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Do I have to give up casual sex?
Dear Dr.,
I recently read with dismay about the study showing that genital hsv-2 increases the risk for getting hiv EVEN WHEN THERE ARE NO ACTIVE LESIONS. The study stated that even in healed skin, there are an increase number of immune cells in the area. The doctors then presume microtears in the skin allow the hiv to get into the cells.
About me: I have been diagnosed wiht genital hsv-1 at the base of my penis, where the condom doesn't always reach. I always perform safe sex with condoms, and have not had an outbreak of the hsv-1 for about 2 years. My questions:
1)The above study was in regards to hsv-2. Do you believe the same is true for genital hsv-1 patients?
2)Should I be worried about getting hiv. I have always believed that using a condom is 100% effective if used properly. And I would never have sex during an outbreak. But, the condom doesn't always cover completely where I have had active lesions in the past.
3) If you do believe the study also relates to hsv-1, then why do studies in the past not show an increase risk of hiv with genital hsv-1. And finally, why isn't hiv transmitted through oral sex (an extremely rare occurence apparently) when so many people have oral hsv-1. With active and healed oral sores, wouldn't there be so many of these immune cells around for the hiv to get into. But you rarely if ever hear of a case of someone getting hiv through oral sex.
I obviously do not want to get hiv, and have always felt completely safe that if I used a condom and had no active lesions I would not get hiv. But now I am afraid and worried. Am I over reacting or do I have to give up casual sex to be safe? Thank you for your time
I recently read with dismay about the study showing that genital hsv-2 increases the risk for getting hiv EVEN WHEN THERE ARE NO ACTIVE LESIONS. The study stated that even in healed skin, there are an increase number of immune cells in the area. The doctors then presume microtears in the skin allow the hiv to get into the cells.
About me: I have been diagnosed wiht genital hsv-1 at the base of my penis, where the condom doesn't always reach. I always perform safe sex with condoms, and have not had an outbreak of the hsv-1 for about 2 years. My questions:
1)The above study was in regards to hsv-2. Do you believe the same is true for genital hsv-1 patients?
2)Should I be worried about getting hiv. I have always believed that using a condom is 100% effective if used properly. And I would never have sex during an outbreak. But, the condom doesn't always cover completely where I have had active lesions in the past.
3) If you do believe the study also relates to hsv-1, then why do studies in the past not show an increase risk of hiv with genital hsv-1. And finally, why isn't hiv transmitted through oral sex (an extremely rare occurence apparently) when so many people have oral hsv-1. With active and healed oral sores, wouldn't there be so many of these immune cells around for the hiv to get into. But you rarely if ever hear of a case of someone getting hiv through oral sex.
I obviously do not want to get hiv, and have always felt completely safe that if I used a condom and had no active lesions I would not get hiv. But now I am afraid and worried. Am I over reacting or do I have to give up casual sex to be safe? Thank you for your time
MEDICAL PROFESSIONAL
You've got it as far as your HSV-1 is concerned. But partner number is not your main HIV risk factor. Some people might have twice as many partners and be at lower risk than you are. The bigger problem is your self-admitted lack of selectivity, i.e. that some partners might be at particular risk of HIV.
That's all for this thread. Take care.
That's all for this thread. Take care.
Thank you for your quick reply. Essentially what you are saying is that my genital hsv-1 plays no part in my hiv risk. My risk is higher than you because of my increase number of partners, some which may be high risk people. If this is correct can you please just respond with a yes, I realize your time is important and have other questions to answer.
MEDICAL PROFESSIONAL
"Does this really matter?" Hard to tell. No, I have never seen of a case who acquired HIV despite consistent condom use. On the other hand, there are many people with HIV who claim consistent condom use. Does that mean the condom failed? Probably not; more likely, they were lying or just didn't remember one or more lapses in condom use.
Here is another way to look at it: With the lifestyle you describe and 100% condom use, your risk of getting HIV is probably 100 times higher than if you were monogamous with a low risk partner. At the same time, there's still probably less than 1 chance in 1000 you'll get HIV someday. These are only very rough guesstimates of the actual risk. The point is that your risk is higher than mine, but a lot lower than if you didn't use condoms.
If I were you, I would avoid those partners who you suspect are at higher risk for HIV. But the choice is yours. Whatever you do, please plan on a routine HIV test, as well as testing for other STDs, about once a year.
Your genital HSV-1 makes no difference one way or the other. It's not relevant to assessing your risk doe HIV.
