STDs Expert Forum
Increased Risk For Hep B And Hep C
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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Increased Risk For Hep B And Hep C

Hello Doctors.  I tested positive for Herpes 2 a little over two years ago while being checked for all possible STDs / infectious diseases during my annual physical.  Herpes 2 was the only result that came back positive.  I have never had any obvious signs of a breakout, so it was quite a shock to me.  At the time, I realize I was quite ignorant about the virus and how it works.  Since then, I have tried to learn as much as possible about it.

Here are my questions:  I have read on this forum that having Genital Herpes can increase your risk of being infected with HIV, even if you do not have an obvious outbreak due to Herpes causing tiny breaks in the skin that may not be apparent to the naked eye. I am wondering if the same is true for possible infection with Hepatitis B and / or Hepatitis C?   Does it increase the likelihood of infection if exposed to those?  Also, Dr. Handsfield has said that if a condom is used, there is no risk even if you have Herpes, but since a condom does not cover the entire penis and the surrounding area, is there a chance of infection if fluids get on those parts of the genitals which are exposed?  It would stand to reason that there might be the same tiny breaks in the skin there.

Thank you for all you do to give people the correct information about STDs.  You are doing a great service to people like myself who are sometimes confused by all the information (sometimes conflicting) from the Internet and even from some doctors who do not seem to have the most up to date information.
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Welcome to the Forum.  I’ll be pleased to address your questions but, before I do, I need to ask you how your herpes was diagnosed.  If it was a blood test, I would be quite interested in the sort of test you had and the numerical value of your positive test.  All too often blood tests done under the circumstances you were tested under turn out to be falsely positive.  You can read more about this by using the search function on this site at the top of this page.

As for your questions, indeed there are studies that show that people with HSV are at about a 3-fold increased risk for acquiring HSV, on average.  Since over 80% of genital HSV infections occur towards the tip of the penis, condoms would be anticipated to be highly protective and offset any increase risk associated with HSV.  The "micro-lesions" which may facilitate HIV acquisition in persons with HSV would be covered by condoms.  

The relationship between HSV and hepatitis B or C have not been studied in the same way as HIV has.   For all practical purposes, Hepatitis C is not an STD in heterosexuals and thus the presence of HSV should not modify the risk for infection.  Hepatitis B is transmitted similarly to HIV and so there may be parallels. There is one enormous difference however, there is a VERY effective vaccine for hepatitis B and if you have had that vaccine (as you should have), there is effectively no risk for hepatitis B acquisition.

I hope these comments are helpful. EWH
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Thank you for your quick response Dr. Hook.  Just for clarification, when you said "about a 3-fold increased risk for acquiring HSV", I'm assuming that was a typo and you meant "acquiring HIV".

To answer your question, the test I had was a blood test at LabCorp.  The results say that it was a "HSV-2 aB IgG" test and the numerical value listed is "3.51 H".

Your comments were very helpful.  I did not know that 80% of
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Avatar_m_tn
Sorry, I hit the "Post Comment" inadvertently there.   I was saying that the 80% of HSV infections happen towards the tip of the penis fact explains Dr. Handsfield's comment about condoms and their effectiveness.  That is good to know.

I did have a couple of follow up questions if you don't mind.  Why is Hep C not considered an STD?  Is it because it is only transmitted by blood to blood and there is rarely blood involved in heterosexual sex?  Would it make a difference if a woman was close to the end of her period and had some "spotting"?

As far as Herpes 2, I have never had any blisters, but I have had sciatica-like back pain in my right leg for decades.  I have read on some other Herpes websites that some people think there is a connection since Herpes "hides out" in your nerve cells and could be effecting them causing the pain.  What do you think?

I did start the Vaccination process for Hepatitis B a few years ago and got the first two injections but did not get the third (stupid forgetfulness on my part).  When i had this battery of tests run, it said negative for Hep B.  Does this mean the vaccination didn't take and do I need to redo the entire process again?

Thank you for your help Dr. Hook.  I really do appreciate it and hopefully our conversation will help someone else with similar questions.  I know it has helped me and reinforces the rule to always wear a condom!  Say hello and thanks to Dr. Handsfield for me.  You gentlemen are the best.
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Thanks- and you did catch a typo, I meant HIV.  You already have HSV and the additonal data you provide does suggest that at some point in the past you acquired HSV-2. When, where are how is unknowlable- over 80% of Americans with HSV do not know that they have it unlesss it is discovered with a blood test in the way that your infection was.  

Sexual transmission of hepatitis C has been studied and has only been detected very, very rarely in thousands of couples followed for long periods of time.  The virus does not get into geneital secretions.  It is sometimes transmitted through the practice of receptive rectal intercourse but that is the only time it occur with any meaniful frequency and even then is rather uncommon.   Blood exposure to menstual blood has not been abserved to increase risk for hepatitis C.  

Our clinic experience, validated by research that chronic sciatia is not a manifestation of genital HSV.  the two sometime occur in the same peole leading people to mistakenly make the association but this appears to be a case of "true-true but unrelated"

About 15% of peole who get fully vaccinated for hepatis B do not develop antibodies.  your risk is a bit higher becasue you forgeot your 3rd vaccination.  If you were my pateint, I would recommend re-vaccination.

Thanks for you complement.  I hope these further answers are helpful. EWH
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Avatar_m_tn
Yes, your answers were very helpful and informative.  I hope you can answer one last question for me (I realize I'm pushing it a bit here -  this will be my final question).  I have read in several posts by you and Dr. Handsfield that "fingering" a woman's vagina poses no threat of infection from hepatitis or HIV.  Intuitively, this would seem to be the case since people who use condoms don't become infected yet they are using bare hands during foreplay.  I'm just curious as to why this is?  Most people have small cuts or abrasions on their hands that they get from daily activities.  Is it because the skin on hands is "tougher" than skin on the genitals and mucous membranes?  If you do have damage to the skin on your hands, does it "seal up" more quickly than other skin?  I seem to remember something else about the pathogens having a better chance of infecting the deeper into your body they get - perhaps that is it?

Anyway, thanks again for all your help!  If you ever have any questions about computers, automobiles, boats, military history or where to get a good meal in the SF Bay Area or Hawaii (my areas of expertise), drop me a line.   : )
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It is suggested that is because of the structure of skin on the hands/fingers vs the genitals that persons do not become infected with HIV or other STDs during masturbation, even if there are cuts or sores present. The skin of the hands and fingers is much, much thicker, tougher and has fewer of the types of cells (called dendritic cells) which are the major targets for HIV.  EWH
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Avatar_m_tn
I'm not sure what happened there with the re-posting of my question, but thank you for your answer.  Happy Holidays to you and yours Dr. Hook!
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H. Hunter Handsfield, M.D.Blank
University of Washington
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Edward W Hook, MDBlank
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