[Question #301] Hiv and HSV 1

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102 months ago
I had an unprotected oral sex with CSW on may 2015 and I experienced many symptoms. after 3 months I took the oraquick and it was negative. After 5 months I did full STD panel with hiv 4 generation, all was negative except HSV 1. the range was 50 .
stupidly I went to a thai message and had professional message without any hand job but I was having a open wound on my arm and I am afraid that it could transmit this way although I did not notice any blood on her hand.

After 2 weeks from the message exposure , I had very severe muscle pain and aches with fever along with some tiny spot in my arm. I was very tired , I could not even drive and shop for the blackfriday and that what scared me.

At the HIV test I was taking many ibuprofen and many cvs headache and pain relievers  and also a pills for the pumps in my head.

My Questions are:
1- Could these medication affect the result?
2- Do I need to worry or test after my message exposure?
3- I had cold sores after I went to a strip club and kissed and suck a stripers nipple, Could I have gotten the HSV 1 from this exposure?
4- Can the HSV 1 causes muscle pain and pumps  in head and part of the body?
DO I need to test again for HIV??

Thank you 
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H. Hunter Handsfield, MD
102 months ago
Although Terri Warren answers herpes questions, I interpret your concern as primarily related to risk for HIV, so you have me this time.

I'm sorry to see you remain so concerned about such a low risk exposure. Oral sex -- especially receiving fellatio, i.e. mouth to penis transmission -- is low risk for all STDs and zero risk for some, including HIV. Based on the exposure, symptoms, and test results, I agree with Terri that your HSV1 infection probably is not genital, and your history of oral cold sores shows it almost certainly is oral. It is unrleated to the oral sex or hand-genital exposures you had with the CSW or anyone else. (It is conceivable you acquired oral herpes by kissing the sex worker. But still very unlikely if you didn't develop severe sore throat and multiple oral/throat sores in the week afterward. Probably your HSV1 infection is oral and was acquired in childhood. No way to know or prove it, but that's the best bet.

Second, although HSV2 increases the risk of HIV infection if sexually exposed to HIV, HSV1 does not -- no matter whether the HSV1 is genital or oral, with or without symptoms.

Third, the HIV tests are among the most accurate diagnostic tests ever developed, for any medical condition. No matter how high the risk of HIV might have been at the time of exposure, your negative results prove you were not infected. You could have described typical HIV symptoms (you do not) or the highest risk exposure imaginable. The answer would be the same:  you didn't catch it. There are no illnesses or medications that change the reliability of HIV testing.

Those comments answer all your questions, but to be explicit so there can be no misunderstanding:

1) No, your medications had no effect on your HIV test results.

2) You do not need testing for HIV or any other STD on account of the event described.

3) See comment above. It is very unlikely you acquired your apparent oral herpes from the stripper.

4) Initial herpes can be accompanied by muscle aches, headache, etc. But only if there also are other symptoms like fewer and multiple sores; and only in the first couple weeks after catching it. Ongoing symptoms like this have nothing to do with either herpes or HIV.

5) From a medical or risk standpoint, no further HIV testing is needed. But of course you are free to do that if you would find another round of negative test results would help you stop worrying about it. (This does not mean I believe there really was some risk. There was not.)

Best wishes--  HHH, MD

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H. Hunter Handsfield, MD
102 months ago
And by the way, my comments apply to both the sexual events described. Nobody ever caught HIV, herpes, or any other STD from having a massage, especially without any genital contact.