Herpes exposure

[northeast78]

Hi Doc HHH

I just had a question for you to get your advice on my situation.   I had protected oral and protected intercourse(3mins long) with a female escort 5 weeks ago.  I have tested positive for genital herpes which really shocked me about two weeks after the encounter. I have been tested before so I know it came from this situation..... My question to you is that I know herpes can spread from skin to skin and I know its easier to get than Hiv, but i'm starting to think the worse about  HIV now .  I took a rapid test at 25 days after the event, so between 3 and 4 weeks and I got a negative result.  My doctor said that i shouldn't worry so much about HIV and focus on my herpes result,  Should i be worried and should i test again for hiv.
Thank you

[H. Hunter Handsfield, M.D.]

Sounds like an initial HSV infection, regardless of the atypical aspect of acquistion despite condom use.  (But if you had sex with anybody else in the 3 weeks before onset of symptoms, I would suspect that person as the source rather than the CSW.)  In response to your statement, I cannot speculate on the mechanics of how you were infected.

As already noted by another forum user, If not yet done, you need to learn the virus type, which will make all the difference in predicting frequency of symptomatic recurrences and asymptomatic viral shedding, transmission to future sex partners, and need for treatment.  If it's HSV-1 probably you won't have much of a problem in the future.

Congratulations on a level-headed attitude about both the herpes and your HIV risk.

[maybeitstrue]

That does sort of sound like like a first infection (with 2 crops and all) though 6-8 days heal time is still pretty quick unless you were on Valtrex or some other medicine.

Did they type it HSV1 or HSV2? If HSV1 then you won't get as many outbreaks.

The Dr. would probably say that most likely the hand contact wasn't what got you and that it was most likely you had some skin to skin contact with friction where the condom wasn't covering.  I guess you didn't notice if she had any sores on her mouth or down below?

Anyway, I have been lurking this board for a while and this sounds like the first time I have heard a confirmed story of someone getting infected during a 1 time condom protected encounter.


Again, very sorry to hear about your situation! It is a real leson for us all.

[H. Hunter Handsfield, M.D.]

First, let's discuss the herpes.  Did you develop symptoms?  Where, mouth or genitals?  What test was done?  Culture or other test for the virus, from a genital or oral sore?  Or just a positive blood test?  If a blood test, which virus type?  What exactly blood tests were done, both previously and for the more recent test?  The answers to these would help me judge whether you in fact acquired herpes during the sexual encounter you describe.  It is very rare to acquire HSV from condom-protected vaginal or anal sex, so I have to suspect you were infected at some other time -- even with your story of having been tested and negative before.  (One example that commonly causes this kind of confusion:  If your recent positive test was an IgM antibody test, it can be disregarded.  IgM testing is worthless.)

Your doctor is right about the HIV tests.  A negative result 25 days after the last possible exposure highly reassuring.  Whether or not you have a new herpes infection makes no difference.  For definitive proof you don't have HIV, your doctor probably will recommend another test 6-8 weeks after the exposure.  You can expect another negative result.

I'm interested to know more about your herpes diagnosis.  But relax about HIV.

Best wishes--  HHH, MD

[H. Hunter Handsfield, M.D.]

That makes much more sense than infection despite protected vaginal and oral sex.  Thanks for letting us know.

[northeast78]

Just to follow up,  I know I asked to many questions but I have found out that the infection came from a sexual experience two weeks before the escort.  So you were right.

[H. Hunter Handsfield, M.D.]

Sorry, you cannot keep returning with every additional little question that comes to mind.  I have no further comment.  

[northeast78]

Thanks,  I would assume then would be really low after my negative test(25 days) and use of a condom?  I was pretty nervous on getting it done,  just don't want to if I don't have to again.

[H. Hunter Handsfield, M.D.]

Your HIV risk is sufficiently low that repeat testing is optional, which undoubtedly is why your own doc didn't bring it up.  But the fact that you ask probably means it's on your mind and that you might sleep better knowing that an additinoal blood test is negative.  In other words, it's up to you, but it's probably a good idea.

