[Question #1860] herpes and hiv transmission with protected sex

42 months ago
I was infected with genital herpes 3 months back the infected region being the base of my penis where condoms don't cover .. according to a research done by CDC there needs to be no open sore to acquire hiv if u have a past history of genital herpes .. will I get hiv if I have sex with someone whose HIV status I don't know and I always used a condom even if my lesions have healed ? I know herpes is quite common but I don't wanna get infected by hiv .. has there been a documented case where a person used condoms and still got hiv despite using condoms if he had previous history of genital herpes? should I avoid sex as I'm terribly afraid ? I've asked many doctors here in india and they say it's not possible to get hiv if u have a previous history of herpes if u used condoms correctly and ur lesions have healed .. I'm confused after reading this research 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
42 months ago
Welcome to the forum. Thanks for your question.

It is true that genital herpes caused by type 2 herpes simplex virus (HSV2) increases the risk of HIV infection if sexually exposed. (But only HSV2. Half of all new genital herpes is due to HSV1, historically the cause of oral herpes more than genital. And HSV1, whether genital or oral, does not increase HIV risk. Given the apparent source of your genital herpes, i.e. probably genital intercourse despite condom protection, probably you have HSV2. However, you should be tested to know for sure if it's HSV1 or HSV2. In addition to the differences in HIV risk, genital HSV1 causes less frequent recurrent outbreaks and is uncommonly transmitted to sex partners. So it's always important for people with genital herpes to know their HSV type.

Your doctors are wrong about no HIV risk if there is no active herpes outbreak, i.e. after lesions have healed. In other words, the CDC information is correct:  the risk from HSV2 occurs regardless of overt sores or outbreaks. However, the the risk is only about double what it would be without HSV2. Remember that HIV is inefficiently transmitted:  for unproteted vaginal sex with a woman with untreated HIV, the average risk is once for every 2,000 exposures. Double that risk means the chance rises to an average of once for every thousand episodes of vaginal intercourse. And that's without a condom. With condom protected sex, the chance of HIV, even in someone with HSV2, is under one chance in 10,000 to 100,000 events. In other words, extremely rare.

So if you have HSV2, the main risk from your genital herpes is not your health due to HIV. The main problem is the risk to your partners that they will catch herpes from you. In addition to using condoms consistently, you should always inform partners you have genital herpes -- even if no current or recent outbreak, and this includes commercial sex workers as well as othe rwomen. You also can reduce the transmission risk by daily treatment with an anti-herpes drug like valacyclovir or acyclovir.

I suggest you discuss all this with your doctor. If not confident in his or her expertise in herpes and HIV, see an infectious diseases or genitourinary medicine specialist. Both IT and GUM physicians are readily available in India, at least in the major metropolitan areas and medical centers.

I hope this information has been helpful. Best wisehs and stay safe--  HHH, MD


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42 months ago
doctor so ur trying to say that there is still risk if I used condoms correctly for hiv if I have previous genital herpes infection? has there been any documented cases ? I know u can can get hiv if the condoms fail but if it's intact then also there's risk or what? and I've read that primary hsv 2 infection is less severe if u don't have rough sex .. that's because of the Microscopic tears created in the mucous membranes .. I've had a chat with several hsv2 positive people and they say that they haven't passed it when they used a lot of lubes and avoided sex when they sensed prodormal symptoms.. I think having herpes isn't a big deal at all .. it's just a stigma created by pharma companies so that people use their drugs .. I don't take valtrex except my outbreaks 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
42 months ago
You misunderstand. I am saying that if you use condoms consistently, you will always be at very low risk for HIV, even though you have HSV2. It appears you are spending too much time on the internet and finding unreliable sources of information. Condoms are not perfect but are highly effective -- just like all safety devices. (Seat belts are necessary when driving, but they don't prevent all deaths.) When condoms fail, it is usually because they break open or are used improperly. HIV and other bacteria and viruses cannot pass through intact latex or polyurethane, and there is no such thing as microscopic leaks that allow disease transmission.

There are no data to suggest that rough sex or good lubrication make any difference in transmission of herpes, HIV, or any other STD. Any such effect is miniscule. 

It is true that herpes and other STDs often carry stigma, which comes not from pharma but from infected persons themselves, primarily because of the fear of infecting partners and the difficulties it causes in discussing the infection with partners. News stories and the internet have contributed to this, and so do some misguided school education programs. Pharmaceutical companies have little if any efect on stigma from herpes or other STDs.
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42 months ago
so I won't get hiv if I use condoms always right ? if it doesn't break or fail I won't get it just because I have the infected region at the base of the penis where condoms don't cover .. ? If I be careful that the condoms do not fail and is used correctly then should I be worried since I was previously infected by herpes ? anyway thanks for ur time 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
42 months ago
With consistent and careful condom use, most likely you will never been infected. But nobody can say you can never get HIV, even if a condom does not break and fail. You cannot expect 100% assurance against HIV if you're going to have non-monogamous sex. Having herpes, and the location of your initial symptoms, makes no important difference one way or the other. I have explained all this above. Please carefully re-read my comments above!

That concludes the two follow-up comments and replies with each question and so ends this thread. I hope the discussion has been helpful. Best wishes and stay safe.

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