[Question #6333] HIV-Follow up to Question #6328

16 months ago
Hello Doctor,

In 2008 my son went to a massage parlor.  He paid the woman to lick his anal area while he masturbated. Approximately 2-3 weeks later he had his first herpes outbreak.  He went to a dermatologist who performed a swab of the lesions/anal area which came back for HSV1.  In October, 2013 he went to his primary care physician and had blood tests performed for HSV1 and HSV2.  The result for Herpes 1 IGG was >5.00 INDEX with a range of (0.00-0.89) H.  The result for Herpes 2 IGG was 0.18 INDEX with a range of (0.00-0.89).  My son has been completely monogamous with his wife since this unfortunate event.

Based on the information provided by the swab and blood test, can we conclusively say he has rectal HSV1 and does not have  rectal HSV2?

If the anal herpes is HSV1 and or HSV2, in order to prevent getting HIV for the rest of his life would the same apply to not have unprotected oral, anal, vaginal sex and not share needles/drug injection equipment?  

In other words, how would someone with anal HSV1 prevent getting HIV for the rest of their life?

How would someone with anal HSV2 prevent getting HIV for the rest of their life?
Edward W. Hook M.D.
Edward W. Hook M.D.
16 months ago

Welcome back to the Forum. On this occasion I happened to pick up your question.  As an FYI, let me tell you that Dr. Handsfield and I have worked together for more than 35 years and never disagree on the substance of our assessments of recommendations although out verbal styles do vary.

Your son's laboratory tests are diagnostic of HSV-1 and in no way suggest HSV-2.  His infection is caused by the same virus that causes cold sores and which infectious over 60% of American adults.  The data suggesting increased risk for HIV in persons with HSV refers to HSV-2, not HSV-1.  When persons acquire ano-genital HSV-1 they have fewer recurrences than persons with HSV-2 and rarely transmit their infections to others.

Your son's risk for HIV due to his HSV-1 is not higher than if he had oral HSV-1 (cold sores).  To avoid HIV he should follow the recommendations that Dr. Handsfield has already made.  If he is in a monogamous relationship with someone who does not have other partners and does not have HIV, he is not at meaningful risk for HIV acquisition.  If he has other partners who may have HIV, condoms are the best mechanism for avoiding infection.  The same measures hold if his infection was due to HSV-2. HIV is not acquired through environmental contact.  I agree with Dr. Handfield's recommendation that your son may be overreacting to his diagnosis and may benefit from formal, professional counseling. 

I hope that this information is helpful. EWH

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16 months ago
Thank you for the information Dr. Hook.  In your response you said:

 “If he is in a monogamous relationship with someone who does not have other partners and does not have HIV, he is not at meaningful risk for HIV acquisition.”

He is only with his wife (who does not have other partners) sexually who is HIV negative, and he does not inject drugs.  So wouldn’t he be at no risk of HIV acquisition?
Edward W. Hook M.D.
Edward W. Hook M.D.
16 months ago
Correct.

 Parenthetically, I would add that as this thread has continued I find it very unlikely that you are a mother calling on behalf of her son. This sort of subterfuge serves no purpose.   EWH
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16 months ago
Thank you so much Dr. Hook, I sincerely thank you for your help.