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Herpes, Betrayal, Cervix Mysterys, and HIV risk--Oh my!!!
Dec 22, 2010

Hey Bob,

I'm actually writing to you, or at least I know of you, since I'm an Oberlin Alum myself (we even met briefly!).

I'm writing to ask you a bit about my risks of HIV transmission, and to get some clarity about some of the stats out there.

I recently was dating a guy, and after our third sexual encounter I was diagnosed with herpes. We used a condom for intercourse, although there was genital-to-genital contact prior to intercourse. Anyways, when I told him this, he was very surprised, but supportive. He admitted that he has had oral cold sores in the past, but to his knowledge has never experienced anything in the genitals. My concern was that the doctor saw lesions on my cervix. I've spoken to some doctors saying its impossible for them to be on my cervix if a condom was used, and other doctors have said that it could even be HSV-1 on my cervix. (I do not know what type I had because I am not currently residing in my home state where my established gyno is, so I've only been to clinics where it seems like I know more about HSV than some of the doctors....)

Well, he agreed to get tested. We continued dating for about two weeks (without any sexual contact), and then he pretty much dissapears off the face of the planet.

All of my friends say this is my guilt talking, but all of a sudden I'm worrying about HIV transmission. I know that it probably is me partially still trying to come to terms with HSV (and I'm 9 weeks in, need to wait 3 more for a reliable Igg test), but I feel like him being so supportive, and telling me things that he was so happy to be with me despite the circumstances....I dunno, as silly as it sounds, I'm scared he somehow figured he was diagnosed with HIV and thats why he is no longer answering phone calls, etc.

All right, it sounds ridiculous, but I feel like I just had to say it. Whew. But I also think it caused me to wonder, if he lied to me about getting tested, about caring about me, what else did he lie about? And thats where I wonder, what if a condom broke and he didnt say anything? We only had vaginal intercourse twice, and even though we used condoms, he masturbated both times afterwards, so he did not ejaculate inside me--broken condom or not.

My mind keeps getting caught between the feelings of betrayal, the ambiguity of my diagnosis, and these mysterious lesions on my cervix. Do you think I should be concerned for HIV?

Also, this is a bit random, but I've seen stats saying the chance of getting HIV from vaginal intercourse from an infected individual is 1 in 1000....I feel like that must not be true given that heterosexuals account for about 25% of new infections. Where does that stat come from? How do you even measure transmission risks in percentages? (I was just wondering)

Thank you!

Response from Dr. Frascino

Hello,

I'm always pleased to help another Oberlin alum.

HSV-1 is generally associated with cold sores around the mouth while HSV-2 is generally associated with genital lesions. However, either virus can, and sometimes does, appear in either location.

Unfortunately I have no way of knowing what your doctor actually saw on your cervix. Since HSV is so common, it could have been a reactivation of an old infection or a new HSV-2 or HSV-1 lesion or it could have been an ulcerative lesion caused by something other than herpes.

Your scumbag ex-boy-toy had HSV-1 by history; he may also have had HSV-2. We have no way of knowing and now it's a moot point because no matter what he has, you've got whatever you've got.

If you used latex condoms properly and the condoms didn't break, your chance of contracting HIV is essentially nonexistent. HIV cannot permeate intact latex. No way. No how. Most STDs are far easier to acquire than HIV (thankfully). Herpes transmission requires only skin-to-skin contact. I agree with your friends: your HIV fears are unwarranted, even if Mr. Scumbag was positively charged.

The statistics you've seen pertaining to unprotected receptive penile-vaginal sex with a partner confirmed to be HIV infected are from a CDC publication of estimated per-act risk statistics for acquisition of HIV by exposure route. These population statistics cannot be applied to an individual coupling, as there are many potential confounding variables, such as viral strain, viral load, concurrent STDs, local trauma, host immune integrity, etc. The CDC statistics are helpful in describing relative risk, e.g. unprotected anal receptive sex is riskier than unprotected receptive penile-vaginal sex, which in turn is riskier than oral sex.

I would suggest you get screened for HSV and follow up with your gyno as needed. Primarily for peace of mind you could also get a single HIV-antibody test at the three-month mark. I'm quite confident the result will be negative. I'll repost below some information about HSV.

Be well. Happy Thankschristkwanzaakkah.

Dr. Bob

My thanks to you Dr. Bob! (HERPES, 2010) Nov 2, 2010

Hello Dr, Bob

I came on here to ask you a question and doing so I had to re-write my post because I realized how remarkable you truly are Dr. Bob. As I was writing it hit me, you have been helping people on here for years! It is truly remarkable that you take time out of your day and share your knowledge with people from around the world. I remember I wrote to you years ago with a concern and I knew that if I needed an answer there was Dr. Bob that would be around to give his advice in a humourous and charming way. I also would like to ask, how is everything with you? I wish you the best and thank you! I hope you realize the community, or should I say worldly service you provide to people. You should be proud.

So for old times sake can I ask you a brief question? Let me explain briefly my situation....I have been with my gf for many years now and have always been faithful and she has as well. Recently I had some small bumps on my penis, I went to a doctor and he said it could be a few things, maybe Herpes....he tested me. I am currently waiting to hear back, however he has freaked me out. The thing that has me confused is that my gf and I have both been faithful (yes I truly believe this)...and he said the possible genital herpes could be from a woman that I had unprotected sex with back in 1999. I cannot believe that herpes would stay in my body and not come out for that many years.

1)Do you think this is possible....and 2) Maybe if my gf had a cold sore in her mouth, could I have gotten genital herpes from that?

The oral sex scenario I see as a possibility. But could herpes really hide and not come out for eleven years?

Please let me know what you think, I truly trust your opinion.

Thanks!

