[Question #12586] Transmission

6 months ago

received oral sex only. she CSW in high prevalence country. She tested 5 days after and found out she is HSV 1-2 positive but also has MCH, MCV low and RDW high which potential HIV infection signs. She tested negative to CMIA 1&2 AB/AG.

Got on pep 1 pill/day but miss one after the 13th day.What is the risk HIV?

6 months ago

Detail to add is have a feeling of urethritis after 10 days so probably infect from herpes.

Edward W. Hook M.D.

6 months ago

Welcome to our Forum. Thanks for your questions. I'll be glad to comment. Receipt of oral sex is a very, very low risk variety of sexual encounter. There are no proven cases of HIV acquired from receipt of oral sex and likewise, acquistion of HSV-2 is very, very unusual. Your partner's negative HIV test assures you that she could not have transmitted HIV to you. Your risk of HIV is so low that most experts would decline to prescribe PEP for you in this situation. Missing a single dose of PEP at day 13 would not reduce it's efficacy.

10 days is late for the onset of either herpes or other forms of sexually acquired urethritis. It would also be unusual to have herpes without lesions on your penis. I would suggest you seek testing with swab or urine tests (NOT blood tests). EWH

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6 months ago

thank you for your fast answer.

I just received my results. Positive to HSV-1 very high >500 Au/ml (test is positive at 19 au/ml).

Hsv-2 negative, Chamedia and Goronhea not detected.

I looked at the timing and it was at 6-7 days not 10 that I got the urethritis. So asked for acyclovir.

Here are my following questions:

1- Did I miss other tests that I should proceed with (example non gonococcal urethretis)

2- the fact that this csw showed signed of low MCV & MCH,MC and high RDW, could be a indication for acute HIV. Even if tested negative to CMiA AB\AG, she could still be in the window period as she tested only 5 days after. She could be potentially in her high viral load and highly contagious?

3- As she as HSV 1 & 2, also make her more inclined to transmit the virus. Her results for HSV 1& 2 was positive but only by few points (I think it was 15 over the positive range results). I did not see obvious signs but did not inspect her mouth. Does sores for hsv could have lead to blood transmission?

4- is circumcised reduce risk for this exposure for hiv?

Thank you

Edward W. Hook M.D.

6 months ago

You seem to want to treat yourself. It is often said that someone who wants to treat themselves has a fool for a doctor. Starting acyclovir is a waste of time. As for your follow-up questions:

1- Did I miss other tests that I should proceed with (example non gonococcal urethretis)

A urethral swab test with a gram stain of the specimen would provide the information you need. A urinalysis might also provide useful information.

You are clearly not listening. You were not exposed to HIV and even if you have been, NO ONE has ever gotten HIV from receipt of oral sex. Low MCV, and MCH are simply signs of anemia and are NOT att all suggestive of recently acquired HIV. The timing of her test PROVES that you were not exposed. She was beyond the "window.

Irrelevant.

4- is circumcised reduce risk for this exposure for hiv?

Circumsized persons have about half the risk of acquiring HIV IF EXPOSED (you were not!!!!).

You have one follow-up remaining. Since you have not listened to anything I said thus far, please understand that after the next follow up, as per Forum guidelines, the thread will be closed. No follow-ups will be accepted and should you post, the thread will probably be closed without a response and without return of your posting fee. EWH

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