[Question #5673] Herpes hiv risk

21 months ago
Hello and thanks for this great service that you guys provide.  I am in Angola Africa and I was having sex with my wife on May 5th and condom broke so on June 13 I got tested for hiv 1,2 antibody, syphillis, HBS, HCV,chlamydia, and herpes 1 and 2, all negative except (herpes 1 igm= 20  and Igg 58) and (herpes 2 igm 17 and Igg= 25) all have reference value of <20.  Wanted to make sure that I didn’t pass anything to my wife. I get canker sore maybe twice a year but never had any genital outbreaks that I was aware of.  On June 11 and 15 and protected encounters with two separate girls. ( not prostitutes but I feel like they sleep around). I did not get my results back until June 16th so I wasn’t aware that I had herpes 2.  I didn’t have any sore or lesions that I was aware of but after the June 15 encounter on17th of June I noticed red area between pelvis and thighs.  And during both encounters their was vaginal fluid contact with genital area as they where on top of me. I have also been itching all over but no real visible rash it comes and goes, and also feel dull  pain in lymph node areas but not swollen, I also have a weird taste in my mouth some days and when I eat I get some abdominal pains.  I got retested for hiv1-2 antibody on july 4 also negative. And still waiting separate p-24 results.
1.) since on July 4th I am still negative can I assume I did not transmit hiv to my wife from the May 5th encounter. 
2.) could having a positive herpes test have put me at risk for hiv from the two encounters even though I used condoms that remained intact?
3.) how good of an indicator is the negative test on July 4th for the June 11 and 15 encounters.  
4.) I have had no real visible rash, no fever, no flu like symptoms, but the itching all over is not normal, the pain in the nodes is something I’ve felt before when I was stressed about a previous incident last year, weird taste in my mouth and some burning in my urethra both while peeing and normal but not constant. Do you beli
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
21 months ago
Welcome to the forum. Thanks for your question.

Frist, I'm not sure you have HSV2. I'm not familiar with any tests that give those numbers for reference value and positives. But with reference 20 and HSV2 result only 25, my guess is that it's false positive. HSV1 probably doesn't matter:  almost all persons born in Africa are HSV1-positive as adults, probably mostly from childhood infection, and HSV1 doesn't raise HIV risk, unlikel HSV2. As for your sypmtoms, herpes never would cause "a red area between pelvis and thighs". Herpes causes discrete lesions, not general skin redness.

1) I agree. Your test result show you do not have HIV, so you could not transmit HIV to your wife.

2) If you have HSV2 -- which is uncertain, as discussed above -- it roughly doubles the risk of catching HIV if sexually exposed. So if your risk of catching HIV were, say, 1 chance in a thousand for any particular exposure, HSV2 would raise  that risk to 1 in 500. In other words, the odds would still be strongly in yoru favor.

3) This depends on exactly what tests were done. With most HIV antibody tests, a negative result about 3 weeks after exposure is probably around 60-70% reliable. You should have another test 6 weeks or more after the exposure.

4) These symptoms are not at all typical of a new HIV infection, or of any other STD.

All things considered, there is little chance you have acquired HIV or any other STD from the events described. However, your question reveals a very high risk sexual lifestyle. If it doens't change, there is a pretty good chance you'll get HIV someday, in which case there is a strong possibility you will infect your wife. I fully understand that sexual lifestyles like yours are common in much of Africa, and I am not criticizing you. But the risks are real. If you expect to continue sex with both your wife and other partners, I strongoly suggest you see a doctor to discuss prescription of anti-HIV medications (pre-exposure prophylaxis, PrEP). And if you are not circumcised, consider doing that, to further reduce the risk of future HIV infection.

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

HHH, MD
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21 months ago
Thank you for your advice and I will for sure change my lifestyle after I get through this ordeal. In terms of the herpes results do you think it can be that low because it’s a newer infection or does that make no difference?  All the hiv test are 3 gen hiv 1-2 antibody but I have also taken a p-24 antigen test that I haven’t received results for yet.  My wife doesn’t live with me so that’s why I have this kind  of lifestyle but that makes no difference I have to protect myself and her I appreciate your sincere advice.  If it is possible can you describe the lesions a little bit just so I can check if I have anything visible?  Would I know if I had them?  
1.) how long should I wait before I repeat all tests so that I can confirm I have nothing transmittable before sleeping with my wife again, and what test do you suggest to do?  I will have 1 month before I see her again. 
2.) I’ve been really stressed over these incidents and the herpes hiv risk.  What do you think the chances are that my 3rd gen antibody test comes back positive after 6 weeks?  
3.) I ran out of words on the first question, but I am also feeling some abdominal pain and some pressure in my liver and spleen area.  I read online that some people present with these initial symptoms of hiv.  But they didn’t explain if it would be along with the usual symptoms or not what is your experience on this. The itch is also very weird I get it all over my body suddenly, never had it before. 
I’m sorry for the long questions but as you can imagine I have no access to a decent medical staff here, nor do I have anyone to talk with so I’m really stressed and have nowhere else to go to understand my possibilities fully.  Reading on the internet has not helped my case. 
21 months ago
Have I posted my first follow up correctly?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
21 months ago
All correct -- sorry for not getting to this sooner. Thanks for your patience. Also thanks for clarifying your sexual exposures.

