[Question #2115] herpes and related risk for hiv

45 months ago
My question is for Dr Hunther Hansfield.. im a practising Oncologist from Mumba, India .. a few years back i got diagnosed with genital herpes type 2 at the base of my penis where condoms do not cover .. after that ive been very careful and have been using condoms everytime with all my sexual partner .. i asked the same question to Dr hook and i asked him if there would be a risk to contract hiv if my lesion were healed and i used condoms always and he said that studies have not been conducted in the given scenario and the risk will be nearly zero if my lesions have healed and i used condoms always but he didnt say the risk will be comoletely zero .. then he said there have been no documented case like this.. likewise i saw another person posting the same sort of question to u and when i was going through already asked questions you said that the risk would be neglible if the lesions have healed and it wouldnt matter even if the infected vaginal secretions came in contact with the previous healed skin .. so would condoms be sufficient or i would be increased risk since there is a synergy and increased risk of getting hiv if you already have herpes .. why cant u guys be sure and say the risk would be zero if i always used condoms and i dont have an active outbreak going on ? earlier u also said that you dont have to screen your partner before having sex for hiv but what if my condom rupture while having sex and since i already have herpes i may end up contracting hiv ? u had said if u choose ur partner sensibily but anyone can  have hiv right ? its not that only high risk population are at risk .. and my last question is about hpv .. im already past the age to get vaccinated and since hpv can cause oropharyngeal cancer so how do i be safe from it if i have an active sex life ? im worried and have not been able to develop sexual relationships with anyone due to the above stated reasons .. my biggest fear is hiv .. what if i used condoms always making sure it doesnt bre
45 months ago
my biggest fear is getting infected with hiv even if i used condoms always because i have a past history of herpes .. but i make sure i have sex only in monogamous relationships and i make sure that condoms dont break .. and if at all i decide to have unprotected sex should i tell my partner to get tested for all stds ? 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
45 months ago
I answer the questions on this forum about genital herpes.
Here's the deal - you won't contract HIV if you aren't having sex with someone who has HIV infection.  I think given your concerns, it would be a good idea to have your partners tested for HIV.  Is there a problem with that?  In this day and age, if I was single again, I certainly wouldn't have sex with anyone without them having a full STD screen.  You are correct that if you have sex with someone who has HIV infection and you don't know it, there is small risk for you of contracting HIV, just like anyone else would be.  The reason we can't tell you there is zero risk is because I think it's possible that you could have a very mild outbreak that you don't notice.  Certainly the risk of acquiring HIV is greater since you have herpes and most of that is due to lesions being present - if they are healed, the risk drops dramatically but you are looking for 100% certainty which none of the three of us can give you for the reason stated above. 
So yes, I would suggest that you have every partner tested for HIV and if they are negative then you don't need to worry about this, right?  Do you see a problem with that?

Terri
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H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
With my additional reply, you have heard from all three of us. I agree with the replies you have had from Dr. Hook and Ms. Warren.

The association of HSV2 with increased HIV risk has nothing to do with whether or not there are overt outbreaks, or with whether the infected area is exposed. Simply having a positive HSV2 blood test, indicating HSV2 infection, elevates the risk of HIV regardless of actual outbreaks. They apparently make no difference in risk. There may be a still more elevated risk if an obvious, symptomatic herpes lesion is exposed to the virus. But I assume you would avoid sex at such times.

Having said all that, your risk of HIV because of your HSV2 really isn't raised very much, only double. "Double" may sound like a lot, but not really. For a male partner having vaginal sex with an infected woman, the average risk of acquiring HIV is around once for every 2,000 exposures. With HSV2, that risk becomes 1 in 1,000  -- still very low. And that's only with a female partner known to have HIV, and without a condom. With a woman unlikely to be infected, plus condom use, your risk remains extremely low.

As Terri says, you can lower that risk still more by selecting partners who definitely do not have HIV, which might involve asking them to be tested. But I think we all understand that won't always be practical. However, even among commerical sex workers in India, under 5% are infected on average. And if you use condoms consistently, your risk of HIV will be extremely low. Not quite zero, but close enough.

Cheers--  HHH, MD


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45 months ago
ya asking all my sexual.partners 2 get tested is quite impractical so that is y i why i was concerned .. has there been a documented case where a person had herpes and still got infected by hiv even when he used condoms ? Dr hook said no there hasnt been any case like that so i think il bring my mind to ease and always use condoms for all my sexual encounters since there has been no case of infection in this way 
45 months ago
i think its a theorotical risk only in a similar way as 2 how hiv gets transmitted by receiving oral sex in men .. the risk is there in theory but it hasnt happened actually so i think using condoms would be sufficient right ? what say doctor ? 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
Has there EVER been a case in which people acqured HIV despite proper condom use? Could be -- given millions of sexual exposures with condoms among millions of infected persons, I suppose it has happened, probably mostly because of condom breakage, but maybe sometimes because infected secretions got inside the condom. If you want 100% assurance you'll never get HIV, your only choice is to only have sex with a mutually monogamous, uninfected partner; or avoid sex entirely, or at least to have non-monogamous sex only with people you know for sure do not have HIV. Most sexually active peole don't expect or require this level of certinaty, but only you can decide what is appropriate for you.

Please note the forum does not permit repeated questions on the same topic or exposure. This being your second, it will have to be your last; future new questions about this exposure, testing, and your fears about HIV, herpes, or other STDs will be deleted without reply and without refund of the posting fee. This policy is based on compassion, not criticism, and is designed to reduce temptations to keep paying for questions with obvious answers. In addition, continued answers tend to prolong users' anxieties. Finally, such questions have little educational value for other users, one of the forum's main purposes. I trust you will understand.    

I hope the discussion has been helpful.
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