[Question #678] Hiv question this time and hsv2
102 months ago
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Terri Warren, RN, Nurse Practitioner
102 months ago
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Edward W. Hook M.D.
102 months ago
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Welcome to the Forum. As Terri indicated, I will be answering your question. FYI, typically Terri, Dr. Handsfield and I all agree on our recommendations to clients and answering your queries in a timely fashion is a priority for us.
From the sounds of things, a broken condom on March 19 ( a little over 3 weeks ago) has led you to seek testing to rule out having acquired an STI. In addition, your recent exposures include giving unprotected oral to a partner on the 19th and 25th of March (same partner as with the broken condom- I will presume so unless you correct me). I note as well that his HIV test was negative on 3/25 as well.
Given these facts, I would assess your risk for acquiring an STI of any sort as quite low. Additional comments:
1. Most people do not have STIs, thus even without testing your risk for infection is quite low.
2. Most single exposures to infected partner do not lead to infection, so again, your risk for infection is low/
3. From the broken condom, the major risk for infection is gonorrhea or chlamydial infection and perhaps trichomonas. As such, testing is appropriate and negative. If the tests are negative, there is no reason to worry further about these infections.
4. From giving unprotected oral sex your major risk if oral gonorrhea. this overall risk is low but you can eliminate any concern at all by having a throat swab tested for gonorrhea.
5. If his rapid test for HIV was negative a week after the broken condom, your risk for HIV is virtually negative. I realistically see no reason for further testing.
6 In terms of blood tests for herpes, we do not recommend testing to see if you were infected. Without symptoms or knowing that he has HSV, your risk of having a falsely positive test is substantially higher than finding out that you acquired HSV. If you choose to test (which I think we all believe would be a mistake in your case), about 90% of persons who do not have HSV will go on to have positive tests will have positive tests by three months after an exposure. For the last 10% it may take up to 6 months for a blood test to become positive.
Thus, in summary, I would suggest testing for gonorrhea and chlamydia if it has not already been done. On the other hand, I do not recommend testing for other STIs.
I hope you find these facts helpful. EWH
102 months ago
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Edward W. Hook M.D.
102 months ago
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I'm having a bit difficulty understanding the basis for your anxiety. Do you know that this partner has HSV-2? Even if he does, to have HSV-2 on the face or lips is very, very rare and this is particularly true in terms of recurrences (that is to say, in the very, very rare occasion when a person does get oral HSV-2, recurrences are rarer still in that location). Further when persons have HSV (i.e. cold sores or genital herpes), when recurrences occur they tend to follow a repetitive pattern for each person. thus if your partner has cold sores on his lips, that is where his recurrences will tend to be.
If you already have HSV-1 which recurs on your lips or face, you can be confident that you will not acquire a new infection with HSV-1 at a different location on your face/body from a new partner.
My suspicion is that the lesion you noted on his chin could is likely to be something other than herpetic. EWH
101 months ago
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Edward W. Hook M.D.
101 months ago
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thanks for the additional information, particularly regarding your partner's HSV "diagnosis". I use the quotation marks since our research shows that fewer than half of persons with HSV blood tests which are positive at a level of between 1.5 and 2.0 actually have herpes as confirmed by western blot. Further, persons with HSV-1 are far more likely to have falsely positive blood tests than persons who do not have any other HSV infection. I suspect he does not have HSV-2. Further, and particularly with the additional information,. I really doubt that the lesions you noted on his chin represent HSV of any sort. the location does not work as well. In my more than 30 year career I have seen thousands of persons with herpes and fewer than five with oral HSV-2. ALL of those had lip and mouth lesions. He should have the lesions, if still present, tested for HSV using PCR- I anticipate the test will be negative, just as I anticipate that a Western blot will be negative.
I know nothing about your relationship with this partner but it would be sad if it was negatively impacted by a mistaken diagnosis of HSV-2. This scenario is PRECISELY the reason that we do not recommend routine blood tests for HSV, particularly after very low risk events like having a condom break during use. Did you know that, even if the sexual partner is KNOWN to have herpes, the chance of acquisition of infection from unprotected sex if an obvious outbreak is not present is less than 1 in 1000 (1/10th of 1%) and likely close to 1 in 10,000 (1 100th of 1%).
I hope my further comments help. EWH
101 months ago
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