1) Your HIV test result already is nearly conclusive. Having HSV2 (or not) has no bearing on HIV test performance. You have already been tested about 6 weeks after the broken condom event, and that result is higly reliable if not quite conclusive. The subsequent exposures (mid-June) being condom protected, there was little risk. But for conclusive HIV results after those exposures, have anohter HIV antibody test 8 weeks after the last event -- or to be consistent with most official guidelines, at 3 months. (If you have access to a clinic or lab that provides a 4th generation HIV test -- "duo", "combo" antigen-antibody test), that result is 100% conclusive after the last possible exposure.

2) Extremely low chance. Remember that even with entirely unprotected sex with a known infected partner, the average HIV transmission risk is around 1 chance in 2,500. With HSV2, it could be as high as 1 in 1,000. In other words, even with no testing at all, the chance you have HIV is no higher than 1 in a thousand. With a roughly 95% reliable test, the probability you have HIV is around 1 chance in 20,000 -- pretty good odds! But you need the additional test(s) noted above for 100% conclusive results.

3) These symptoms are not at all suggestive of a new HIV infection. Also, you can't have HIV symptoms without having a positive HIV antibody test. So for sure these symptoms are not due to HIV. See a doctor if they continue or you otherwise remain concerned about them.
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21 months ago
Absolutely fine, I understand you are busy and lots of people awaiting responses.  I thank you for you response once again.  
1.) I was also asking what other std test do you suggest I do after what period of time from my last exposure.  I want to make sure I’m all clean and put this all behind me.  I tried contacting the lab to understand wether it is a gen 2 or gen 3 rapid antibody test that they perform but as you can imagine he had no idea what I’m talking about.  Does the result make a difference in terms of the timing? Would the gen 2 be less conclusive at 6 weeks?  
2.) if it’s a gen 3 test you prefer I did a test after 3 months instead of 6 weeks?  Is their something from my symptoms that has triggered this response dr. Please be honest with me.  Because normally from all your answers and the guidelines you give, you normally consider a 3rd gen conclusive at six weeks right?  Do you think my symptoms point to some kind of autoimmune disease that is delaying the results? My main concern here is that I didn’t give my wife anything because she doesn’t deserve that.
3.) you said that you can’t have symptoms caused by hiv and not have a positive test, is that after specific period of time, meaning when I have symptoms that are due to new hiv infection automatically the test will be 100% positive?  Is a weird taste in the mouth after eating related to any STI or hiv as far as you are aware?
I appreciate all the time you have taken with me, especially on your weekend.  
21 months ago
Hello Dr. since you have not yet responded, I wanted to inform you that I found a lab that does 4th gen test, they said it’s not a rapid test  they put it in  a machine.  I got the results after  one hour and it’s non Reactive.  Do I need to do do any further testing for hiv 1-2, and when?
21 months ago
I also did a test for Mono but the results need a few days, if it is positive would that effect the negative hiv results?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
21 months ago
Sorry for the delayed reply.

Your 4th generation HIV test is conclusive any time 6 or more weeks after exposure, and nearly conclusive after 4 weeks. Have a final test 6 weeks after your last exposure.

Other STD testing and timing:  Urine gonorrhea/chlamydia any time 5 days or more after the last exposure. Syphilis blood test 6 weeks. HIV as discussed above. You should not have any other tests after these events. Don't assume testing is wise for every infection that sometimes is sexually acquired; it doesn't work that way. Mono testing was nonsense. Nobody tests for it after any particular exposure. Even if positive, it probably would not be from the event described.

The HIV test you already had proves 100% that any symptoms you had before that test (or afterward) are not possibly due to HIV.

That completes the allowed follow-up comments and replies included with each question and so ends this thread. I hope the discussion has been helpful.
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