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Risk of HIV through Oral Sex When Herpes is present and contracted
Sep 13, 2010

Dear Dr. Bob--

About 7 years ago, you helped me through the only other HIV scare I've ever had (which turned out to be Lyme disease). I hope you can help with this one, as well. And I believe the specific facts of my "case" will help others and hopefully differentiate this question from the standard "HIV Oral Sex" questions.

About 14 days after the biggest mistake of my life (receiving oral sex from a sex worker in a central american country with a very large HIV population), I developed all the classic symptoms of genital herpes. Severe lower back pain, leg muscle soreness, neuropathies (shooting pains, burning sensations) in my penis, and a fever. A few "bumps" developed on my penis a few days later. 3 weeks after the development of herpes symptoms (and 2 weeks after begining Valtrex), the bumps remain (have not broken into lesions)and the fever remains, though only at night.

I understand that the risks of contracting HIV through a single oral sex exposure are pretty low, particularly when you are a male receiving oral sex. However, there are some factors that may increase the risk in my case.

First, I was using a lot of medicated powder in my genital region at the time because I ran out of baby powder. My forskin "tightened" as a result of becoming too dried out. In the days that followed my exposure (when I was paying attention!), I realized I had abrasions where the mucous membrane of the foreskin meets the "regular" skin because when urine dripped over the area when urinating, it burned and stung. Further, the "performer" had herpes and gave it to me. I may have gotten herpes from her saliva alone (where HIV does not reside in sufficient quantities to infect), but she may have had open sores inside her mouth and I would have never known. My few herpes bumps/blisters are exactly where the abrasions were. With my abraisions and the chances of her having oral lesions being higher than the general, non-herpes population, how much greater are my odds of having contracted HIV? I'm uncircumcized, as well (another negative)!

I have no symptoms of ARS, including my fever and a 2 days of headaches, that could not be accounted for by herpes alone. I have no body rashes, no sore throat, no swollen glands in my neck (just in genital area), no profound fatigue (nothing worse than what everyone gets with a 99-100 degree temperature, etc.). I've had sporadic diarrhea, but that could be from the stress of this incident alone.

Also, does having a poor immune system make one's chances of acquiring HIV (through oral sex or by any other means) any worse, or does one's immune system only play a part in how the body responds to HIV once it is infected? I have XMRV, a newly discovered retrovirus that is believed to be the cause of Chronic Fatigue Syndrome. It's the reason the course of my Lyme disease has been so devestating and why I've never truly recovered. My doctors have described it as the converse of HIV in that it attacks natural killer cells as opposed to CD4 cells (though has been observed to slightly lower CD4 and CD8 cells in some people, just not in a progressive fashion like HIV). Because of my compromised immune system, am I more likely to be infected? Am I more likely to develop antibodies later than others (past the 3 month mark)? To this day, I still do not have a fully positive western blot antibody test for lyme disease because the XMRV virus has prevented it (so my doctors speculate), though we know from multiple peices of circumstantial evidence that I have it.

I learned from you 7 years ago that nobody can or should be defined by their worst moments. I continue to contribute to your foundation because, having believed I've come close to this virus once before (even though it turned out I hadn't been), and having a similar though less devestating virus such as XMRV, I feel an enormous bond with those who have HIV and those who ask questions just like this one. I hope I've dodged a bullet here, but the stress of this situation and the possible outcomes is killing me. I will be getting a full STD panel run, including an HIV PCR test, next week, approximately 6 weeks after my exposure.

Dr. Bob-- thank you. Doctors are everywhere. But more than a doctor, you're a caring human being. That's the other reason I contribute every year. The world needs more of you, one for every illness and fear. God Bless You.

Sincerely and Gratefully, Mike

Response from Dr. Frascino

Hello,

Welcome back to the forum. Sorry to hear about your XMRV diagnosis, but perhaps it helps explain some of your symptoms. We still have much to learn about XMRV.

Regarding your current concerns:

1. White blood cells recruited to the site of herpes sores or blisters may increase susceptibility to HIV and facility HIV transmission. This is primarily a problem of an HIV-negative person with active herpetic lesions being at greater risk for acquiring HIV from an exposure. This would not apply to your situation.

2. From what we know so far about MXRV, it should not affect the immune response to HIV, increase the risk of acquiring HIV or delay the production of specific anti-HIV antibodies.

Consequently Mike, despite your extenuating circumstances (herpes and XMRV), your HIV-acquisition risk remains extremely low and equivalent to others who have had unprotected insertive oral sex.

Thanks for your kind comments and your donations to The Robert James Frascino AIDS Foundation (www.concertedeffort.org). Both are warmly appreciated. In return I'm sending you my best good-luck/good-health karma that you are now and will always be HIV free!

Good luck Mike. Be well!

Dr. Bob



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