[Question #6185] Risk Assessment & HSV2

16 months ago

Hello Good Doctors,

This post is related to my earlier post #6119.  Admittedly, I am on the autistic spectrum and trying to accurately quantify risk seems to be my coping mechanism, at least until I hit 6-weeks past exposure when I can be tested for all STI’s.  I would like your assistance with 3 questions.

First, could you please help me understand if I’m quantifying my risk accurately?  As you’ll note in my previous post, my only potential exposure consists of me providing brief oral (on a man wearing a condom, he did not climax by oral, he climaxed by masturbation while wearing the condom), kissing (not previously mentioned), and I tried to masturbate after and may have had a small amount of his semen on my hand.  Also, he rubbed my rear with his hands (did he have precum on his hands?)

My assessment of risk: Oral 1:10,000, wearing a condom 1:100, stated he was negative (“most people don’t lie”) 1:10 (?), equivalent of mutual masturbation N/A?, given this, would it be reasonable to assume my risk is 1 in 10,000,000?  Am I at more/less risk?  This may seem ridiculous but it helps until I’m tested… and as it was once said, the odds are cold comfort to the one whom the odds are against

My second question, I have read that those with HSV2 have greater chances of acquiring HIV. If HSV2 causes lesions in the genital area, but HIV becomes non-infectious outside of the body (“no penetration no risk”?) how can HSV2 lead to greater incidents of HSV2 transmission?  I don’t know that I have HSV2, but I understand approximately 20% of adults do and the majority are unaware.  My rear may have been sore from sitting in a conference chair all day, or maybe I do have HVS2… either way, if the guy rubbed my rear and had some pre-cum on his hands, could this elevate my risk?

Last question, you doctors do amazing work, and your patience and careful consideration of questions you’ve heard many times before is appreciated more than you know.  Is there a cause, study, or other that we can voluntarily support financially to continue this good work?  I’m not bargaining with my health outcome or risk assessment, it is what it is, but I do place tremendous value on the services you provide and I’m wondering how we can help ensure it continues.

As always, thank you for your patience and understanding.


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
16 months ago
Welcome back, but sorry you found it necessary.

The estimates on which your calculations are based are rough, but with that qualification, your quantitiative risk estimate seems about right. However, the condom figure is too high; the 1/100 failure estimate is for pregnancy and includes instances of known condom failure. For a single exposure with a condom that remained intact, surely the chance it actually failed is under 1 in a thousand, perhaps truly zero. I also could quibble with 1 chance in 10 someone who denies having HIV actually is infected. The odds you were infected with HIV probably are closer to 1 in a billion. You're probably at higher risk of being killed by a meteorite.

You can discount the HSV2 business. First, it only applies to genital exposure to HIV. Even then, "double" is big at a population level (other things being equal, there are twice as many HIV infections among HSV2 infected vs uninfected persons) but means little for individual exposure. If your risk of HIV really were 1 in 10 million, and if you had had a genital exposure, and if you had HSV2, your risk becomes 1 in 5 million -- still zero for all practical purposes.  

Thanks for your thanks about our services. Half your fee for your two threads counts as a charitable donation to the American Sexual Health Association, the nation's premier non-gonvernmental STI prevention agency. (Dr. Hook and I are former ASHA Board members.) If you would like to contribute more, visit www.ashasexualhealth.org.

HHH, MD
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15 months ago
Dr. Handsfield,

Thank you for the reply.  A follow-up question if I may, what are the specific symptoms of ARS and what is the timeframe it can appear (is 7-weeks too late?)

As mentioned previously, I have a personal condition that I'm dealing with and this has proven to be a challenge for me.  The advice you and Dr. Hook have provided is very comforting and as I understand it, neither of you would get tested for STD's if you were somehow in my position. Being the tremendous experts that you both are, I'm using this as part of my coping mechanism. Everyday I reassure myself and make it a point not to get tested because the best experts in the world would not do so in my place.  This likely seems ridiculous but coping mechanisms are a way of life for me, and this helps.  So too does your expert advise and your patience.  By answering the questions above, I hope to get past this latest health concern and continue my progress (not exactly what this forum is for, I realize, but it helps and it's appreciated.)

Thank you for understanding and for your service.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
15 months ago
The most common symptoms in people with ARS are sore throat, fever, skin rash, and enlarged lymph nodes in several areas, but most commonly noticed in the neck and groin. All typically start 1-3 weeks after exposure. There are many more symptoms as well -- you can find more detail if you google things like "acute HIV", "acute retroviral syndrome", or "ARS", you can find those details. However, symptoms are rarely useful in judging new HIV infections. The idential symptoms occur in a hundred other conditions, mostly much more common and less serious than HIV; and many people with new HIV don't have symptoms anyway.

Blood testing is far more reliable than symptoms and is the main way to check out HIV. Even with a virtually zero risk of testing, you probably should consider doing it. Many anxioius persons are more reassured by negative test results than by professional opinion, no matter how expert.
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15 months ago
Oddly, your recommendation that I get tested has once again peaked my anxiety,  I was under the impression we were talking about a 1 in many millions to billion chance that I could have contracted HIV (same odds and being hit by many meteorites?)

In my place, with the same exposure, would you get tested doctor? If so, why?

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
15 months ago
Please re-read my advice above. I was very clear that you can consider being tested strictly for reassurance, not because there is any chance of a positive result.

No, I would not be tested if I were in your circumstance.

That concludes this thread. Please note that repeated anxiety dirven qeustions on the same topic are not permitted. This being your second, it will have to be your last; additional ones will risk being deleted without reply and without refund of the posting fee. Thanks for your understanding of the policy. I do hope this discussion has been helpful to you. Best wishes and stay safe. 
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