[Question #5220] Risk from unprotected exposure

25 months ago
I have some general questions about exposure and risk. 

-what are chances of contracting HIV from one unprotected exposure? 

-What are chances of contracting genital HSV from one unprotected exposure? 

-if you have HSV1 (with no known lesions and tested positive at young age so presume it’s oral HSV1?) does that offer you some immunity or create antibodies that lower your chances of contracting HSV2 genitally? 




H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
25 months ago
Welcome back to the forum.

HIV transmission risk is a lot lower than many people assume. The US Centers for Disesae Control and Prevention (CDC) has published estimates. For unprotected vaginal sex, if the male partner is infected, it's 8 in 10,000 (i.e. once for every 1,125 exposures). That's equivalent to sex with an infected partner once daily for 3.4 years before transission might be likely. The risk is somewhat higher with anal sex and far lower for oral sex. The risk also is much higher than this if the infected partner recently acquired HIV (within 3-4 weeks). Fortunately, however, at any point in time such recently acquired infections are rare, especailly in heterosexual men and women.

Today the risk is even lower. Those numbers were calculated several years ago, when most people with HIV were not taking anti-HIV drugs. Today 60% to 90% of HIV infected people in the US (with wide variations in different parts of the country) are on treatment, which removes any risk of transmission.

The risk for HSV2 is probably in the same range as for HIV, about once for every 1,000 vaginal sex events with HSV2 infected partners. This is for sex with a partner without an active outbreak at the time; the chance is higher during outbreaks. Also, HSV2 is much more transmissible from partners who recently acquired their own gential herpes than from persons with longstanding recurrent herpes. So the transmission risk can vary quite widely from one circumstance to another.

Very insightul question about cross-protection from one HSV type to the other. Having HSV1 slightly reduces the risk of catching HSV2, and it tends to make the first HSV2 outbreak less severe. Protection is much better in the other direction: it is very rare for anyone with HSV2 to catch HSV1. 

I reviewed your recent discussion with Terri. I agree it is unlikely the symptoms you described were due to herpes. Did you go ahead with an HSV2 blood test? If so, I'd be happy to answer any questions you have about the result.

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

HHH, MD
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25 months ago
I did not get a blood test. I asked my doctor and while I don’t fully understand her rationale, I think she honestly didn’t think my symptoms looked my HSV and worried where I tested positive for HSV1 in the past that it would only make me more anxious. 

I had a new partner 7 days ago that was unprotected. 5 days later I developed red dots on my vulva, spread out and not raised and not on a red base. Almost looked like I was poked with a needle. The entire vulva is red and inflammed and burning. The spots are not sore.  I should note that for past year while this burning comes and goes, flares up after sexual encounters or with use of hot tubs. Have been evaluated by several doctors and have been diagnosed with contact dermatitis/vulvitis and prescribed hypoallergenic products and vulva care. I’m convinced this is HSV but doesn’t really look like pictures I’ve googled. Waiting to get an appointment with my doctor. I also told partner and he states he has never had any symptoms before but would go to get tested. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
25 months ago
Thanks for the additional information.

Despite you being "convinced" this is herpes, probably it is not. It's possible, but quite unlikely based on your description. HSV rarely causes the "entire vulva" to be "red and inflamed and burning". This sounds more like contact dermatitis or perhaps a rather severe yeast infection. "Red dots" also could go along with yeast. You should not tell your partner you suspect this is herpes -- that will probably alarm him and is unjustified. I would advise that he NOT be tested for HSV until and unless that's confirmed to be your diagnosis. I hope you're able to get an appointment right away -- if your own doctor can't see you by Monday, I would advise you to find another provider, preferably one experienced in STDs and female genital infections. A Planned Parenthood clinic or your local health department would be excellent options.
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25 months ago
Okay thank you.  So this encounter happened one week ago today (Saturday night/Sunday morning). While I started to feel soreness and uncomfortable on Wednesday, I didn’t see any redness or bumps until Friday morning. And now they are almost gone and vulva no longer inflammed or red.. Still with burning, and itching at vaginal opening and inside. Having lesions/red bumps or dots for only a few days is less consistent with HSV right? 
25 months ago
And yes, I plan on going to Planned Parenthood first thing Monday morning just to be tested. Thank you for your quick replies. 
25 months ago
Sorry I forgot to put this in last post. 

Does having light period during pelvic swab test for chlamydia/gonhorrea/BV/ trich affect  accuracy of results? 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
25 months ago
I'm glad to hear you'll be seen at PP. STD testing is not affected during menstruation or by any genital symptoms. Just don't use any vaginal creams, inserts, ointments, etc.---


Threads normally are closed after two follow-up comments and replies, but I'm leaving this open for one more cycle, in case you want to let me know the outcome of your clinic visit tomorrow. But I won't have any more comments or advice until then.---
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24 months ago
So I went to Planned Parenthood. She did not feel as though this was HSV. But agreed I was red and inflamed. The red bumps that I noticed on vulva Friday AM were gone by Monday morning - so prob not consistent with HSV right? 
I got tested for everything else and all negative. Except vaginal swab came back with a yeast infection so that explains redness, burning and itching. 
I now have 4 bumps on bikini line all spread out. Only one hurts and they seems different than normal razor burn but I admit I am overly anxious/ paranoid about HSV so trying to let it go. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
24 months ago
Sounds like yeast only. But when evaluation has been done by an expert provider or clinic like PP, it's a mistake to attempt confirmation online. I cannot judge the situation from your description nearly as well as the provider or clinic who has directly examined and treated you. Continue to follow up with or otherwise contact PP if you continue to have symptoms or otherwise remain concerned.

That concliudes this thread. I hope the discussion has been helpful.
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