Herpes and HIV

I couldn't find a thread on this topic, and I think it's an important one about which I have a few questions. We've talked about it before, but I'm still confused about several things. I want to better understand the realistic risks of me catching HIV due to having genital herpes. I'm a white male, and I pretty much have sex with only White, Asian, and Latin women. I sleep around more often than the average guy. Since I got diagnosed with herpes, I've been much more careful about using condoms.

Having herpes increases your risk of getting HIV by three times if you come into contact with HIV.

I came across an article (posted below) on HIV and Herpes, and I'm trying to make sense of it. The gist is that thanks to herpes, HIV transmission is now becoming most prevalent amongst straight, non-intravenus drug users.

The article says that female to male transmission rates of HIV are 4 out of 10,000 risk events. To me, this is somewhat low odds. Even if you add herpes to the equation, that would be 3x more likely, so then it becomes 12 10,000 risk events, or 1 in 1000. First of all, is my math right here? Secondly, it is still much less than anal sex (138/10,000) or needle sharing (63/10,000), so how could it be that that herpes is making heterosexual sex HIV's "Biggest mover"?

Here are some more questions that I have:

If this is the case, how come we don't see great masses of heterosexuals catching HIV? Especially considering that so many people have herpes and don't know, and that 90% of people in the USA have HSV1? Wouldn't we be seeing an epidemic of oral sex induced HIV due to so many people catching it through their CD4 cells left over from cold sores?

Also, what role does race play in this? If you are a white heterosexual man having sex with white women, does that change your risk of catching or coming into contact with HIV compared to being, for example, A heterosexual man who is having sex with black women (whom 50% of which have herpes)?

To further that question- does it matter if you have herpes or not if you are not having sex with high risk populations of HIV?

Here's a technical question: Herpes leaves CD4 cells at the site of a breakout which make HIV transmission three times more likely. Let's say you had your breakout on the tip of your penis. Does that mean that if you cover the tip of your penis with a condom that three times higher risk of getting HIV is still present, or is it cancelled out? What about if HIV comes into contact with any other area in the boxer shorts region that didn't have a breakout- is it still three times more likely to transmit?

Is this article confused? Is it a scare piece?

Here is the article:

https://motherboard.vice.com/read/hivs-biggest-moves-are-hetero-and-needle-free

"Among diseases, HIV has a unique relationship with its risk factors. While pretty much any illness has a set of circumstances that make it more likely for a given individual to contract it—some diseases and individuals much more than others—HIV spent much of its named existence as something "of" certain populations. Inevitably then, risk factors comingled with identity, and stigma bloomed.

No doubt there are those remaining, even in 2014, whose whole fucked-up worldview gets a boost from HIV remaining the scourge of gay African-American men and intravenous drug users; for typical far-right narratives, those are two highly-encodable demographics. HIV's relationship to the world is changing, however, and quickly. Years of intensive outreach within high-risk populations is paying off, and the relative silence about HIV outside of those groups is having quite the opposite effect, while, at the same time, HIV itself is finding hetero-transmission help from its pal herpes.

In a study released on Friday, researchers at New York University's Center for Drug Use and HIV Research describe HIV infection rates among IV drug users in New York City falling to an epidemic-low of 10 percent, down from '90s highs approaching 50 percent. In the same time period, HIV rates among heterosexual, non-IV drug users, historically considered to be one of lowest risk pools (but still above not-at-all drug users, for a number of reasons), doubled, from 7 to 14 percent. According to researchers, what's behind the increase, in part, is the spread of HIV's viral ally, human herpesvirus 2 (genital herpes, HSV-2).

