I’ve had HSVII for about two years now. The initial outbreak was at the base of the penis. I’ve only had 2 maybe 3 outbreaks, all in the first year, knock on wood. I’ve read about how having HSVII increases the risk for acquiring hiv, because of the cells that keep the HSV symptoms in check.

My question is, does this mean that HIV can enter via the base of the penis where the outbreaks occurred, even if there are no legions present? I only have condom protected sex if not in a relationship with the person, but if this is true, then the condom might not cover the base all the time leading to exposure potentially.

Thanks

For the rest of this reply, I'll assume you indeed have genital herpes, and that it is caused by HSV2, not HSV1. If so, indeed that roughly doubles the risk of catching HIV if sexually exposed. "Doubles" sounds like a lot, but for most people it really isn't a big deal. If your risk of infection during any one exposure is, say, 1 in a million, that means the risk becomes one chance in 500,000, still very low. However, this can be significant for some people. For example, if you have anal sex with other men, and especially if those partners are high risk (multiple partners themselves), then your HSV2 could significantly elevate the chance you'll have HIV someday. But for the average heterosexually active person, herpes infection makes little practical difference. In addition, as sort of implied above, HSV1 is not associated with elevated HIV risk, even with genital infection.

The higher risk with HSV2 is independent of outbreaks. That is, a visible outbreak doesn't need to be exposed:  simply having a positive HSV2 blood test raises the risk. Of course it is wise to always use condoms for vaginal or anal sex with new or high-risk partners, and condoms reduce the risk in people with or without HSV2. But making sure the condom covering the base of your penis -- where your (suspected?) herpes outbreaks have occurred -- probably makes no significant difference.

I think these comments cover your specific questions. The bottom line is that assuming sex only with women, your HSV2 doesn't really make much difference in your overall HIV risk.

I'll be interested to hear more about your HSV2 diagnosis, as suggested above. In the meantime, I hope this information is helpful.

HHH, MD

I think that answered my question. So even with HSVII, if the condom covered the urethra the whole time, one can assume they were protected? It can’t infect via the base of the penis unless there is an ulcer there (I.e. broken skin). Is there such a thing as a microscopic ulcer? So that maybe the T-cells are amassing at the skin there and HIV can go that way?

Or say my partner had vaginal fluids on her hand and masturbated me? Normally that wouldn’t be a transmission method, but in this case?

Thank you Dr

No data exist on the mechanics of increased HIV transmission as a result of HSV2. As noted, visible outbreaks don't explain it. Whether there might be microscopic ones that explain it, or exposure of mucosal tissues (e.g. urethral opening), or other mechanisms aren't known. Consistent condom use undoubtedly is still highly effective in reducing the risk of sexual acquisition of HIV, but that should be just as automatic and routine in people with or without HSV2. I also doubt that hand-genital contact (with genital fluids as lubrication) carries any measurable risk, but there are no data on this and hence no guarantees.

One more exchange is permissible on this thread. It might be most useful if you'd like to fill me in on the details of your HSV2 test results and symptoms. If you do so, I'll invite Terri to add her thoughts to my own, so you'll get both our perspectives.

Understood on the proper spelling for HSV2, thanks. I’ve only had two outbreaks in the beginning that I can remember. I’ve never taken anti-virals. 

All my tests have been type specific Igg test. The values fluctuate. They’ve never been above 3. I think the highest is like 2.8, all the way down to 1.1. I just never saw the need to get confirmatitory because in all the years prior, my tests were negative. I’ve had a lot of tests over the years, so I kind of established a baseline of negative HSV1 and HSV2 tests. I’ve been tested before even with no symptoms. I get the whole STD test package online but they go through lab corps and quest diagnostics. So it just seems to me based on what I’ve read, unlikely that it’s caused by anything else. Also now, I only date women with HSV2, and my girlfriend now has it, (she had it before meeting me) and we’ve had a lot of unprotected sex, so if I didn’t have it then, I likely have it now. 

Would you agree that I don’t need to go get tested after protected oral, vaginal, anal sex with a female csw (not know to have hiv but other high risk indicators I.e. drugs). Then I remove the condom and finish masturbating myself, possibly having some vaginal fluid on my hand from removing the condom. If I didn’t have HSV2 I would say no and feel ok having sex with a regular partner, but now having it I’m not so sure. Of course I still get tested once a year and rarely stray from my committed relationship, but it’s happened occasionally.

Anyhow thank you all for all your help. I’ve read your forums and articles for many years and your service has helped many people get through difficult times, even when it’s our own fault. 

As discussed above, I'll ask Terri to weigh in with a final comment before this thread is closed.

I’m going to continue seeing my girlfriend though. I just think that even if I were negative and she were positive, it would not be a reason for me not to be in a relationship with her. In fact I can’t imagine how bad she would feel, I’d never do that to someone. 

Thanks for clarifying the detail of your history with HSV 2.  We know that in people who test positive by IgG test in the index value range of 1.1 to 3.5, half of those are false positives.  With your limited outbreak history, I fully agree with Dr. Handsfield that a confirmatory test, like the herpes western blot, is a good idea.  And I agree with you that herpes should not be a deterrent from being with your girlfriend, not for a minute.  But based on the western blot result, you may wish to consider having sex with HSV 2 positive other partners.  You and your health care provider can work with the University of Washington to get the western blot, 206-685-6066 is the number to call to get the kit to use to get the test.  You will need to get your blood drawn somewhere to ship it back.  If your provider is unwilling to work with you on this, I would be happy to help you do that at westoverheights.com.  We would need to have a video consult first to talk about your history, review lab results that you currently have, and talk about the process of doing this.  I'll be happy to help in any way that I can. 

Your history and lab work just isn't firm enough for me to be certain that the diagnosis of HSV is absolutely correct.  Of course, if you are OK with where you stand now, we'll be OK with that, but it would give you more certainty with a better test.

Please let me know if I can do more to help you.

Terri Warren

That concludes this thread. You can stay in touch with Terri either via westoverheights.com or by posting a new thread in this forum.

I hope the discussion has been helpful. Best wishes and thanks again for your confidence in the forum.