Should I get tested for HIV?

[scaredintenn]

I recently posted a question under the STD forum regarding genital herpes...I am still awaiting my test results to see if I have them of not.  My question here is whether I should get retested for HIV.  I was test three weeks ago and both the HIV and Herpes I and II came back negative, however I have noticed some symptoms of herpes (i.e., low back pain, a couple pimples on my vagina) so I went to get another blood test for herpes and it will not be back until this week sometime.  I was wondering if I need to get another HIV test as well?  My exposure consisted of unprotected vaginal intercourse with a 24 year old heterosexual male, non-IV drug user, from the United States.  My sexual relationship with him lasted for roughly the past two months.  He told me he was clean, but my main concern is that if I do in fact have herpes, then I could quite possible have HIV as well since he didn't know he had herpes, he might not know if he has HIV or not.  And I'm aware that having herpes makes it easier to contract HIV.  I should also mention that he went to the health department of std testing, including HIV, and he told me that all came back negative, but I don't know whether he's telling me the truth or not.  

Thanks Dr. for your help!

[H. Hunter Handsfield, M.D.]

In general, everybody with a new STD should be tested for HIV, since the same behaviors put people at risk for HIV as well as STDs; and most STDs increase the chance of catching HIV.  And herpes is the single STD most strongly linked to HIV risk.  So if the test results show that your genital ulcer is herpes, you definitely should be tested for HIV.  In that case, have an HIV test about 6 weeks after your last sex with that partner.  (You don't say when the HIV test was done.)

This doesn't mean your risk of having HIV is high.  It is not.  And in your case, you could safely skip the HIV test, even if you turn out to have herpes, since your partner is at low risk for HIV and recently had a negative test.  (Most people don't lie in this circumstance, so he's probably telling the truth.)  On the other hand, if you don't have an HIV test at least 6 weeks after your last sex with that partner, you'll probably continue to worry about it.  So discuss additional HIV testing with your doctor when you follow up for your herpes test results.

Best wishes--  HHH, MD

[scaredintenn]

Thanks Dr. H for your response...I was wondering if you could answer one more question for me.  I know the exposure risk for an infected person to a non-infected person is 1 in every 1,000 episodes of vaginal intercourse for male to female...could you possibly tell me how much the risk increases if one has genital herpes?  Also, what is the rate or percentage of hiv infection among heterosexual males who are not IV drug users, are from the U.S. and have never been in prison?  This will be my last questions, I promise.

Thanks so much!

[H. Hunter Handsfield, M.D.]

I strongly suggest you stop asking about details of HIV risk that don't apply to you.  Having HSV-2 increases the risk of catching HIV by 2-4 times, but it's irrelevant after sex with an HIV uninfected partner.

Fewer than 1 in 1,000 men like you describe have HIV, and the actual rate may be as low as 1 in 10,000 or even less than that.  In your partner, the chance is less than 1 in a million, because of his history of having a negative HIV test recently.  Herpes or not, the chance you have HIV is much lower than other risks you accept on continuing basis, day in and day out.  For example, living in the US, the odds you'll die within a year due to an accident are 1 in 1,756, which probably is at least 1,000 times higher than the likelihood you have HIV.

Please accept the reassurance you have been given and stop trying to convince me (and yourself) that you are at high risk for HIV.  You are not.

PS:   Don't forget your seatbelt.