HIV transmission from heterosexual (vaginal) sex is, generally, less likely than other, more-discussed vectors. In fact, the likelihood of transmission from a positive male to a negative female partner is just eight in 10,000, while female to male transmission should occur in four out of 10,000 risk events. For receptive anal intercourse, that jumps to 138 transmissions out of 10,000, and needle sharing should yield 63 infections per 10,000 positive-to-negative shares. The thing about herpes, however, is that it makes transmission much, much more likely, and infection rates for HSV-2 in the United States sit at around one fifth of all adults, with the hardest-hit demographic being African-American women, with a near 50 percent infection rate.

"Heterosexual intercourse is usually not very efficient for transmitting HIV, but the efficiency of heterosexual transmission nearly triples in the presence of herpes simplex virus type 2," said Don Des Jarlais, the study's lead author, in a statement from NYU. There are a couple of reasons for the boost, according to the NIH. For one, genital herpes in outbreak mode causes lesions, open sores through which an HIV virus might find easy passge into a new recruit. Second, even if those lesions are healed and the herpes infection is considered latent, the CD4+ T cells that HIV needs to bind with and infect are known to hang around the sites of healed lesions, offering an alternative passage into the host.

Part of the answer, according to Jarlais and a growing chorus of public health experts, is what's known as "treatment as prevention." That is, we know well enough that antiretroviral therapy and the corresponding drop in viral load can torpedo the likelihood of HIV transmission. So if more HIV patients are getting proper treatment, then they're far less likely to spread the disease. What's more, administering antiretroviral therapy to uninfected individuals boosts those individuals' resistance to infection as well. Obviously that's not the most general solution, but it makes sense in known high-risk populations. Jarlais concludes optimistically: "If we can implement these programs on a large scale, we should be able to control sexual transmission of HIV in the city, and achieve the goal of an "End to the AIDS Epidemic."

I also found this blog entry which makes it seem like a three times greater likelihood due to herpes is still barely even a drop in the bucket of risk:

http://www.aliveandwell.org/html/risk_realities/whatever_happened.html

"Health officials have known these things for years. A growing pile of federally funded reports on HIV transmission, published over the past decade and available to anyone who has the time to read them, shows that men almost never get HIV from women. In fact, according to a 1998 study in the Journal of the American Medical Association, a disease-free man who has an unprotected one-nighter with a drug-free woman stands a one in 5 million chance of getting HIV. If he wears a condom, it’s one in 50 million. He’s more likely to be struck by lightning (one in 7000,000). "

Bumping this..

From what I know... I think it can increase transmition by having open sores, or being more prone to it. I was curious about this myself. I don't think having herpes just increases the risk by magnetism or something.

Have you heard of prep?

@Sundevourer. I believe it has to do with trauma from sex as well. This is just opinion not factual. Most of the time it's the girl that will get cuts, dryness, etc. This could apply to anyone (male on male) too. The one getting..er.. the penetration will probably have the most damage so to speak. Again, purely opinion.

And the cells that respond to HSV outbreaks are the cells HIV likes. (something like that, you get the gist, sorry-I'm just getting off work and I should probably be sleeping lol).

Hopefully once I get to the viral sections in my micro class I will be able to put more factual information out there.

If HIV transmission is 4 out of 10,000 risk events (female to male) and hsv2 is 1.5 per 10,000 , then how come we sit here time and time again saying how common hsv2 is???(both studies were with condom usage)

^because I think herpes tends to affect a wider variety of people than HIV.

@hippyherpy When I first got diagnosed, doctors at PP told me that herpes increases the chance of transmission of hiv virus because the integrity of the skin is comprimised. However doctors in the clinic that I recently visited confirmed since hsv is a viral infection, there are CD4 cells present even after the OB is healed because of the asymptomatic shedding. CD4 cells, also known as T-cells, act as an identifier, their job is to hang around at the site that certain types of viral infection are present. They signal CD8 cells (killer cells).

Hiv virus attaches itself into Tcells and uses them to make copies of itself. There are a number of drugs to distrupt this process - some of them stops the virus to attach itself to immune cells, some of them slows down the replication process. That is why, hiv+ people uses a combination of drugs and keep track of their Tcell counts. In short, having hsv almost certainly increses the chance of acquiring hiv.