Response from Dr. Frascino

Hello,

Welcome back to the forum and many thanks for your extremely kind comments. Yes, I have been answering questions here for nearly a decade! Yikes! I now get comments that the archives are so extensive that they are becoming difficult to navigate. Could this really be a question of TMI (too much information)? Nah, I doubt it. Folks are probably just a bit overwhelmed when they search for a specific topic, such as lap dances or blow job or lesbian-Mormon midgets or whatever and get such a lengthy list of questions and responses to wade through.

Regarding your question, herpes genitalis can indeed remain dormant for many years. Responding to your specific queries:

1. Yes, it's possible.

2. Herpes labialis and herpes genitalis are two distinct viruses. Herpes labialis (cold sores) is generally HSV-1 (herpes simplex virus type 1) and herpes genitalis is generally HSV-2. It's important to note that either virus, HSV-1 or HSV-2, can cause lesions (sores) in either location!

I'll reprint some information below from the archives.

Could herpes hide out for 11 years without an outbreak? Yep! It's possible.

You're welcome!

Dr. Bob

Herpes Simplex (Cold Sores and Genital Herpes) May 25, 2010

What Is Herpes?

Herpes simplex refers to a group of viruses that infect humans. Like herpes zoster (shingles, see Fact Sheet 509), herpes simplex causes painful skin eruptions. Itching and tingling are usually the first signs, followed by a blister that breaks open. The infection stays dormant in nerve cells. This is called "latency." However, it can become active again with no warning. Herpes can be active without symptoms or visible signs.

Herpes simplex virus 1 (HSV1) is the common cause of cold sores (oral herpes) around the mouth. HSV2 normally causes genital herpes. However, through sexual activity, HSV1 can cause infections in the genital area, and HSV2 can infect the mouth area.

HSV is a very common disease. Approximately 45 million people in the US have HSV infection -- about one in five people over the age of 12. The US Center for Disease Control estimates that there are 1 million new genital herpes infections each year. The rates of HSV infection have increased significantly in the past ten years or so. About 80% of people with HIV are also infected with genital herpes.

HSV2 infection is more common in women. It infects about one out of four women and about one out of five men. Genital HSV can cause potentially fatal infections in babies. If a woman has active genital herpes at delivery, a cesarean delivery is usually performed.

Repeat outbreaks of HSV may occur even in people with normal immune systems. Prolonged herpes outbreaks may be a sign of a weakened immune system. This includes people with HIV disease, especially those over 50 years old. Fortunately, prolonged outbreaks are rare except in people with HIV with very low CD4+ cell counts. Also, they have become very uncommon since the introduction of more effective antiretroviral treatments in the 1990s.

HSV and HIV

HSV is not one of the infections that are part of the official diagnosis of AIDS. However, people infected with both HIV and HSV are likely to have more frequent outbreaks of herpes. These outbreaks can be more serious, and last longer than for people without HIV.

Herpes sores provide a way for HIV to get past the body's immune defenses and make it easier to get HIV infection. A recent study found that people with HSV had three times the risk of becoming infected with HIV as people without HSV. A recent study found that treating HSV can lead to a significant reduction in HIV viral load. However, another study found that treating genital herpes did not prevent new HIV infections.

People with both HIV and HSV also need to be very careful during outbreaks of HSV. Their HIV viral load (see Fact Sheet 125 on viral load) usually goes up, which can make it easier to transmit HIV to others.

On the other hand, treatment of HSV in people with both HIV and HSV can reduce HIV viral load. It might also reduce the risk of transmitting HIV to others.

How Is HSV Transmitted?

HSV infections are passed from person to person by direct contact with an infected area. You don't have to have an open HSV sore to spread the infection!

Also, most people with HSV don't know that they are infected and aren't aware that they could be spreading it. In fact, in the US only about 9% of people with HSV2 infection knew that they had it.

How Is Herpes Treated?

The standard treatment for HSV is the drug acyclovir, given orally (in pill form) from two to five times a day. Another form of acyclovir is valacyclovir. It can be taken just two or three times a day, but it is much more expensive than acyclovir. Famciclovir is another drug used to treat HSV.

These drugs do not cure HSV infections. However, they can make the outbreaks shorter and less severe. Doctors may prescribe "maintenance" therapy -- daily anti-herpes medications -- for people with HIV who have had repeated outbreaks. Maintenance therapy will prevent most outbreaks. It also significantly decreases the number of days each month when HSV can be detected on the skin or mucous membranes, even when there are no symptoms.

Can Herpes Be Prevented?

It is difficult to prevent the spread of HSV. Partly this is because most infected people don't know that they carry HSV and can spread it. Even people who know they are infected with HSV may not realize they can transmit the infection even without an open herpes sore.

Condoms can reduce the rate of HSV transmission. However, they cannot prevent it. HSV infections can be transmitted to and from a larger genital area, such as that area covered by "boxer shorts" -- and also around the mouth. If people with herpes take valacyclovir every day, they can reduce the risk of transmitting herpes to others. Once-daily valacyclovir is approved for persons without HIV who have up to 9 outbreaks a year. However, once-daily therapy is less effective in people with HIV and others with very frequent episodes.

Drug companies are working on vaccines to prevent HSV. One vaccine showed good results against HSV2 in women, but not in men. No vaccines have been approved yet to prevent HSV infection, but research is ongoing in this area.

The Bottom Line

Herpes simplex is a viral infection that can cause genital herpes or "cold sores" around the mouth. Most people infected with HSV don't know it. HSV is transmitted easily from person to person during sexual activity or other direct contact with a herpes infection site. Herpes can be transmitted even when there is no visible open sore.

There is no cure for herpes. It is a permanent infection. People with herpes have occasional outbreaks of painful blisters. When each outbreak ends, the infection becomes latent for a while. People with HIV have more frequent and more serious outbreaks of HSV.



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