[northeast78]

Ya I completely agree with you doctor and I'm looking at the bright side that I got atleast the less complicated one downstairs.   Do you think i need another HIV test thou,  I know you said my doctor will probably recommend one after 6 weeks which he didn't, so your thought on this last questions then i'm done.

[H. Hunter Handsfield, M.D.]

Yes, if someone has to get genital herpes, HSV-1 is the type you want to have.  Almost half of all infected people have no recurrent outbreaks at all and most have just 1-2 outbreaks over the next 1-2 years, then no more.  And asymptomatic viral shedding and genital-to-genital transmission are uncommon, so your future sex partners are not likely to be at high risk.

It is unlikely you caught the infection more than 3 weeks before onset of symptoms.  If you received unprotected oral sex from someone within than limit, she probably is the source.  But you might never know for sure.  Even if that person has no history of oral herpes, she could still be infected; and in this circumstance, I don't think it would be appropriate to insist that she be tested for HSV.  In any case, at this point it really doesn't matter where you caught it.

[northeast78]

I just called this morning and I have HSV1.  Which you said is good news,  because its causes less problems.. right?.   I'm surprised,   and after reading what you and the DR have to say I could have contracted it from recieving oral sex a few weeks from another girl before all of this escort business.  I'm going to call and find out soon enough.

[maybeitstrue]

You don't necessarily need to get a blood test if you had a type specific culture test. You may only need to call your Dr. and ask.

If your Dr. didn't sit down with you and go over all the details/joys of having herpes, he should have.

You could always check out information from reputable sources on the web www.westoverheights.com
www.ahastd.org

Sure sounds like Dr. HHH is surprised about your atypical way of becoming infected. As I said, there have not been too many confirmed transmissions described on this board after someone has used protection. Unless the other partner theory holds water...

Anyway, good luck to you and keep us posted if you want. If you have any questions, your Dr should be able to help. Otherwise, there are plenty of knowledgeable people lurking this board.

[northeast78]

I haven't found which type of HSV yet,  i was just assuming i got gential herpes(HSV2) but you are the doctor and I will find out.  I'm still yet to do a blood test,  i was just more focused on getting better.  I have been precribed Valtrax from my doctor and healed within 3 days,  that stuff really works but its still very ****** on what i went threw.  Thank you for your comments I appreciate it.

[northeast78]

I had two crops of scores first was at the base and second came couple days later that was on the top and hurt when i peed like 2 days after and last for a good 6-8 days,  which i was told is a give away that I contracted it.   I had swollen glands in my groin during the outbreak,  i did feel a little ******,  had a heachache, no fever, and just ****** feeling for that first week.  This all happen the first week so i'm convinced I contracted herpes by this escort which sucks.  It was pretty ugly site down there but its all cleared up and I have never ever experience anything like it.    Also i was tested for everything else and all came back negative except for the herpes test.    When I think back on it,  she did touch me alot around the base of the penis with her hands after touching herself so I think thats what did it.

[maybeitstrue]

Sounds like you might have had pretty bad luck. Very sorry to hear it.

Just curious, what do you mean by your symptoms being bang on for a first outbreak?

Did you have a whole crop of blisters?
Did it hurt?
Did it take 1-2 weeks to heal?
Were you otherwise sick? Fever? Swollen glands? etc...

In otherwords, the Dr. usually says that a true first outbreak can be pretty impressive both with presentation and physical symptoms. If you just had 2 or 3 blisters that went away in a week or so, there is a good chance that what you had was  a recurrence and not your initial outbreak.

Just my 2 cents. I am not a Dr.

[northeast78]

I got a culture test done on an outbreak 6 days after.   The outbreak was on the underside of my penis where the condom didn't cover .  I was pretty confused,  but i only had visual tests done before hand so you are right it could have come from before hand.   But,  my symtoms were bang on for a first herpes outbreak so i think somehow i got unlucky and contracted during intercourse.  The HIV i'm not that worried about because i've been told that its highly unlikely that i have it.  I was just curious. thanks for your responds.