[Question #2255] One night stand risk of STIs

47 months ago
Hello Doctor,
3 weeks ago I made a foolish mistake. I had one night stand with a girl. Unprotected oral sex and protected vaginal sex. She said she is clean but I cannot trust her. What are my chances of incurable infections HIV and Herpes? I have been doing some research online and came to conclusion that HIV is rare infact 0 chances. What about herpes? She has no visible sores or blisters. And I read online that even then there can be transmission? I am quite concerned about herpes. I don't have any symptoms and I am checking my groin and penis every few hours for lessions. What do you think the chances are with one time unprotected oral sex? I am negative for both HSV 1&2 before this incident. Thanks 
47 months ago
It shows my account was updated 9 minutes ago but I don't see any reply??
Edward W. Hook M.D.
Edward W. Hook M.D.
47 months ago
Welcome to our Forum.  I'll try to help.  Your risk for infection is a function of the likelihood that your partner had an STI, as well as the likelihood of transmission following a single exposure.  Putting these together, the statistical risk for infection is very low for either HIV or HSV although the risk for HSV is a bit higher than the risk for HIV.  With respect to herpes, while not everyone who acquires genital herpes develops symptoms, most do, particularly if the are looking for symptoms and the fact that you have not developed symptoms makes the probability that you were infected far lower.  In my opinion, at this time, three weeks after your exposure, I see no reason for concern or for testing of any sort.  Several additional comments below:

1.  I agree with your assessment for HIV.  Not 0 chance but close to that.  Factors which shape this opinion include:
     a.  Few women have HIV, only a small fraction of 1%
     b.  Your genital exposure was condom protected.  Condoms are highly effective.  Even without a condom, if she were HIV infected the likelihood of transmission through genital sex is less than 1 in 2000.
     c.  Even though your oral exposure was not condom protected, the CDC conservatively suggests that the risk for acquiring HIV from receipt of oral sex is less than 1 in 20,000 and we think this estimate is conservative.  Neither of us has ever seen a case of HIV which was proven to result from receipt of oral sex.

2.  For herpes, we roughly estimate that, if your partner had HSV, and IF she was asymptomatically shedding the virus, the risk for infection would still be less than 1 in 10,000.  Further
    a. There is only about a 50/50 chance that she has HSV-1 which could be transmitted by receipt of oral sex.
    b.  HSV-2 is almost never transmitted through receipt of oral sex.
    c.  Even with a negative HSV-1 blood test, you may still have the infection since the HSV-1 commercial blood test missed about 1 in 4 HSV-1 infections.  (It works much better for detection of HSV-2 and your test does assure you that you do not have this infection).  If you did have HSV-1 this would protect you form HSV-1 infection and reduce your risk for HSV-2.
    d.  As noted above, that you did not develop symptoms in the interval since your exposure is additional evidence that you were not infected. 

I hope this assessment and these comments are helpful to you.  My advice to you is to not worry about the encounter that you describe.  I see no medical need for testing at this time in relationship to the exposure you have described.  EWH
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47 months ago
Thanks for the reply sir. Also what percentage of people will develop symptoms or lessions within 3 weeks?
And on asymptomatic viral shedding, will it be continuously 25% of the time like online says irrespective of how long She had the infection? And I asked her did she have any cold sores before or especially after our encounter (10 days) which she said no. So most probably she did not have shedding right? And let's say she had viral shedding during our encounter,  does it mean that I will definitely get the infection? 

And one last thing, I was tested for hsv 1&2 prior to this incident 4-5 times and all times it was negative. So even if the test missives 1 in 4, it should show up atleast once right( based on probability) and to add to this I never had cold sore in my life and I am pretty much confident about it. Since in my country it was not common to kiss a child or hug him culturally. And I am 26 years old and this is my 1st sexual encounter( little embarrassed). Also I got tested multiple times because I received hand job in a massage parkour and got scared and tested for all STDs 4-5 times. I hope you won't judge me. Thanks
Edward W. Hook M.D.
Edward W. Hook M.D.
47 months ago
Nearly everyone who is going to develop symptoms of recently acquired HSV does no within two weeks of exposure. 

Over the years, the longer a person has HSV, the lower the rate of asymptomatic viral shedding.  There is no way to predict when shedding occurs and the time since last cold sore or HSV outbreak does not predict whether or not asymptomatic viral shedding will occur.  As I noted above, even if she was infected and asymptomatically at the time of your exposure, it is unlikely (less than 1%) that you would become infected.

Multiple negative tests for HSV-1 and 2 certainly make it less likely that you have herpes infection.

Finally, no need for embarrassment but there is not reason for STD testing in the absence of penetrative sexual exposure.  STIs are not transmitted by touching or receipt of masturbation.  EWH 
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47 months ago
No what I meant was when you said I might already have hsv1 and the test for hsv1 misses 1 in 4, I said before this exposure I tested multiple times. After this exposure I haven't tested yet. Do you think I should get tested now (4 weeks since exposure) for hiv and hsv to put my mind at ease? Or wait till 6 weeks. And if it's negative then can I move on with my life? Given very low risk exposure. Or should I get tested at 12 weeks?  I know this is my last question here. Can you assure me that I was not infected given my exposure and no symptoms in 4 weeks? Please don't be conservative. I won't hold you accountable for anything. Thanks. I am only asking you because you are leading expert in STIs and I will be really happy if you can answer me based on your experience and all the scientific evidence. Sorry if I was mean or rude. I hope you understand. Thanks once again for your great work.
47 months ago
Also I final question is it true that rate of transmission is more from male to female than female to male? All the new cases of ghsv1, are females more or males or it is about same?
Edward W. Hook M.D.
Edward W. Hook M.D.
47 months ago
I realized what you meant.  With repeated testing the chance of missing a diagnosis goes down however, thus your repeated testing validates that you probably do not have either HSV-1 or HSV-2. 

I recommend against getting tested at all after your encounter. We recommend use of HSV blood tests to evaluate whether or not you might have gotten asymptomatic HSV.  With repeat testing, your chance of a false positive goes up- this is a simple mathematical fact.  My sincere advice is for you to accept that you were not infected by the low risk encounter you described and move on without further testing or concern.   That is what I would do.

And in answer to your other follow-on question- transmission of HSV appears to be biologically more "efficient" (i.e.. likely to occur) in transmitting infection from an infected male to an uninfected female than from an infected female to an uninfected male. 

As you have acknowledged, this will end this thread.  I hope I have addressed your questions.  If there are further questions about HSV, and I hope there are not, they should be addressed to Ms. Warren.  Take care.  EWH
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47 months ago
sorry doctor one final question. Can i have sex with my wife unprotected? we are planning to have a baby 
Edward W. Hook M.D.
Edward W. Hook M.D.
47 months ago
Yes, of course you can have unprotected sex with your wife.  EWH
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