[Question #12311] Herpes/HIV question
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8 months ago
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Dear Drs.,
It's been a while and thankfully I've gotten a grip of my anxiety. I have two questions that I would love your perspective on:
1) I met a lady on a date this morning. We engaged in deep kissing, breast sucking on my end, and her hand to my genital. I also touched her genital but she was fully clothed. She later disclosed to me that she tested positive for Herpes (prob HSV2) and that she's taking treatment since diagnosis in ER in September. My questions:
- Did I expose myself to any HSV2 risk orally via mouth (I assume no HIV risk here)? I've been feeling tingly in my lips for the past few hours. If so, what would testing look like? To my best knowledge, I'm negative for everything.
- Is there any prophylactic treatment I can take given that I had this exposure this morning?
- Does HSV-2 transmit through clothing? My touch was very brief over her leggings.
- Are there any additional information that I can ask her for to better understand my chances?
2) Other situation (brief comment if allowed per forum guidelines): I had protected vaginal sex with a different woman a month ago. I recall ejaculating in the condom but after finishing the condom was empty. It was intact and unbroken but it probably leaked at the bottom. She was also a virgin so there were light bleeding on condom and at the base of my penis. I've been waiting to test at the 6-week window:
- Is this something you foresee any HIV risk around? There were no oral or unprotected intercourse.
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Edward W. Hook M.D.
8 months ago
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Welcome back to the Forum. I'll be glad to comment.
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The encounter this morning that you describe was no risk and any symptoms you are experiencing are unrelated to the encounter. There are no STIs which would cause symptoms within one or ever two days of any exposure
- In response to your specific questions:
- Did I expose myself to any HSV2 risk orally via mouth (I assume no HIV risk here)? I've been feeling tingly in my lips for the past few hours. If so, what would testing look like? To my best knowledge, I'm negative for everything.
- No. HSV-2 is not transmitted through oral contact except on very rare occasions among men with other men as sex partners. As I explained above, it is too early to be experiencing symptoms due to an STI acquired in the past day or two.
- Is there any prophylactic treatment I can take given that I had this exposure this morning?
- There is no need for any preventative measures
- Does HSV-2 transmit through clothing? My touch was very brief over her leggings.
- No STIs, including HSV are transmitted through clothing, even if the cloth is thin and/or wet with genital secretions.
2) Other situation (brief comment if allowed per forum guidelines): I had protected vaginal sex with a different woman a month ago. I recall ejaculating in the condom but after finishing the condom was empty. It was intact and unbroken but it probably leaked at the bottom. She was also a virgin so there were light bleeding on condom and at the base of my penis. I've been waiting to test at the 6-week window:
- Is this something you foresee any HIV risk around? There were no oral or unprotected intercourse.
- Condom protected sex is safe sex as long as the condom does not break. Further your partner was low risk. I would have no concerns and see no reason for testing.
EWH
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8 months ago
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Thanks Dr. Hook. As part of a routine visit today, I
mentioned the encounter to my dermatologist. She filled a 3-day Valtrax
prescription as HSV2 prophylaxis. I didn’t know this was a thing and confused
me about my risk, especially at ~90 hours post-exposure. My questions:
- Is
this treatment effective at preventing infection altogether? Does it
affect potential symptoms or testing timeline like PEP does for HIV?
- The
doc said this is a “lower” risk encounter. Does this mean a risk for me
exists indeed (deep-kissing, mouth to breast, her [washed] hand to my
genital contact)?
- The
lady doesn’t know whether her HSV2 is oral or genital, but confirms only 1
genital outbreak at the onset 10 weeks ago. Does this change your
assessment, in terms of getting HSV2 if I kissed her and she had
asymptomatic O-HSV2? Have you or any doctors on the forum seen something
like this? I had 1 tiny pimple a bit above my mustache.
- After
~4days, I only had a small painless whitehead pimple on my mustache on day
2 that bursted on its own, and a (day4) bruise-like pain upon-press
feeling in a small area middle of my left knee. Do those sound like
potential HSV2 outbreak symptoms or pre-lesion pain?
- Should
symptoms occur, what would they look like? When should I expect to be in
the clear vis-à-vis this encounter?
