[Question #647] Worried about contracting HIV

48 months ago
Hello,

I was hoping you could help with some worries concerning HIV. I recently visited a strip club and received a private dance from a female. During this dance we engaged in some kissing along with skin to skin contact, including me biting her nipples and her biting mine. There was also contact between her vagina and my penis, but that was not skin to skin due to my boxers being on. The entire encounter last roughly 15 minutes. My main concerns are what my risks are of catching HIV and Herpes from this encounter. I also have a question concerning previous HSV test results that I hope you could address, since I've started seeing someone and would not want to transmit anything. 

I've received the following HSV results over the past several years:

9/11/2009
HSV 1 - 1.50 IgG positive 
HSV 2 - .18 IgG negative 

4/19/2010
HSV 1 - 0.11 IgG negative 
HSV 2 - .07 IgG negative 

5/4/2012
HSV 1 - <0.01 IgG negative 
HSV 2 - <0.01 IgG negative 

8/4/2015
HSV 1 - .16 IgG negative 
HSV 2 - .08 IgG negative 

At the bottom of each test it  states that the assay is type specific for HSV 1 and HSV 2 IgG and each test was administered the minimum 3 months after an exposure. 

My questions are as follows:

1. Is there any real risk of me contracting HIV based on my experience with a stripper? Should I get tested? I'm really concerned that the biting of nipples and kissing could have transmitted the disease if she had it.
2. How likely is HSV 1 to be transmitted by just kissing without a cold sore present? 
3. Based on my results above. Would it be safe to say that I do not have HSV of either type? My PCP doesn't seem to up on HSV testing and never gave me a direct diagnosis, just the results for each test. I've done some research online and I'm lead to believe that my first HSV-1 positive result of 1.50 was a false positive due to the numerical being within the low positive range and my subsequent tests all being negative. Would you agree with that? Can I move on assuming I don't have HSV based on my results and since I've never experienced any of the classic symptoms?

I know you can't believe everything you read on the internet so I thought I'd check with experts. I'm hoping that you can help calm my anxious mind and I can get on with my life. I appreciate this service and your time.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
48 months ago
Welcome back yet again. You need not start a new thread with every new question. Each initial question comes with two follow-ups at no additional cost; and Ms. Warren, Dr. Hook and I all are equally able to address questions about herpes, HIV, or other STDs. Also, you really should be using a single username, please.

1. There is no chance of HIV transmission from the events described. Without penile insertion into vagina, rectum, or maybe very rarely the mouth, HIV is not sexually transmitted. I will also add that it is statistically very unlikely your stripper partner has HIV.

2,3) Terri and I have both answered your HSV questions in your other two threads; please see those discussions. If indeed you have oral HSV1 -- which (as I said earlier) I think is probably not the case but cannot be ruled out -- the chance of transmission from an oral infection any particular kiss or genital contact in oral sex, in the absence of an obvious outbreak, is probably under one chance in many thousand.

I hope this settles things for you. Best wishes and stay safe--  HHH, MD

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47 months ago

Hello Dr. Handsfield,

 

Apologies for the multiple usernames, for some reason I thought that was the protocol if you wanted to start a new thread.  In the other question I had with you and Terri concerning my results, I did have one more follow up to try and get clarification. In Terri’s last response in that thread she stated that she did not have a percentage that could be provided on the chances that I do not HSV-1 due to negative IgG test being positive on the western blot. I must admit that this confused even more and was hoping for some clarity. 

I was confused, because even though I’ve read that the western blot is the gold standard, I’ve also read that IgG blood tests for HSV-1 and HSV-2, although not perfect, are still very good with accuracy rates being above 90%. Has the testing changed and become less reliable? I’ve checked with my doctor’s office and they stated that they use the most up to date HSV testing and they are all a type specific assay. My concern is that western blot tests are now showing negative HSV-1 IgG results to be positiveMy quick follow up questions are as follows:

1. Would you consider IgG blood tests for HSV-1 to still be good and mostly accurate?
2. If the western blots are now showing that negative IgG blood tests for HSV-1 are positive, how common does that occur? Based on studies is it a small percentage? Are the western blots only showing that a single negative test for HSV-1 IgG are positive or are they showing that multiple negative IgG tests like mine are positive?
3. Does the fact that I’ve had a low positive IgG for HSV-1 followed by three clearly negative IgG confirmatory results after that mean my probability of not having HSV-1 and the western blot showing a positive is not that high or likely? Would a western blot be recommended?

Apologies if I wandered in circles a bit, now I see your point as to why only one username should be used. Once again, I’m just trying to help determine if my next course of action is to get a western blot, which is a big and costly decision for me since I recently moved and am between jobs and have no health insurance. I thank you  and Terri again for all of your phenomenal work.  

47 months ago
I also forgot to mention that I would've posted this in my other thread, but I've reached my allotment and it was closed. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
47 months ago
Yes, the HSV1 antibody tests are "mostly good and mostly accurate". But they're not perfect, obviously. As Terri said, they probably detect 75-80% of HSV1 infections, i.e. 20-25% of infected persons might have positive Western blot with negative IgG. The IgG tests are falsely positive probably somwhere around 1% of the time, i.e. those persons would have positive IgG and negative WB. There probably are differences in these figures, not well studied, between various brands of tests.

Given your conflicting IgG results and lack of sympotms, as guess, I would imagine there's roughly a 10-25% chance you have HSV1. Frankly, I see no reason why you think it's important to know; the large majority of people don't know whether or not they have HSV1 and most go through life just fine. But if you feel you just have to know, WB is the way to do it. The test is done primarily (or only) by the University of Washington clinical lab in Seattle, but most local labs know how to refer specimens to them for testing.
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47 months ago
Thanks again. This will be my last follow up then we can go ahead and close this out. Would you agree then that three negative IgG results after a low positive would further assure my results and lower the chances I have HSV1? Just trying to understand the testing as best I can without wandering around the Internet.  Thank you again and my best wishes. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
47 months ago
"Would you agree then that three negative IgG results after a low positive would further assure my results and lower the chances I have HSV1?"

Yes, of course. That has been the main point of the replies you had on all three of your threads. 

That winds up this thread. Take care.

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47 months ago
Whoops. Thought I added this to the last in one. In your opinion, without confirming with the western blot, would it be safe to assume I could resume my normal sex life without worrying about HSV?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
47 months ago
Sigh. I don't see the point in repeating the same answers in different words. I already said that as well.---