[Question #4898] HSV2 and the increased risk for HIV

26 months ago

Dear Doctors,

I am a gay male with genital HSV2. (I’m guessing I could also have it orally, but don’t know)

I recently engaged in kissing and mutual masturbation with someone who told me he was HIV negative. After our hookup, we were discussing our relationship history and I came to find out that he had dated an HIV positive person several months prior. He reiterated that he was negative, but I started to feel uneasy because I know that I face and increased risk of acquiring HIV as a person with HSV2

Maybe this is ridiculous, but I’m worried that during the mutual masturbation his pre-cum was rubbed into my penis and that, because of my HSV2, this usually ‘no-risk’ activity is bumped up to the category of ‘possible risk.’

Apparently, genital skin can remain a target for HIV long after lesions have healed:

https://www.sciencedaily.com/releases/2009/08/090802155237.htm

My specific question aside, I don’t really know what to do with the information that I am at an increased risk for HIV, especially as someone who does not engage in unprotected anal sex.

Are there things (like mutual masturbation with pre-cum/semen exposure) that HSV2 negative people don’t have to worry about, but I DO because of my increased risk? Or is it still the case for HSV2 people that unprotected intercourse is high risk for HIV, oral is low risk and everything else (kissing, touching, rubbing) is on par with being hit by lightning?

Any clarification would be greatly appreciated!

H. Hunter Handsfield, MD

26 months ago

Welcome to the forum. Thanks for your confidence in our services.

It is correct that having HSV2 increses the risk of HIV if sexually exposed to HIV. However, the actual effect is much les than you might think. Here are some basic facts. You are correct that herpes lesions do not have to be present. Simply having a positive blood test for HSV2 roughly doubles the risk, even in people who never have recignozed outbreaks. However, "double" is actually a very small rise in risk. Why? Look at it this way. For unprotected anal sex exposure with a known HIV infected partner, not on HIV treatment, the chance of HIV transmission averages about once for every 1,000 exposures. With double the risk, it's still only 1 chance in 500.

For your particular exposure, you weren't at risk for HIV at all. Your own summary of the risks from various exposures is exactly right: the main risk from unprotected intercourse, and incredibly low isks for oral sex, hand-genital ontact, etc. And double zero risk is still zero risk! Or if we assume some very small actual risk, say 1 in a million, then a doubled risk because of your HSV2 becomes 1 chance in 500,000. Still nothing to worry about. On top of that, I'll point out that you describe a partner who almost certainly is not HIV infected.

We epidemiologists like to think about "population level risk". In that context, HSV2 is exceedingly important in HIV transmission. Double the risk means that in a country where 90% of all people have HSV2 (e.g. sub-Saharan Africa), as many as half of all HIV infections would be prevented if HSV2 were not an issue. Therefore, preventing HSV2 (maybe with a vaccine someday?) could be a very important HIV control strategy. Nevertheless, for the reasons outlined above, the roughly doubled risk for any single exposure doesn't really mean very much for most individuals concerned about HIV. For you, it just means paying close attention to what you already know: avoid unprotcted sex with infected (and untreated) or new partners of unknown status. But don't lose any extra sleep over your HSV2 infection. (Of course, you also need to be informing any and all your partners about your HSV2!)

I hopet hese comments are helpful. Let me know if anything isn't clear.

HHH, MD

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26 months ago

Dear Dr. Handsfield

I cannot thank you enough for this clarification. You've made it clear to me that despite having major implications for large populations/demographics, my individual infection HSV infection doesn't really change what I should be doing/avoiding to prevent HIV infection.

Thanks again for your time and expertise!

26 months ago

Dr. Handsfield,

One last quick question just to make sure I have understood the nature of the probabilities: If the risk for unprotected anal is 1 in 1000, double the risk makes it 1 in 500 and triple makes it 1 in 250 right? Or did I mess that up?

Thanks

H. Hunter Handsfield, MD

26 months ago

Triple risk would calculate to 1 in 333.---

26 months ago

Got it!

Thanks again Dr. Handsfield!