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8 months ago
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Thank you Dr. Hook for baring with me on these questions. It’s
very hard to source “true” knowledge on HSV2, even from medical providers, so I’m
relying on your advice on how to move forward with this. I hope you don’t find
my 6 questions annoying, as I’m trying to properly educate myself. I’ll hold
off my second follow-up in case any symptoms occur.
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Edward W. Hook M.D.
8 months ago
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As you know, questions on HSV should go to Teri. I'll continue to answer but any future questions should go to her.
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- Is this treatment effective at preventing infection altogether? Does it affect potential symptoms or testing timeline like PEP does for HIV?
- The doc said this is a “lower” risk encounter. Does this mean a risk for me exists indeed (deep-kissing, mouth to breast, her [washed] hand to my genital contact)?
- By now you should know that in medicine one can never say never. I explained why the contact you described was virtually no risk above.
- The lady doesn’t know whether her HSV2 is oral or genital, but confirms only 1 genital outbreak at the onset 10 weeks ago. Does this change your assessment, in terms of getting HSV2 if I kissed her and she had asymptomatic O-HSV2? Have you or any doctors on the forum seen something like this? I had 1 tiny pimple a bit above my mustache.
- No! Please re-read my original response. HSV-2 is virtually never transmitted orally
- After ~4days, I only had a small painless whitehead pimple on my mustache on day 2 that bursted on its own, and a (day4) bruise-like pain upon-press feeling in a small area middle of my left knee. Do those sound like potential HSV2 outbreak symptoms or pre-lesion pain?
- No
- Should symptoms occur, what would they look like? When should I expect to be in the clear vis-à-vis this encounter?
- If lesions were going to occur they would typically occur within 10 days of exposure and by typical. Your taking valacyclovir could alter this but it's hard to say how
- You have 1 follow-up remaining. EWH
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7 months ago
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Dr. Hook or Terri,
I have decided to not move forward with the Valtrax and move past the experience. I wanted to follow up with 3 questions:
1. In 4 weeks post-exposure, some symptoms come up, do you mind confirming if any are signs of HSV2 outbreak:
Day 6: Scratchy throat and pain when I swallow. A day later I got a cough and sneezing. No concurrent skins symptoms. Resolved within 3 days
Day 14: Pain/burning on upper mustache area. I saw some swelling, but then it went away the next day
Day 16: Same issue , but with a red bump. Squeezing on it, some pus came out. I went to the dermatologist for swabbing, but they said it’s likely irritation as the symptom went away within 24 hours
Day 22: Discolored area in the middle of the tongue. Looked like “geographic tongue”. Went away within 48 hours although my tongue is still a bit irritated 5 days later
Day 24: Ulcer inside my bottom lip. I wasn’t sure if this could be a herpes symptom
2. With my exposure being fully oral, is there a risk for genital self-infection? I did get a hemorroid-like episode when traveling day 16 and had one bump between my scrotum and my anus (wasn’t sure if pimple or something else; painful to touch, but no burning or tingling)
3. Regarding HSV2 testing in general, do you recommend it for peace of mind? I decided to date someone seriously and want to navigate this before intimacy. For context, I’ve had many encounters in the past years without ever testing for it and I don't think I would miss symptoms if I had them. Since breaking up with my ex-partner, I had penetrative sex with 4 women for about ~10 times total, fully protected and no oral sex given besides one brief instance
Thank you Doctor and Happy New Year!
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Edward W. Hook M.D.
7 months ago
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I agree with and support your decision not to go forward with the valaciclovir. Regarding your final follow ups::
1. The symptoms you describe, including scratchy throat, pain on swallowing, discomfort in the mustache area, the red bump you squeezed, discoloration of your tongue and sore inside your bottom lip are all inconsistent with herpes acquired at the encounter you described. It's time to move forward'
2. There is no risk of infection moving from one site to another. Genital herpes infections are local and do not move to other parts of the body, either on their own or through transfer on hands, etc.
3. Moving forward involves trust more than anything else. We do not endorse testing within a partnership in the absence of a history or signs of infection- the tests are not good enough to be relied upon for this purpose.
As you know, this completes this thread which will now be closed. Wishing you a happy new year. EWH
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