[Question #678] Hiv question this time and hsv2

53 months ago
Thank you Terri for your info.

Today I had the ALERE DETERMINE HIV-1/2 Ag/Ab rapid test done , which was negative. Based on broken condom exposure on March 19 and giving unprotected oral to male March 19 and 25, whose hiv status was negative as per a rapid test (specific test I'm not sure of) on March 25 (and he claims his last sexual intercourse was at least a month before me), how concerned should I be? Should I get a different hiv test form? If so, when?

As for hsv2, at what point can I get an accurate blood test for these above listed exposures? Thanks.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
53 months ago
Jennifer, I'm a bit under the weather.  Dr. Hook has agreed to answer your question today.  Thanks.  So glad your test was negative.
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Edward W. Hook M.D.
Edward W. Hook M.D.
53 months ago

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

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53 months ago
Thank you both for your follow up. It is hugely helpful. My last concern is regarding my partner's current outbreak on his chin. He claims he does not recall ever having a herpes chin outbreak and only has had recurrence on his lips (for hsv1). Is it possible he is having an outbreak on a new location? Could this be more indicative of a first hsv2 outbreak for him? I saw his lesions on his chin and we kissed for a few minutes since I didn't seen Lesions on the lips and I know myself to be hsv1 positive, but I'm  now thinking I could (1) acquire hsv2 from
His chin lesions that appear like herpes and/or (2) possibly get herpes on a new location on my face.  Clearly I have too much anxiety to be with this partner moving forward. Thank you for all your help doctors.
Edward W. Hook M.D.
Edward W. Hook M.D.
53 months ago

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

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53 months ago
Thanks for all of your info- it continues to shed light on my situation -

My specific anxiety comes from:partner was tested after condom breaking and found to be 1.6 positive igG hsv 2. He has not done a western blot as of yet. He has been positive for hsv1 for years he says.  I saw multiple lesions that both my partner and I agreed appeared like a herpes outbreak in its healing pattern, rather than pimple (one on the front of the chin, a couple on the underside of the chin). He claims cold sores in past were around the lips. This recent outbreak seems un-pattern like to him. Given that, and my hsv1 positive status, my thoughts are: his low positive hsv2 could be a newer infection that would test higher still today, since reportedly his last sexual encounter was 6 weeks prior to him testing. Perhaps this was his first noticeable outbreak of oral hsv2. It seems to me hsv2 on the chin makes for a male who gives oral to a female. Now having kissed him with noticeable sores on his chin, I worry I am high risk for acquiring hsv2 on my own face. Is any of this valid? And also I know hsv2 is less readily acquired from genitals to face than genital to genital, but where does face to face fit in, when lesions are present? I truly appreciate your help and yes I realize I overthink and believe me I have been in therapy for years and have not encountered std anxiety in years . Thanks for everything, really. 

Edward W. Hook M.D.
Edward W. Hook M.D.
53 months ago

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

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53 months ago
Thank you so much for the specifics of your response. It truly helps put me at ease here so I can make an informed relationship decision. Seriously - thanks.