[Question #7502] HIV Vaginal Sex

3 months ago
On December 5th, I had unprotected vaginal sex with a woman who I know. She is three months out from a year-long-term relationship with a guy and I believe I was her second partner since then.  She believes she's negative but I am always suspicious and you never know what her partner was doing w/o her knowledge or if she might have gotten tested too soon. So I always think maybe she got it and doesn't know?

I have HSV-2 and didn't see any outbreaks on my penis (that's where I usually get them) and went to an Urgent Care the following morning and they didn't see anything either.  

On December 7th I was nervous about my actions and my doctor put me on PEP, which is a 30 day supply of Emtricitabine-Tenov 200mg/300mg and Tivicay 50mg once a day.  I started it with 8 hours left of the 72 hour window period.

On December 8th, the next day, my doctor sent me for blood work at Quest.  All other STDs and HIV came back negative. But she ran a Complete Metabolic Panel and CBC (includes Diff/Plt) as well. 

I read somewhere that HIV is attracted to T-cells especially with people with HSV-2 or where the outbreaks previously and were and have since healed. So it got me thinking, my blood work showed my ABSOLUTE LYMPHOCYTES were low.  It was 832 (850-3900 normal range).  Then I googled what it meant and the search results said it can be from fighting infection such as HIV/AIDS.

Everything else in my CBC was normal.  My Glucose was 130 but I wasn't fasting.  I have no symptoms of anything.
 
Should I be worried this is related to HIV?  If not, please explain why as it will help with my anxiety and my stupid mistake I made.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
3 months ago
Welcome back.

You've been on the forum a whole lot, and your HIV related questions all have been similar to one another. I'm going to attempt to answer your past, current, and most if not all future questions with some basic facts. First, except in special risk groups (injection drug users, sex workers, etc) HIV remains very rare in women in the US and other industrialized countries, so you can safely assume you have almost no chance of encountering an infected women among  your current, past, or future partners. Certainly the sexual lifestyle of the partner described here suggests someone at virtually no risk of HIV. Second, although HSV2 raises the risk (roughly doubling it) of HIV if sexually exposed, for any one exposure the elevated risk is trivial. If the chance of HIV from any one encounter is say one in a million, which is consistent wth all thee xposures you have described, then double risk from your HSV2 makes it 1 chance in 500,000 -- still zero for all practical purposes. (However, penile outbreaks make no difference. The elevated risk from HSV2 is no different with or without visible lesions.) 

However, the other obvous problem here is your choice of unprotected sex with new or unknown partners! What were you thinking??? Get in the condom habit, for goodness' sake.

Your current exposure therefore was very low risk -- much too low for PEP, in my view. And PEP has a downside you might not have considered:  it delays the date of reliable testing to at least 6 weeks after completing PEP and some experts say 3 months. Therefore, the anxiety time until you know for sure is extended from 6 weeks without PEP to up to 4.5 months with it. Putting all this in personal terms, if somehow I had been in your situation, I would not even have sought HIV testing, let alone PEP.

Your statement about the biology of HIV-HSV2 interactions is correct:  The ongoing immune response to HSV2 at infected sites, including the HIV-susceptible T cells located there, are what raise susceptibility to HIV. That's why having an active lesion makes no difference:  the T cell response is continuous and accounts for the elevated risk, without lesions. However, that localized T cell response is entirely unrelared to levels of lymphocytes and T cells in the blood. In any case, your lymphocyte count was normal. Everybody's counts vary (even from hour to hour), sometimes slightly out of the normal range. That result says absolutely nothing about having HIV or your risk for it. Your blood glucose is unrealted to any of this and is entirely normal if you had eaten in the hours before testing.

Including your herpes questions answered by Terri, I count 19 questions, which I'm pretty sure is the most by any user -- and they've all come in a little over half a year. We appreciate your confidence in the services privided, and ASHA truly is thankful for the donations to its worthy causes. Nevertheless, such repeated questions are strongly discouraged -- especially when so many are pretty similar to one another. My opening comments above should pretty well cover most if not all additional exposures and questions that may arise.

Best wishes--  HHH, MD
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3 months ago
Thanks for your detailed answer. 
I do have some follow up questions. 
I was tested negative for Clamydia and Syphilis 4 days after. Would the test be accurate? For some reason I wasn’t tested for Gonorhea. 

I don’t have any pain when urinating or ejaculating. 


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
3 months ago
The syphilis blood tests are not diagnostic until at least 6 weeks after exposure. But the chance your partner had syphilis is just as low as for HIV, as discussed above. Chlamydia testing is valid at 4 days. Probably you were tested for gonorrhea; the most commonly used tests automatically test for both chlamydia and gonorrhea. Check with the doctor's office or lab. In any case, gonorrhea urethral gonorrhea almost always causes obvious symptoms, so you can be confident you don't have it.---
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3 months ago
Thanks again for your detailed answer.  I hae HSV-2.  I do have questions about HPV and Genital Warts.  

1) I, as far as I know, do not have genital warts but I am 44 and would I be able to get the HPV vaccine? I read the CDC says males up to age 45 can receive it.  
2) What if I already have HPV would the vaccine still be a smart thing to do?
3) Do genital warts cause cancer either penile or cervical cancer?  I've heard conflicting accounts on this online.
4) I also heard genital warts is caused by HPV but not the kind that can cause cancer, so are they relatively harmless?
5) I have HSV-2 and would not want to get Gential Warts because then I'd have 2 STDs.  Do Genital Warts go away or can your body fight off the infection?
6) How long can you have HPV or Genital Warts and not know it?


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
3 months ago
1) The HPV vaccine is effective and safe at your age but usually not recommended, because the risk of a new HPV infection or of any visible disease is so low. Most likely it would not be covered by your health insurance, so could expect to pay up to $250 per dose -- including administration and clinic fees, total approaching $1,000.

2) The vaccine protects against 9 of the most common HPV types, but not against any types with which you have already been infected. At your age, that likely includes several of the 9 types -- which is part of the reason vaccination is usually not advised for people over age 26.

3,4) Different HPV types cause cancer versus warts. Therefore, typical genital warts do not become malignant. Those most likely to cause cancer or pre-cancerous lesions are called "high risk" types, for obvious reasons. The main wart causing types (HPV 6 and 11) are among those classified as low risk.

5) Many HPV infections persist indefinitely -- usually suppressed by the immune system, but may reactivate. Some HPV scientists believe all HPV infections persist in this manner; others aren't so sure. Either way, in most cases the body indeed keeps the infection suppressed (i.e. "fights it off").

6) As this suggests, HPV may be lifelong, just like HSV. But genital warts, by definition, are visible and obvious -- although some persons have genital warts they don't notice, especially in hidden locations like the rectum, inside the vagina, etc.

That concludes this thread. I hope the discussion has been helpful, once again. Best wishes and stay safe.
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