HIV transmission with HSV-2

Hi doc,

If have a question relating the transmission of HIV through an asymptomatic genital herpes outbreak. I have read in one of your replies on the forum, that the risk of acquiring HIV by having sex with someone recently infected with HIV and having (asymptomatic) outbreak of genital herpes can be about 1:5. My question is whether a condom protects your body from the HIV during sex?

Or is it possible when the (asymptomatic) outbreak is at an area uncovered by the condom, the HIV virus can enter the body (I have no other std's)? I know the skin protects your body, but I have also read that the HIV load in HSV-2 shedding is more than 10.000 copies per ml.

Thank for the help!

[Edward W Hook, MD]

You are asking a question which goes beyond the limits of currently available scientifically proven data.   That said, I think we can come up with a reasonably logical answer.

Your statistics are correct--this risk of acquiring HIV if you, or your partner has herpes is increased.  This increase occurs irrespective of whether or not lesions are present and are the average of observations from lots of people taken over time.  Thus extrapolating to individuals and single exposures is difficult.  

The is good scientific evidence that properly used condoms do clearly and without doubt over protection from HIV, from herpes and from both together in persons who have both infections. The HIV viral load is increased in persons who have both herpes and HIV but there is not a specific viral concentration increase that accompanies dual infection.  The average increase is about 1.5 (50%)  times,  HIV can enter through any uncovered open lesion so if a person has an outbreak with lesions, the lesions can be an entry point for HIV, if exposed.  Obviously however this is still a numbers issue and while the odds of infection go up 50%, the risk from a single exposure is still relatively small.  Not so small as to not recommend condoms and other safer sex measures but also not so large as to suggest that if exposed you will certainly become infected.

I hope this helps.  EWH

[Johnherp]

Thank you doc, 1 clearification if possible? To state in short: when I have safe sex with a HIV infected person who at that moment has an (asymptomatic) outbreak of genital herpes, it is possible to get infected through the skin just because the HIV viral load in lesions are numerously higher than in other body fluids (except blood).

[Edward W Hook, MD]

I am not sure I understand the question but let me try to answer.

When persons with HIV have herpes outbreaks, there are increased amounts of virus present in the herpes lesions, making them more likely to be transmitted to others.  Transmission of HIV does certainly occur in persons who have otherwise intact appearing skin.

BTW, your post starts with the phrase "When I have safe sex with a person with HIV....".  The safest thing to do is try to avoid such exposures, if possible.  If that is not possible due to the nature of a relationship, etc, then the safest approach is to practice safer sexual acts, with condoms.

Hope this helps.  EWH

[Johnherp]

Thank you doc, this answered my question. It was a 1-time sexual encounter last week, and as I notice some symptomes that appear to be genital herpes (or anxiety), I wanted to know whether I should get an HIV test also. I will test it also, since the chance of infection is possible. Many thanks.