Recently, I read a study abt hiv&hsv 2. They state having hsv 2 increases the chance of having hiv 1 (the strain that found in Africa, there is also hiv 2, it is the strain commonly found in US) at least 2-fold (some studies say 2 to 4 fold). Also, if the hsv infection is recent, chances are higher. I can send you the study.

"Here's a technical question: Herpes leaves CD4 cells at the site of a breakout which make HIV transmission three times more likely. Let's say you had your breakout on the tip of your penis. Does that mean that if you cover the tip of your penis with a condom that three times higher risk of getting HIV is still present, or is it cancelled out? What about if HIV comes into contact with any other area in the boxer shorts region that didn't have a breakout- is it still three times more likely to transmit?"

Imo yes, it's still 3 times more likely since you might be shedding from anywhere in the boxer shorts area and there will be immune cells there.

Interesting.

Here is how I look at it- you'd probably want to avoid risky sex with someone who has HIV even if you didn't have HSV.

This means avoiding high risk populations and using condoms, stuff that anyone who is worried about HIV should be doing regardless of herpes.

The reason they saw an increase in the studies was because the studies were being done on gay men in San Francisco were HIV was rampant. Within that already high risk population, herpes can increase the chance of transmission three fold.

With regard to HIV transmission In low or almost zero risk populations, it won't make a difference if you have herpes because HIV isn't around to begin with.

Does asymptomatic shedding cause an increase in CD4 or do CD4 levels get raised only at the area where the blisters occur. If it's a asymptomatic, is that by definition mean that the body doesn't know the virus is shedding and won't send CD4 etc. ? If that's the case than the boxer short area doesn't become a big HIV sponge.

I just wanted to say I don't like the "low or zero risk" population, and the assumption that "HIV is not around to begin with" because that (to me) is assuming that only certain people have HIV. And that's stereotypical.

I live in a small town. I was going to draw a 20 something year old straight female in the ER a few months ago. Now, we are not allowed to discuss patients history with each other, but there are comments made to hint at it. I was pulled aside four times by others before even getting to the patients room and told "make sure you wear gloves". She was a single mom, not a drug user, no red flags to a typical person. She was HIV positive. Her baby was HIV positive. And from gossip I found that she isn't lacking in sexual partners. I don't care what statistics say- Never assume someone is safe..it doesn't matter who they are. And I think we should all know this by now.

AND she never mentioned it to me. Never once said be careful. I would have never known.

So please, we can talk statistics out the ass.. it doesn't matter. Be careful. Period.

"Does asymptomatic shedding cause an increase in CD4 or do CD4 levels get raised only at the area where the blisters occur. If it's a asymptomatic, is that by definition mean that the body doesn't know the virus is shedding and won't send CD4 etc. ? If that's the case than the boxer short area doesn't become a big HIV sponge"

I think your body knows the virus is shedding. According to some studies, the difference between being asymptomatic and symptomatic is immune response, some sort of enzyme must be present to handle the virus and symptomatic people's immune system is kind of slow to produce it from what i remember from my research. So, Tcells are present. If you are worried, you can get in touch with a clnic cause some of drugs they use certainly lowers the risk of transmission. You can use them as well.

As for the high risk populations, dont forget that people lie about their past. The way I see it, a low probability event already happened to us. It can happen again. Having an hiv test only takes 2 days and it can pick up antibodies in 2 weeks. Also, in special clinics it is free. So, It isn't a major inconvenience to ask people to get tested.

@Mmissouri I couldn't agree more with your above statement...I also work in the healthcare field and there is no stereotyping when it comes to any disease...heck, I'd even be the last person they would look at and think I had a veneral disease...because I don't fit the "profile" put out there with the stigma associated with stds....

Getting tested for any disease is scary....are you ready for the result? Could you handle knowing? I didn't expect this, I would rather of not known.

