[Question #5097] Herpes and HIV

23 months ago
I had sex with a new partner on Feb 23, he is an immigrant from the Dominic Republic (I say this because the HIV rate is higher there than the United States). Within a week, I believed to have a uti because I was having pain while peeing. I went to urgent care and got uti tested (positive) and chlamydia and gonorrhea (both negative). On March 1 after taking the uti meds for a few days and having my symptoms get worse I went to an obgyn doctor. He looked at my vagina and said he was 99% sure it was herpes but took a swab of the bump to be sure. I have not received confirmed lab work that it was herpes but I started taking valacyclovir and my symptoms are almost all gone. However, on March 1st the day the doctor told me I had herpes I had horrible night sweats that are continuing even though I am on valacyclovir. Additionally, I cannot find anything online about herpes or valacyclovir and night sweats, I only see HIV. Additionally,  I had a swollen lymph node in my neck and chills. However, I have not had a rash or thrash. I am confused if the herpes are causing the flu like symptoms or if it is HIV? Today, I am having a sore throat and have experienced some diarrhea is the past few days.   I am also worrying that HIV could have caused the bumps on my vagina, is that possible? I called the new partner to inform him on my herpes outbreak and he said he was surprised and he has never had an outbreak. He also informed me that we used a condom because I was too intoxicated to remember but I am worried he was too intoxicated to remember fully or maybe he put the condom on incorrectly. How likely is it that I contracted both hiv and herpes? thank you for answering
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
23 months ago
Welcome to the forum. Thank you for your question and your confidence in our services.

Your story is very typical for a new (primary) genital herpes infection. The timing of symptoms, worseing symptoms despite antbiotic for UTI, the presence of genital "bumps", and the confident diagnosis by a clinician who seems experienced in herpes all point to a correct diagnosis. I'm glad to hear your symptoms are improving with acyclovir, which is additional evidence for the diagnosis. I expect the lab test from the genital bump to be positive. I suggest you contact the doctor or lab and make sure they determine virus type. Sometimes the lab stops at HSV, without telling whether HSV1 or 2. It makes a big difference in what you should expect in terms of recurrent outbreaks and, going to your main concern, the risk for HIV.

Primary herpes itself ofen causes fever, night seats, and inflamed lymph nodes in the groin. It also causes genital "bumps" (actually, on close exam you would have seen that some of them looked like blisters) and HIV does not. A single swollen lymph node in the neck is not typical for either herpes or HIV. And if indeed a condom was used, that would have been excellent protection against HIV, but condoms often do not prevent herpes, because of skin contact above the condom. And it also is possible your infection is due to HSV1, which is acquired by oral sex. (Did the sexual encounter include oral sex on you?) And HIV is NOT transmitted by oral sex, or so rarely that it's not a realistic risk.

Having said all that, you definitely need to be tested for HIV. It's not likely you have it, but HIV is higher risk if exposed at the same time as herpes. (But still low risk!) Your partner also should be tested for HIV -- if negative, you'll know for sure you were not exposed and no risk for it. And by the way, he should also have a blood tst for HSV. That test will tell if he has HSV1, HSV2, or both -- so it could help confirm your own diagnosis. But if you are no longer in touch with him, or if he declines HIV testing, it would make sense for you to have both a nucleic acid amplification test (NAAT, also called a PCR or RNA test) and an antigen-antibody ("duo" or "4th generation") HIV blood test. You can expect negative results, but better safe than sorry!

I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD
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23 months ago
Thank you for your quick response. I have some additional questions. First, we did not engage in oral sex so I am assuming the HSV is 2. However, it has not been confirmed. Are there any symptoms that would occur during acute HIV but not during a primary herpes outbreak that I could look out for? Also, is it odd that the valacyclovir is helping the herpes but I am still having night sweats? Additionally, I believe I have transferred the herpes to one of my fingers (I am taking 40 mg of prednisone because I have an autoimmune disorder) so my suppressed immune system would allow for that to happen, so if I have herpetic whitlow on my finger and wrist, does that have asymptomatic shedding or is it only contagious if there is a sore? Lastly, how accurate would both a nucleic acid amplification test (NAAT, also called a PCR or RNA test) and an antigen-antibody ("duo" or "4th generation") HIV blood test be if my potential exposure to HIV was Feb 23?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
23 months ago
Correct, probably HSV2 if no oral sex exposure. Although HSV1 isn't likely, it's still possible and you still need testing to determine the type you have.

Symptoms almost never are useful in predicting whether or not someone has HIV. Some of the symptoms that occur with primary herpes occur with acute HIV, but also with a hundred other conditions. There are no symptoms that occur only with HIV. You simply cannot tell or predict based on symptoms:  only lab testing can tell.

I would have to know more about exactly what finger or wrist symptoms you have to judge whether you have herpetic whitlow. But if the symptoms started after starting acyclovir, whitlow is unlikely. Asymptomatic shedding doesn't apply here. You have (or recently had) genital symptoms, so it wasn't asymptomatic. There are no data on the exact mechanics of auto-inoculaiton causing whitlow. But we really shouldn't go there unless and until we know you have a whitlow.

Taking the fairly large amount of prednisone you are on could prolong the symptoms of primary herpes, even on acyclovir. So might the autoimmune disorder itself. (What is your autoimmune problem?)

If you caught HIV, there is at least a 95% chance your NAAT would be positive and 90% probability for the AgAb test. In other words, negative testing at this time would be nearly 100% proof you didn't catch HIV -- but to be absolutely certain, another AgAb test would be necessary 6 weeks after the exposure.

Primary herpes is a fairly complex disorder, and so sometimes is the diagnosis of HIV -- even in people with autoimmune problems or on prednisone. You really need to be the care of an expert, preferably an infectious diseases specialist. Or at least be in touch with the doctor who cares for the autoimmune problem. There is also the issue of advising your partner to be tested for HIV and HSV. Please do not expect conclusive diagnosis for any of these problems or treatment recommendations from this forum. We can only provide general information -- we do not provide direct medica care. I'll be happy to hear your responses to the additional quesitons I have asked about your symptoms and autoimmune diagnosis, but that will be the last exchange on this thread. Thanks for your understanding.
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