Here is another way to look at it: With the lifestyle you describe and 100% condom use, your risk of getting HIV is probably 100 times higher than if you were monogamous with a low risk partner. At the same time, there's still probably less than 1 chance in 1000 you'll get HIV someday. These are only very rough guesstimates of the actual risk. The point is that your risk is higher than mine, but a lot lower than if you didn't use condoms.
If I were you, I would avoid those partners who you suspect are at higher risk for HIV. But the choice is yours. Whatever you do, please plan on a routine HIV test, as well as testing for other STDs, about once a year.
Your genital HSV-1 makes no difference one way or the other. It's not relevant to assessing your risk doe HIV.
To be honest , occasionally some of my partners may be at a higher risk for hiv. But does this really matter if again i always use a condom correctly, and never have sex with an active lesion of hsv-1? Have you ever heard or seen a case of someone getting hiv who used a condom correctly, and had no active genital lesions of hsv-1? Again, the condom may not cover the entire base of the penis where the initial outbreak occurred. Thanks for your reassuring comments.
MEDICAL PROFESSIONAL
Welcome to the forum. I'll try to help. The bottom line is that your worries are overblown. Your risk of acquiring HIV is not significantly elevated.
Genital herpes due to HSV-2 indeed increases the risk of acquring HIV by roughly two-fold, regardless of symptomatic herpes outbreaks. However, since the risk the average heterosexually active person will acquire HIV is in the order of 1 in many thousand, a double risk due to herpes doesn't mean very much. For example, if a person's baseline risk was a lifetime risk of HIV of 1 in 10,000, with HSV-2 it's 1 in 5,000. To the specifc questions:
1) No, the data do not seem to apply to HSV-1, even for genital HSV-1 infections. There is no apparent increased HIV risk in such persons, probably because both symptomatic outbreaks of genital herpes and asymptomatic shedding of the virus are much less common for HSV-1 than HSV-2.
2) Combining the low risk implied above plus consistent condom use, you can expect to go a lifetime with a very active sex life and never catch HIV.
3) This is a complex question with many parts. Part of it is based on a mistaken premise: in fact, oral sex is the primary mode by which people catch genital HSV-1. Genital-to-genital HSV-1 transmission is rare; in 30+ years in the STD business, I have never seen a case. However, it is true that oral sex is very low risk for HIV, regardless of whether or not someone has oral HSV-1. The reasons aren't completely understood, but it undoubtedly has to do with the relative infrequency of recurrent oral HSV-1 outbreaks and viral shedding.
Bottom line: There is no basis for being "afraid and worried" on this basis; and indeed you are overreacting. Even frequent, casual sex with multiple partners is not a significant risk, as long as you 1) continue to use condoms consistently and 2) select your partners with care (e.g., no commercial sex workers, injection drug users, or others at particularly high risk for HIV).
I hope this helps. Best wishes-- HHH, MD
Genital herpes due to HSV-2 indeed increases the risk of acquring HIV by roughly two-fold, regardless of symptomatic herpes outbreaks. However, since the risk the average heterosexually active person will acquire HIV is in the order of 1 in many thousand, a double risk due to herpes doesn't mean very much. For example, if a person's baseline risk was a lifetime risk of HIV of 1 in 10,000, with HSV-2 it's 1 in 5,000. To the specifc questions:
1) No, the data do not seem to apply to HSV-1, even for genital HSV-1 infections. There is no apparent increased HIV risk in such persons, probably because both symptomatic outbreaks of genital herpes and asymptomatic shedding of the virus are much less common for HSV-1 than HSV-2.
2) Combining the low risk implied above plus consistent condom use, you can expect to go a lifetime with a very active sex life and never catch HIV.
3) This is a complex question with many parts. Part of it is based on a mistaken premise: in fact, oral sex is the primary mode by which people catch genital HSV-1. Genital-to-genital HSV-1 transmission is rare; in 30+ years in the STD business, I have never seen a case. However, it is true that oral sex is very low risk for HIV, regardless of whether or not someone has oral HSV-1. The reasons aren't completely understood, but it undoubtedly has to do with the relative infrequency of recurrent oral HSV-1 outbreaks and viral shedding.
Bottom line: There is no basis for being "afraid and worried" on this basis; and indeed you are overreacting. Even frequent, casual sex with multiple partners is not a significant risk, as long as you 1) continue to use condoms consistently and 2) select your partners with care (e.g., no commercial sex workers, injection drug users, or others at particularly high risk for HIV).
I hope this helps. Best wishes-- HHH, MD
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