@janedoe, I haven't researched HIV testing but I was told years ago when I got tested that although I had a negative HIV test result that if I had any recent partners I needed to retest in so many months to make sure that negative was a true negative. Does this not apply anymore? (I'm too lazy to research this at the moment)

IF that is still the case, someone who has multiple partners on a regular basis would be a risk regardless of a negative result.

Well, the clinic I visited was a government funded facility that specializes in AIDS and HIV. First, I wanted a Rapid test which gives results in 20 mins but they told me that they aren't accurate that is why they don't use it anymore. So, I got combined 4th gen antibody/antigen test (Ag/Ab, p24) which is highly accurate in four weeks. I got tested in 6 weeks but they assured me that it can pick up antibodies in 2 weeks. After day 90, it is 99% accurate. I got the results in 2 days.

There is also RNA PCR test which has a shorter window period (3 days to four weeks) but it's used for a recent infections.

Here is a short info: http://i-base.info/guides/testing/appendix-1-different-types-of-hiv-test

"Viral load can sometimes be detected within a week, p24 on average by day 16 and antibodies by day 25"

If you slept with someone in past 2 weeks, I guess you can take a combination of tests. PCR combined with antibody/antigen test should give a almost definite answer. But you are right about the last comment you made. It'd be a good idea to catch a break before testing.

So if I'm reading that top paragraph correctly, then it takes 3 months since your last sexual encounter for that test to be 99% accurate.

I'm not trying to pick things apart and make them more scary.. wait.. yes I am. HIV IS scary. We are all here because we are trying to come to terms with HSV, disclosures, future relationships, etc.

Could you imagine sitting on a forum discussing the exact same scenario because you've gotten HIV?? It's all good to toss around statistics while having fun.. unless you get that positive result ..

Since we are a fan of the whole "car accident" relation when it comes to the risk of getting H, how is this for a comparison. Say you go to the doctor and your eye sight has gotten so bad that every time you get into a car you have 1 in 4 chances of getting into a wreck that could potentially cause your death..

Now you can get in that car and pray for the best (and hope you don't take a few people out along with you) or you can take every precaution possible-driving only known routes (trustworthy, honest partners), getting a car with multiple air bags and killer seat belts (protection), or hang up the darn keys and be satisfied you had your fun, now it's time to retire. (And be thankful that you were warned of the consequences before it was too late).

Edited to add: I'm not saying not to have sex, I'm just saying that if your worried about your HIV risk, H didn't teach you anything. (Sorry..that's just my opinion.)

You may not like stereotyping, but there are populations that higher risk than others. You left out a lot of info about that single mom.

My point is that, unlike HIV, Herpes afflicts almost every one and hasn't been correlated to a specific group. The most correlation I've found is that black women are almost 50% herpes. HIV has a very obvious population to anyone who has looked closely at the stats.

Of course there will be outliers.

We shouldn't be politically correct when talking about this stuff.

Also, HIV isn't a death sentence anymore. In fact, I'd go as far as to say that HIV might even be more controllable than herpes. There are people who can get their viral load of HIV down to undetectable levels with today's medicine.

With herpes, we still have to deal with some fog of mystery. A small one at that if you take anti virals and use condoms, but we can't measure herpes load, or predict when asymptomatic shedding will occur as precisely as they can measure viral load.

I didn't spend much time with her and I don't have any personal information. She was young, healthy looking, a little plump, pretty, quiet, and seemed nice. Would I have suspected she had HIV? Nope. But.. I'm sure you will jump on this since you watch the stats.. she was black/african american.

Let me make one last argument. Sex is different these days. Everyone is riding the bisexual wave, people are experimenting, races are intermingling. It's all good but you can't assume that just because you don't do certain people or things that other people haven't.

I don't care how controllable HIV is these days, people are still dying from AIDS. If we had a vote on this forum over which STD someone would pick, I bet most would take H over HIV hands down.

