[Question #2008] concerned about Hiv after my repeated exposures

48 months ago
My question is for Dr. Terri Warren .. im a practising oncologist from Mumbai, India .. as a doctor myself i always use a condom for having sex but once had unprotected intercourse with my girlfriend 4 years back and got infected with genital herpes type 2  .. i broke up with her due to other personal issues and after my breakup i had been having sex casually on and off with a few girls but with condoms and as far as my medical knowledge i was mentally satisfied that i cannot get infected with hiv since ive always made sure the condom doesnt break or slip off .. condoms are not considered fullproof since they break or sometimes people dont use them properly.. but as per my knowledge if they r used correctly and they dont fail im certain that they cant let u get infected with hiv.. i used to inform my partners about my herpes status and it wasnt a big deal for them so i was continuing to live my life and practise safe sex.. but recently i was going through some article and it said u dont need to have an active outbreak or sores to get infected with hiv if u have herpes .. ur risk is elevated if u have genital herpes type 2 irrespective of having an outbreak or no .. even if the lesions heal ur still at increased risk .. i get the lesions at the base of my penile shaft where the condoms do not cover the area .. so can i get infected with hiv despite using condoms ? i dont have sex while i have an outbreak .. initially i thought only the urethra is suspectible for hiv to enter the male body so i was carefree but after reading this research paper im very anxious since ive been having sex with condoms on thinking i would never get infected with hiv.. i do not know the hiv status of my partners whom i had sex with .. should i get tested ? has there been a proven case of trmasmission in this scenario or is it just a theorotical concept ? i consulted my dermatologist and he said u dont have to worry about it since i always use condoms and they dont fail.. im perplexed .. sho
48 months ago
what if someone is hiv positive and her infected vaginal secretions come in contact with my infected area and i end up getting hiv despite using condoms always making sure they dont break but somehow i get infected .. even if the risk is slighly high like one in million then y to play russian roulette with ur life.. should i get my potential partners tested atleast for hiv before hitting the bedroom ? herpes and hpv are super common so i think getting ur partners tested for that wouldnt make a difference .. i initially used to think that u should avoid sex during outbreaks because they bleed easily so maybe because of that there is an increased risk so even protected sex would be dangerous but after reading this research i think the microspic tears get generated and its still possible to get infected even if ur lesions have healed up.. im very anxious after that and ive been sleepless and losing weight because of anxiety and i cant concentrate on my work .. im super concerned .. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
48 months ago
I have referred your question to Dr. Hook because it is more about HIV than HSV, I think.  Thank you

Terri
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Edward W. Hook M.D.
Edward W. Hook M.D.
48 months ago
Welcome to our Forum and my thanks to Ms. warren for referring your question for me.  The question you ask is one that has not been specifically studied but nonetheless there are related data which may be helpful to you.  Persons acquire HIV in two major ways: when the virus passes through mucosal surfaces such as inside the urethra or at the uterine cervix.  The is the way the the majority of sexually acquired HIV infections are acquired.  The 2nd, less common route of infection is thought to be the introduction of the HIV virus into the body of an uninflected person through an infected genital lesion such as occur in persons with Syphilis or herpes.  When condoms prevent contact of sores with the secretions of an infected person, the also reduce risk for infection but if the sores are not covered, a person could become infected with HIV in that way.  For that reason, in your case, it is good to continue to always use condoms but I would advise you to also avoid sex when you have lesions due to a herpes recurrence.  On the other hand, your risk from contact of infected genital secretions when you do not have an active outbreak is quite low.  Obviously while the safest possible approach would be to avoid sex with infected person, I would not be overly worried as long as you continue to use condoms a and avoid sex during your HSV recurrences.

This is a complex issue.  I hope my comments are helpful.  If not, you may ask up to 2 followup questions.  EWH
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48 months ago
Doc u said the risk would be quite low but the risk i think would be there even if its little so i dont think its worth playing playing russian roulette with ur life and risking ur life to have sex since there are no studies done on the said situation .. should i ask the person to get tested for hiv before having sex with them ? i think that would be the safest way to ascertain if or not the person has hiv or no .. ive always made sure that i dont have an active outbreak before having sex and ive always used condoms .. so should i get tested tested for hiv? m worried .. 
48 months ago
i was reading a similar question on this forum in which a person asked the very same question which was answered by Dr. Hunther and he said the risk would be quite low but even if the risk would be quite low and even if its 0.1 percent the risk is always there so i think its not safe to take a risk with ur life which would be stupid.. i think having herpes have made my sex life very complicated and now i would have to be very concerned in choosing my partners.. he said that there is no need to worry but the risk would be quite low but he didnt say that there would be no risk which is not quite assuring .. i think i should go ahead and get tested to relieve my anxiety and in the future before choosing my partners il have to ascertain that my partner is not hiv positive .. 
Edward W. Hook M.D.
Edward W. Hook M.D.
48 months ago
Dr. Handsfield and I agree about this, as we do on all of our advice. ,please remember that all of life involves risk.  You could fall and injure yourself today or perhaps be struck by lightening or a meteorite falling from space while reading this.  The "risk" of any of these things however is very, very low.  If you use a condom for all sexual activities and do not have sex whe you have lesions your risk is much, much lower than it would be for playing Russian roulette or even lower than being struck by lightening.  Of course you could make the risk lower if you made sure you know your partners' HIV status before sex but that is sometimes difficult.  How much risk you accept is a personal choice.

I hope this perspective is helpful.  EWH
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48 months ago
Doc as far as my own medical knowledge i know that the risk for people who dont have herpes and who use condoms making sure it doesnt break is zero .. since there are no researches or studies conducted on this scenerio as u previously mentioned u cannot say that the risk is zero like people who do not have herpes so some amount of risk is always there .. if u say that the risk is zero if i dont have an outbreak and i make sure that condoms dont fail then i think it would be alright for me .. but since there r no studies conducted before as u righltly said i think getting ur partners tested is the only viable option i have at the moment and avoiding casual sex 
Edward W. Hook M.D.
Edward W. Hook M.D.
48 months ago
The decision about what you and your partners do is, of course, up to you.  As I pointed out to you, there are no studies of the specific scenario that you describe however my reply was based on my experience in caring for persons with and at risk for HIV since the beginning of the epidemic, my reading of the medical literature on this topic and my discussions with other experts over the years.  You asked for my opinion and advice and you got it.  What you do with this advice is, of course up to you. 

This is my 3rd reply to your questions. Thus, as per Forum guidelines, this thread will be closed later today.  I wish you the best.  EWH
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48 months ago
just last question .. has there been any documented case in this scenario when a person used condoms but got hiv because of herpes ? 
Edward W. Hook M.D.
Edward W. Hook M.D.
48 months ago
No there has not been.  End of thread.  EWH
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