chances of herpes or hiv

On a trip to Hawaii with my friends I slept with a street hooker. A condom was used before any sexual acts and was used properly. About six weeks after I got home a small bump appeared on my penis.  There was only one and it looked like a small pimple or ingrown hair. It never itched or was painfull and I had no other symptoms of herpes I've read about. I know it is very likely to be herpes simplex virus 2 and i understand it is at the bottom of my penis where the condom didnt cover. What I am really worried and stressing about is my chances of being infected with hiv. I read that it is easier to recieve hiv if a person is infected with hiv also. I am getting tested tomorrow at my local clinic but I want to know how likely I am to be hiv positive. I know the condom reduced the risk greatly but since it looks like I got HSV from her will I probably have HIV too if she had it?

[H. Hunter Handsfield, M.D.]

I can't tell from your description whether you in fact got herpes, or just had a pimple.  Six weeks is a bit long for herpes to show up, although you could have herpes that was present before your contact in Hawaii.

Most female commercial sex workers do not have HIV; and if she did, your chance of catching it from a single exposure is very low.  Although herpes increases the risk of HIV if exposed, even doubling a near-zero risk still leaves the chance of infection near zero.

You need to see a health care provider who is knowledgeable about STDs, such as your local health department STD clinic, for testing for both HSV-2 and HIV.  I'm certain the HIV test will be negative; can't tell about HSV-2.

Good luck--  HHH, MD

[monkeyflower]

On a related note, I just read about a clinical trial on the role of suppressive therapy in reducing the chances of contracting HIV. I'm interested in just how having HSV can increase the risk of contracting HIV. Is it through open lesions only (breaks in the skin), or are you at higher risk regardless of outbreaks? What about during asymptomatic shedding? Or is it possibly just a matter of risky behavior, i.e. if you have HSV2, chances are you've had more partners, unprotected sex, etc.? Thanks - as always :-)

[monkeyflower]

On another related note, I'm female, have HSV1 and 2, and never have outbreaks. I rarely have other partners for intercourse, but I do have a few I see a couple of times a year, and they're pretty risky (men who also have sex with men, men with multiple partners). I use condoms religiously, although not for oral. My two concerns are: transmitting HSV to non-HSV infected partners, and a higher risk of my contracting HIV, due to having herpes as well as potentially risky partners.

I'm not an anxious person about these things, but I want to protect myself and others as much as possible. Would you recommend suppressive therapy?

[H. Hunter Handsfield, M.D.]

It is much more than just risky behavior.  The HSV link with HIV transmission is due to unnoticed (perhaps microscopic) breaks in the skin or mucous membranes, plus the fact that inflammatory cells that come to HSV lesions are loaded with HIV (if the herpes-infected person is HIV+), and are especially susceptible to HIV if exposed.

Suppressive antiviral therapy in herpes is a very personal decision; there are no clear guidelines for health professionals that say "definitely yes" in one situation or "definitely no" in another.  Suppressive HSV therapy would reduce your risk of transmitting HSV-2 to partners.  It is a reasonably good bet it would also reduce the risk of catching HIV, but that isn't proven; a $30 million research study (funded by NIH plus the Gates Foundation) currently is underway in several countries to answer exactly that question.

Regards--  HHH, MD

[jj2000]

the mark that i noticed 6 weeks after my contact in hawaii has healed over and is raised pink skin around a very small scab with a single hair growing out of it. I think it may have just been an ingrown hair.  I have been extreamly stressed out about this and find it difficult to eat and also noticed a white paste on my tongue. Is this a sign of ARS or can it be stress related?  I've worried myself sick over this for almost a week now.  The bump was never painfull, never itched, and i think by not leaving it alone I made it a lot worse than it would have been.  I have been taking my temperature regularly and it is actually below average. about 97 degrees.  I'm glad to hear you think my risk of hiv is very low. Im still worried but it makes me sleep a little better at night.  are there any signs I should be looking for in the future that indicates hiv?  also does my description sound anything like syphilis? I read that created a single sore

[H. Hunter Handsfield, M.D.]

Your description doesn't sound particularly like syphilis, but it is possible.  Coated tongue happens all the time, not usually a sign of ARS.  Your body temperature is normal.  (Most people seem to think that ony 98.6 is normal.  False.  Normal body temperature varies between around 96 and 100; 98.6 is just the average for most people.)

Otherwise, I cannot help.  The advice from my first advice still stands:  see a health care provider.  Online advice is not a substitute for that.  I won't have any further responses.

HHH, MD

[monkeyflower]

Actually, I'd just read about that study - that's what prompted my question. Thank you so much for your quick reply. This has really cleared things up for me, and brought me to a rather sobering realization. I'm pretty cavalier about having herpes, but I hadn't realized quite the impact it could have on contracting HIV in particular. It's also important to me to protect my partners as much as possible. After reading your response, I think I'm going to ask my doctor for a prescription for Valtrex. It certainly can't hurt :-)

Thanks again. You just rock.

[Spursman]

Sorry to bother you again.

Regarding herpes. If I contracted this  on the base of my penis during sex, would it be possible for HIV to be transferred this way? Or is it still only through the Uretha that it is possible?

To clarify this, if the girl I had sex with had HIV, and I have Herpes, or was exposed to Herpes at the pubic area, would it be possible to transfer HIV this way? Or am I just fishing for reasons due to anxiety and guilt?

Thank You

[No-name2]

I got french kissed by a "gay" guy at a party. Even though I realized that it was risky to kiss him, and I spit out some of my saliva after kissing, I still developed a blister on my lipe the next day, which might be herpes. However, I'm more concerned about its transmission of HIV. If that guy had herpes outbreak when he kissed me, and if he was HIV+, what were my chances of catching HIV? I believed that I did not have cuts in my mouth that day.
Also, I got HIV test about 40 days after the incident had happened, and the result was negative. But I heard that the virus may not be detectable within 3 months. So I'm wondering if my test was valid. Thanks for reading or replying my questions :)

[luke murphy]

Hi while on a night out, I got very drunk and slept with a street hooker, a condom was used but burst sometime during sex, I didn’t come and the sex lasted no more than 5minutes, with out being graphic I don’t think she got very wet during intercourse, could this reduce my chances of contacting HIV?? What are the chances if she was infected?? Are there any early symptoms, I read it can take up to six months for hiv to show up in testing, but what is the earliest I can get tested, also is there any know way of reducing the chances of HIV within a few days of having sex????

Thanks

[Iked]

Dr,
I have a gay friend who engaged in unprotected oral sex with a male partner twice on two separate days.  After 2 weeks, he was diagnosed positive with gonorrhea and clamydia (chlamydia). What are his chances of getting infected with HIV. Is he at high risk? His partner does not show any sign of infection from clap and clamydia (chlamydia). I dont know what to tell him as he already started panicking and wants to commit suicide because of the possibility of HIV infection.

[Tom55]

The other night I was in a club. A woman I just met there kept on hugging me, and there was a skin to skin contact on my face. Could I be infected with herpes? I am kind of worried and washing my face like crazy all day long. Help please.