You seem like a happy go lucky guy that's really enjoying sex. Chalk it up to my age, but I've always wanted to ask you what in the world?? Why?? What amount of P is enough and is it really worth taking yourself out over? LOL

Just how old are you? I'm probably old enough to be your mom.. and if you were my kid, we'd be having some issues lol.

End rant :)

okay, I dont wanna interrupt but mom and dad please dont fight you are scaring the children :)

Everyone has different tastes in life. Some likes motorcycles, others prefer cars. We don't pass judgement, everyone makes their own decisions. Yes, some activities are scary but they are also fun for some people.

As far as being politically incorrect goes, if we go down that road, I can say that US population poses higher risk for catching herpes (1 in 5). Is it correct? Relatively. Does this sound good? NOPE. Why? Cause you're assuming that you are above them. so, please dont stereotype.

Now please hug and make up.

It's all good! I wasn't trying to pick on him, I just wanted him to think about this a little differently :)

I don't mind. I like my vitamin P.

With regards to that girl, HIV has hit the African American community a lot harder than others. Especially the gay part. You have guys in that community doing the DL lifestyle who are spreading it to the ladies. In Atlanta, 1/50 people has HIV.

Herpes does have different rates by state. For example, in a place like NYC it's 1/4 people who have it. That's a lot.

Anyway, I want to know if it's the boxer area or what..

One reason I'm confused about the connection between HSV and HIV is the oral thing. All the blow jobs + HSV 1 doesn't seem to have much to do with passing HIV it would seem.

I don't want to die because I like P. i want to have better info on all of this so I can keep myself and my partners safe.

Don't want to get HIV if I accidentally get period blood on my boxer shorts region or whatever.

@janedoe - The risk of *catching* herpes (and by that I assume you mean HSV2 based on the 1 in 5 number you provided) is greater than 1 in 5 if you are talking lifetime risk. The 1 in 5 number is the average for all people between the ages of 14 and 49, including people who have never even been sexually active. I don't know when it hits 1 in 5 exactly; maybe around age 30? Also important to keep in mind that's an average between women and men, though women are infected at roughly double the rate. @hippyherpy - Same goes for your stats on black women. This chart (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3020161/figure/F1/) further breaks it down by partnered and unpartnered, so my reference here refers to unpartnered black women (meaning not cohabiting or married) rather than an average between partnered and unpartnered, but you can see the 50% infection rate correlates to roughly age 25, while almost 80% of 40-44 year old unpartnered black women are infected with HSV2 (or were at the time this data was collected).

Are you saying that in general more than 50% of black women have herpes?

@hippyherpy I am saying that when you quote infection rates, you are quoting the average within a large age range. For instance, according to that chart, the HSV2 infection rate for unpartnered black women in the U.S. at the time of data collection was as follows:

Ages 20-24 36%

Ages 25-29 62%

Ages 30-34 69%

Ages 35-39 75%

Ages 40-44 78%

Ages 45-49 71%

Perhaps the average rate of HSV2 infection for *all* unpartnered black women between the ages of 20 and 49 was 50%, I don't know, but you can see that the risk is highly age dependent. Average infection rate within a large age range does not equate to lifetime risk which is significantly higher as it is incurable.

With studies that start at age 14, HSV2 infection rates for the overall population (all races) begin near zero and reach very high rates by age 49. The overall infection rate that is quoted represents the average within that very large age range.

@optimist what I meant was herpes isnt common in my country and for me US population fell into the a category where I could label it as "high risk group" compared to other countries I have visited. But hey, you can catch herpes anywhere.

Whether it's STDs or other illnesses, rates of infection vary by country. Look at Chancroid, it's an STD caused by the bacteria called H. ducreyi. It's rare in the U.S. but found in many areas such as Africa/Asia/the Caribbean. (Instances in the U.S. are usually from those that have traveled to the area). You want to see something that looks painful-google it.