[Question #4813] HIV transmission risk

27 months ago

Hello Doctor, I am heterosexual man. Genital Herpes +ve with no outbreaks in 8 yrs. Tested HIV -ve in 2013. I had 3 protected vaginal sex since. First two with a female I knew in India who was tested last time in 2012, HIV -ve. She had occasional involvement with people for money ~4 times a yr.  3rd incidence a protective vaginal sex in Thailand in June 2015. Broken marriage girl, low income group but not a sex worker.

April 2014 (previous sex 2 months dated) I had bad throat, low fever. Got resolved in a week. The last protected sex in June 2014 with the Indian girl.

Protected sex with Thai girl (June 2015) during her menses.

Since last 1 yr, my partner (always unprotected sex) started missing periods. She is 43 now.

Questions:  1. With Indian girl, we were very aggressive in oral sex (un-protective). Sometimes I get blood after morning brushing. Any HIV risk?  2. Were April’14 symptoms ARS?  3. Since last 2 yrs, continuous redness on the penile head and itching. No medication worked until I took homeopathy. Better now (90%). Is it HIV symptom?  4. Thai girl was in her menses & I am herpes positive. HIV risk?  5. Is risk materially differ (with protective sex and non protective oral) if one on these girls were in Acute period ?   6. My partner is experiencing perimenopause symptoms (mild night sweats & heat waves fatigue, delayed/missed periods). Is it due to HIV ? Do females have any severe symptoms during perimenopause if they are HIV positive?   7. Do I need testing?

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
27 months ago
Welcome to the forum. Thanks for your question.

Most of your numbered questions can be answered with succinct advice:  get tested for HIV. You have been sufficiently sexually active that you should be tested for HIV, without need to focus on any particular exposure. If I correctly understand, all the exposures you describe were low risk. However, condoms are not 100% protective, and anyone who is sexually active outside a committed, monogamous relationship should be tested for HIV from time to time.  So my advice is that you have an HIV test. Almost certainly it will be negative. When it is, you can stop worrying about any of the particular events you have mentioned. No matter what symptoms you have had or might have in the future, a negative test will prove they are not caused by HIV.

To your specific questions:

1,2) HIV is rarely if ever transmitted by oral sex and bleeding gums is not likely an HIV symptom. But I cannot say the risk was zero, just very low.
3) HIV doesn't cause penile rash or irritation.
4) If your genital herpes was due to HSV2, it slightly increases your risk of HIV if sexually exposed to the virus. However, your Thai partner probably did not have HIV, and sex during menstruation is no higher risk than sex at other times. (The amount of HIV in the blood of infected persons is no higher than in genital fluids.)
5) Yes, the risk of HIV is highest from partners experiencing early/acute HIV infection. But still not transmitted during most such exposures.
6) These sound like straighforward symptoms of menopause. HIV is an unlikely cause, but conceivably she could have HIV. 
7) Yes, you definitely need testing, as discussed above. I recommend it for reassurance, not because HIV is likely. But better safe than sorry!

I hope these comments are helpful. Let me know if anything isn't clear.

27 months ago
Thanks Doctor for your answers. Appreciate such a quick response. It is HSV2 in my case. I actually freaked out  and decided to get your advise because of my partners menopause symptoms at the age of 42. I read its early and HIV infected people can get menopause early. Is this correct

 A few more questions to clear my doubt :
1.HIV infected people get menopause early. Is this correct ?
2. Do HIV infected females have any other specific symptoms when they go through menopause.....does severity of the normal symptoms (night sweats etc ) differ ?
3. Normally i have read your posts where you describe Oral sex as "almost zero risk" for HIV transmission. Is your "very low" description below is semantic to "almost zero" ? 
4. I understand people with HSV2 genital herpes and HIV have recurrent and difficult outbreaks. In my case I practically did not have any for 8 yrs. Does it further suggest that I should not be HIV infected ?
5. Given that I have always used condoms and they never broke, and the transmission risk that you normally state in case of unprotected sex is 1 in 2500 and with condoms as you say it's "like lightning strikes you some day". Does it hold true in my exposures or you find something very different ?
6. Why would you say for my partner "but conceivably she could have HIV". Sorry for my english, it's not very clear to me.  

Thanks again, appreciate your advise and I will get myself tested soon.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
27 months ago
1)  I haven't heard that early menopause is more frequent in women with HIV. But early menopause is quite common, and such women are no more likely to have HIV than women with later onset.

2) Answered in my reply above. To my knowledge, women with HIV have no different menopause symptoms.

3) I mean no difference between such terms as "almost zero risk", "very low", or "zero for all practical purposes".

4) Most people with genital herpes due to HSV2 have noticeable outbreaks 3-6 times a year. However, about half of all genital herpes is caused by HSV1, which recurs much less often. Many people with genital HSV1 never have a noticeable recurrence. And genital HSV1 is almost always acquired by oral sex, so that might be especially likely in your case. If the type of virus you have was not checked when you were diagnosed, you could have a blood test to determine which type you have.

5) For the reasons you state, the chance you have HIV is extremely low. But as noted above, ALL sexually active persons outside mutually committed relationships should be tested for HIV from time to time.

6) Because of your (very low) risk of HIV, it is possible your wife has it. Very unlikely, but given your sexual lifestyle, there is a slim possibility. However, if your own test is negative, then she is not at risk and need not be tested (assuming that she hasn't had any sex partners other than you.)

I'll be happy to comment further if you would like to let me know your HIV test result. Threads are automatically closed after 4 weeks, so do it before then. I won't have any more comments or advice until then.