[Question #8082] Possibility of Herpes/HIV from Recent Sexual Encounters
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49 months ago
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Hello Drs. :
I have had 3 sexual encounters. One on April 1st with a girl (I received oral, unprotected vaginal sex, no ejaculation), one on June 7th and one June 18 (Same scenario: I performed oral sex on a man (no ejaculation, at most precum). I have also received oral sex from a man and ejaculated (same man as June 18, but earlier).
I got the 4th generation HIV test completed on July 22nd. (112 days since April 1st, 45 days since June 7th, and 34 days since June 18) which came back negative.
1) Is a second HIV blood test necessary? And when, the 45 day mark or 3-month mark? I also did not have any cuts/lesions/sores in my mouth, at least none that I am aware of.
2) What is the possibility of contracting herpes from these encounters? (Keep in mind I have no symptoms and my partners said they are clean, the June 7th partner did however have friction rashes on his glans penis.)
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49 months ago
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Hello, it’s been over 2 days since my question has been posted.
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Terri Warren, RN, Nurse Practitioner
49 months ago
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Sorry, we are camping and were out of internet contact until today.
I think there is some limited risk of acquiring HSV 2 from the unprotected intercourse episodes, but is good news that you have no symptoms. The risk from receiving oral sex is primarily HSV 1- the cold sore virus - which can be transmitted when sores are present and they are not. - but again, you are not having symptoms so that's a good thing. The risk is minimal from giving oral sex, but in terms of herpes, that could happen if the person has HSV 2 but is not a common thing to happen at all. And then you symptoms would be oral. I have some patients who have oral HSV 2 infection, but almost all of them also have genital infection as well. They gave oral sex to and had intercourse with the same person and got HSV 2 in both locations.
I believe your HIV test is likely fine, but I do believe the current recommendations advise waiting 6 weeks from a concerning encounter for greatest certainty. So perhaps the one done at 34 should be repeated, but I'm going to ask Dr. Hook to answer this one to be sure I'm up on my HIV testing info - I know for sure he is.
Terri Warren
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Edward W. Hook M.D.
49 months ago
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As mentioned above, Ms. Warren asked me to comment on your questions related to HIV. Your July 22 test results are absolutely conclusive for the exposures that you experienced in April and June.Regarding your June 18 exposure, technically you have tested a bit early. Results are using fourth generation HIV combination antigen/antibody tests are not conclusive until 40 days after an encounter. On the other hand, you are June as I understand it, your June 18 exposure was very, very low risk. There has never been a case of HIV proven to have been acquired from receipt of oral sex and estimates are that fewer than one in 10,000 exposures in which oral sex is performed on a man with untreated HIV infection result an infection in the person performing oral sex on him. Further, the fourth generation test you had was substantially more than 99% conclusive when you had it performed on July 22. Thus, the likelihood that you acquired HIV for many from you June 18 exposure is less than one in millions. If I were you I would consider these results conclusive and would not feel I need to test further.
This will be my only comment related to this thread. Ms. Warren will come out and address any further questions. Take care. EWH
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Terri Warren, RN, Nurse Practitioner
49 months ago
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Thank you Dr. Hook
Terri
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49 months ago
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Thank you Dr. Hook and Dr. Warren for the responses!
To Dr. Warren:
Okay, so since I am not experiencing any symptoms (I have been taking my temperature daily and have never had a fever, no muscle aches, no lesions/sores/blisters), should I be in the clear?
Just for extra information, I am a 20-year old Pakistani male. The April 1st encounter was a 19-year old white female, June 7 was a 35-year old white male, and June 18 was a 20-year old Filipino male. As mentioned, none of my partners had any visible cold sores or scabs around their mouth or genital area. Secondly, I have been in contact with all three persons, who have all stated they do not have any history of cold sores.
However, I am aware that herpes may present itself asymptomatically. Based on this information, what are the chances that I DO have a HSV infection, but asymptomatic? (It has been over a month since my last possible exposure, and I have no symptoms. I've read that the window period for a primary outbreak is 2-12 days post infection).
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Terri Warren, RN, Nurse Practitioner
49 months ago
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So you are correct that not everyone with herpes gets symptoms. The 19 year old female is much lower risk - entering freshmen at the Univeristy of Washington (about that age) have only 3% positive rate - so only 3 out of 100 are infected. So that, along with it being a single encounter, makes this low risk. A similar situation presents with the 20 year old male. And because HSV 2 is rarely transmitted through oral sex, I believe the last person is also low risk. The window for symptoms after a first infection is 2-12 days (more like 10 days) but not everyone, as you know, gets symptoms.
Terri
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49 months ago
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Hello Dr. Warren:
Thank you for the incredibly detailed and informative response. I see that my exposures are low risk for herpes.
I'd like to conclude on a more "present-time" question. I have a red rash just on my upper lipline. It is red, however there is no pain, itching, tingling etc. I have also applied Mometasone Furoate ointment on it and it has greatly diminished. I went to my family doctor and he's stated that it is nothing to worry about. He also checked my lymph nodes and concluded that they were not abnormal. However, I do have a weirdish feeling on the right portion of my upper lipline. It is difficult to describe but it comes and goes and is a very mild (2 on a scale of 10) feeling of pressure. It does feel link tingling at times however these sensations are shortlived (max. 1 minute) and incredibly dull, could easily be mistaken for something else. I do also have noticeable fordyce spots which may be the cause of this.
Is this herpes, or simply anxiety-induced feelings? I have had lip eczema before but that resides rather quickly after using the Mometasone Furoate ointment (the remaining lipline (ie. not on the actual lip itself) has been red for about 2 days now but is greatly improving).
Lastly, thank you and Dr. Hook for your incredibly educated and well-informed responses to my questions, it is greatly appreciated.
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Terri Warren, RN, Nurse Practitioner
49 months ago
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Without lesions, it is not really possible to know if this is herpes, but honestly, to me, it doesn't sound like it. And the good news is that you saw someone in person and had it evaluated, which is better than Dr. Hook or I could do for you over the internet. Obviously, if anything breaks the skin, you would want to be seen again for further evaluation. It could be that you are just super aware of any sensation due to the contacts that concern you. That's normal.
Terri
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