[Question #652] HSV2 Positive - HIV Risk

46 months ago
Hi, I was tested HSV2 positive on March 15th. I have had 8 encounters with CSWs from Jan 18th onwards. My last encounter was  on 12th of March. I tested for HIV on March 15th and 21st, both negative. I also took an RNA test that was negative on on 21st. I have always had protected intercourse.  I was in doubt about condom breaking but not noticing but after reading a lot of posts have been assured that condom break is very noticeable so I can assume that I am safe. However in my last encounter, during vaginal intercourse, I had some pre-period fluid come onto the base 20% of my penis that was not covered by a condom. The discharge was smelly. The person assured me she is HIV negative but I am not sure about that since she could be recently infected.

I have never had a herpes outbreak, atleast nothing that I would have noticed. What I am concerned about is my risks with HSV2 in terms of HIV given that HSV2 increases the risks of transmission. I have also read that a healed sore is still a possible place for infection. So what are the chances that the base 20% of my penis had a sore that I did not know of, it was healed and came in contact with infected fluid from my partner.
Edward W. Hook M.D.
Edward W. Hook M.D.
46 months ago

Welcome to our Forum.  I will try to help.  Despite your diagnosis of HSV-2 (was this made with a blood test?  If so, sometimes these so-called "positive" tests are actually falsely positive), your risk for HIV is about zero and not something to worry about.  The reasons for this are:

1.  It is unlikely your CSW partners had HIV.  Even in locations where HIV is common like parts of Sub-Saharan Africa, most CSWs do not have HIV.

2. You used a condom.  Condom protected sex is safe sex.

3.  HIV is not spread by contact of genital secretions from infected persons getting onto the surface of intact skin of someone who was not infected

4.  While you are correct that HSV does increase the risk of getting HIV if exposed, when that occurs the increase in risk for any single exposure is small and in your case, given all the other facts that you mention which suggest that this was a no risk event, your HSV infection is still essentially zero.

5.  Your RNA test 9 days after your last exposure was not taken at a time when results are definitive but many infected persons would have positive tests by that time so it is additional, partial evidence that you were not infected. 

If you had asked me whether or not you needed testing for HIV related to the exposures you described, I would say no.  That is still the case.  My advice is to move forward without further concern. If you cannot do that, then I suggest that you get a 4th generation, combination HIV antigen/antibody tests (sometimes called "Duo" tests) 4 weeks after your last exposure of concern.  If that test is negative, then I would suggest that you move forward without concern and without a need for additional testing.  I hope these comments are helpful.  EWH

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46 months ago
Thank you very much for your reply doctor. I am very much at ease after your response. I just have 1 additional question regarding my original post. I read the following article (yes the internet is not the best place to be right now but not many can help it):


The article claims that even healed HSV2 skin can be infected by HIV. The following is my question:

"I have never had a herpes outbreak, atleast nothing that I would have noticed. What I am concerned about is my risks with HSV2 in terms of HIV given that HSV2 increases the risks of transmission. I have also read that a healed sore is still a possible place for infection. So what are the chances that the base 20% of my penis had a sore that I did not know of, it was healed and came in contact with infected fluid from my partner."

The fluid in concern is pre-period blood along with other vaginal secretions. Is it possible that I had an outbreak that I never knew of? A sore came up and healed without any pain that I completely ignored? This is all that concerns me.

Thank you very much for your response! I very much appreciate the help you have been providing people here!
46 months ago
And yes, this was a blood test that I took along with an HIV test on March 15th. I would also like to mention that my last encounter was on March 13th and the RNA test was taken on March 21st. That puts me at 14 days exactly. Exclude the encounter and test days, it's still 12 days. Is the result still inconclusive? I also took an HIV 4th gen test on 21st that came negative, i.e 12 days post the event of concern.
Edward W. Hook M.D.
Edward W. Hook M.D.
46 months ago

I am aware of the study you mention but think that you are taking this information out of context.  the study does not change my advice.  When the location of HSV infections is known, the large majority of the infections occur at the tip of the penis, not the base which was uncovered by the condom at the time you had sex.  Your concerns that you had an outbreak that you were not aware of is small and the fact that your partner was about to start her period is likewise irrelevant.

We consider DUO tests and RNA tests to be definitive at 28 days.  While most infections are detectable by 14 days a few are not.  Thus the 28 day recommendation.  Having said that, as I said earlier, your risk for infection is so low that I would not have tested at all.  I think you are worrying entirely too much.  EWH

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46 months ago
Can you elaborate on the "out of context" part? Thank you very much, I will test at the 28 day mark but I am very confident that it will be negative and I am not that stressed any more. Thank you very much again!
46 months ago
Yes this is anxiety talking but you said "your risk for infection is so low that I would not have tested at all". You don't say NO risk, yet the recommendation is to not test at all. Why is that doctor?
46 months ago
I would also appreciate one last advise on the following.

"4.  While you are correct that HSV does increase the risk of getting HIV if exposed, when that occurs the increase in risk for any single exposure is small and in your case, given all the other facts that you mention which suggest that this was a no risk event, your HSV infection is still essentially zero."

Did you mean "your HIV infection is still essentially zero"? Or it is HSV? If so, I don't understand how it is 0. How likely is an HSV false positive?

Thank you again!
Edward W. Hook M.D.
Edward W. Hook M.D.
46 months ago

Our Forum guidelines call for no more than three responses to a client.  This will be my third, repetitive reply, trying once again to get you to stop you unnecessary concerns.  You are playing word games. In science we cannot ever say never or zero risk in the same way that I cannot say you have zero risk of being struck by lightning while reading this reply.  Things happen.   On the other hand, your risk of infection is so low as to be inconsequential.  That is what safe sex means!

By context I mean that as clinicians and scientists evaluating your risk for HIV we evaluate all that you have told us about your partners, about your activities (condom protected), about your initial RNA test results and the statistical risk of infection (1 infection per 1000 sex acts, on average, IF your partner had HIV and IF your sex was unprotected, neither of which was the case for you).  The experimental data from the study you cited (which was carried out by friends and colleagues of ours) demonstrated changes in the local immune response and cells which compose that response in persons with HSV and then went on to HYPOTHESIZE about how this might impact risk of HIV transmission.  It is of minimal relevance to your situation for the reasons I mentioned above and will not repeat. 

Finally, sorry for the typo.  I meant to say your risk for HIV, not HSV is essentially zero.

I cannot comment on how likely your HSV blood test result is to be false positive. that is beyond the topic of this thread and I would need more information including the type of test performed and the numerical value of the positive test, both of which effect the probability of false positives.

This will conclude this thread.  There will be no further answers.  If you have further questions (and I certainly hope you do not) you will need to pay again and start another question.  EWH

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46 months ago
Thank you very much doctor! I will take your word and move on and enjoy my weekend. I intend to stick to a 1 single safe partner, no more CSWs. Will get tested in 2 weeks to throw away any doubts that might come later. Thank you very much for your help again!