The heat of the moment can be controlled, but it's the unapparent mistakes that concern me. It broke my heart to hear him say, 'don't worry, I understand, afterall why would you want to invest in a car that you know is going to break down' ): In reality, after alot of thought (thanks for the use my head comment) even if the HIV issues could be lifted, there are several reasons we couldn't work longterm. Although we're still open to a maybe occasional thing, it's an all stop until he has updated testing. His last viral load was virtually undetectable and CD4 over 600, yet that was a couple months ago... meds may not be working as good now as the virus adapts. Doc, thanks for the congratulations, but it's he who deserves the atta boy. His unbelievably happy attitude and love for life is incredible. He, and the times we've shared, have taught me a great deal about perspective. To be honest, it really kinda pisses me off about some of the threads I've read on here. People are people and if someone was dying of cancer, they wouldn't be thought of so badly. The stigma in this world stinks. In reality, if he plays his cards right, he could be around for another 20 years. Me, I could get cheezed in a car wreck next week. No one can tell the future.

I do have one more question about testing. It's one thing to put myself at risk, minimal as it may be, but what about future partners? Not that there is any at this time, but if I were to meet/ be with someone else, how long should I wait from my pos pals last encounter to take another test and be certain I'm 100% negative?

I am still dying to know about the kissing risks if I actually do have HSV2 orally. Can I pass it? Do I have the 'kiss of death'... little harsh I know, but I wouldn't want to inflict anyone and should know if I have to tell anyone I have it before even kissing. I couldn't find the tread about oral 2 shedding you spoke of MonkeyFlower and I still have to get around to posting my thoughts in the STD forum. Before I do, I will be getting retested HerpesSelect2 to be sure I haven't picked up type 1, well see.

And oh, MonekyFlower, I do enjoy your attitude as well! I have read many, many of your comments. So much, that before I figured out the way this site worked... I thought YOU were a doctor! The idea about a little lube inside the condom... KY warming gel, oh yeah!

Thanks again, take care and be safe!

[monkeyflower]

The other post was titled something like "herpes exposure". I don't know, but I really don't think I'd worry about kissing someone else, even your immunocompromised friend. I'm sorry to hear the relationship isn't going to work out, but I definitely give you kudos for trying. It says a lot for your strength of character and integrity. And as for testing/protecting future partners, I guess you could look up "time to test" and go by that - and make sure you always use condoms in the interim (well, always, but you know what I mean).

And I'm so glad you appreciated my comments. When I was applying to grad school, a couple of the doctors at work encouraged me to apply to med school instead. But at almost 39, with a science background consisting solely of economic botany, I'd end up paying my student loans with my social security check ;-) Anyway, I've learned SO MUCH from this site. Dr. Handsfield's just great, and I thoroughly appreciate his perspective. We're so lucky to have him here :-)