[Question #13808] Possible herpes exposure?

11 days ago

3 days ago I had unprotected vaginal intercouse with an acquaintance. Her vagina looked completely blemish free. Initially did missionary for a little while. Then switched to doggystyle, but after insertion and a few seconds of sex in that new position, I looked down and saw something unsightly. All around the inside of her butt cheeks somewhat close to her anus (but not on the perimeter of the anus) were a bunch of large (in diameter), very white, puss-filled bumps. Underneath and surrounding/engulfing the white bumps were larger, flat, red areas. I immediately terminated all sexual activity and asked about it. She assured me it was nothing to worry about, just “a rash” she always gets after waxing that area. I googled “folliculitis after waxing”. Images looked similar but hers way worse, white bumps way larger and with more underlying red. Can herpes present like this? If I remember correctly, her bumps weren't incredibly closely clustered, more scattered but still quite a bit of them on both cheeks. If it is herpes, how easily could it have been transmitted? I don’t believe my penis or pelvis really came into contact with those areas but if so it was probably only a slight graze during the few seconds in that position. No symptoms as of now but I do know it can take 2-10 days typically.

Terri Warren, RN, Nurse Practitioner

11 days ago

I can understand why this is concerning for you. It is certainly possible that this is a rash from waxing but it could also be herpes, yes. Herpes recurrences are unlikely to be on both checks, though that isn't true every single time.

Also, herpes lesions most often do not include pus but rather clearer fluid, but again, not every time.

If these lesions were herpes, you wouldn't necessarily need to have direct contact with the lesions to acquire HSV. People who have outbreaks on the buttocks or around the anus also shed virus from the genitals as well so it the intercourse was unprotected, there is risk there.

The average time from infection to symptoms is 5.5 days with the range being 2-10 days, as you mentioned.

You could ask this person about their history of herpes testing. You could also get a baseline herpes antibody test but beware of false positives if you do that and use labCorp. Observe your penis carefully but not obsessively for the next week or so and have anything that appears that is not normal swab tested for HSV right away.

Having said all of that, I'm not thinking for sure that this is herpes vs an irritation from waxing. My money would actually be on waxing, given your description of the lesions.

Terri

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H. Hunter Handsfield, MD

10 days ago

Greetings. Terri asked me to weigh in on your situation.

If any STI is responsible for the skin problem you observed on your partner, herpes indeed seems the best bet. However, herpes seems unlikely to me -- if only because such extensive herpetic lesions likely would be quite painful and few persons would proceed with sex in that situation. Your partner knows her body and her judgment of the likely causes probably is the best bet. As for other STIs, syphilis is the only possibility -- and your description really doesn't fit well with syphilis. Whether or not your partner's self diagnosis is accurate, almost certainly this is no STI of any kind. As I write this, the bookshelf at my elbow includes one titled Genital Dermatology Atlas. As the title implies, it is filled with images of genital rashes, ulcers, and every sort of skin problem you might think of. Of its 300 pages, all STIs are covered in 15 pages. In other words, the large majority of genital skin problems are not STIs; most are not infections of any kind.

I endorse Terri's advice to get more information from your partner -- but do it in a sensitive, caring manner! As an "acquaintance" she likely considers herself a friend and not likely to have knowingly put you at any health risk. If she has any reason to suspect herpes or has any uncertainty about waxing as the cause, she should be encouraged to seek care, perhaps having HSV or other STI testing, etc. But ultimately it's up to her. In addition to herpes in particular, it would make sense to ask about her general STI risks (multiple partners, frequent past STI history, etc). For further reassurance, you could consider having a urine gonorrhea/chlamydia test (valid any time 4-5 days or more after exposure) and perhaps syphilis and HIV blood tests in a few weeks. And of course be on the lookout for symptoms like penile discharge or penile blisters, sores, etc over the next couple of week.

HHH, MD

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