Drs Handsfield&Hook appreciate your thorough responses over the years. CSW Oct 27. Hands only & covered oral. Finger in rectum 2 secs. False fingernails. Looked and 90% certain finger not inflamed. She didn’t touch herself – wore knickers.

3^rd day itchy buttocks.

4^th day mild burning in rectum. Three pimples on right buttock.

19^th day Std clinic doc said ‘I’d not get sti from being fingered’. Buttock spots ‘normal, everyday spots’. Blood, urine and rectal swab tests all neg.

5^th week itchy hamstrings.

6^th week buttocks & hamstrings now itchy soreness when sitting. Pimples spread from right to left buttock down hamstrings, front of thighs to knees, calf muscles. Checked daily no spots within five inches of anus. Penis ok.

7^th week 5 days of continuous soreness in left groin. No swelling. No fever, malaise or fatigue.

54^th day test neg hiv, syphilis.

9^th week Dec 20 odd 5 sec sensation in rectum. Rectum became itchier. Two days continuous mild burning. Slight excess rectal mucus. Christmas day night 1 inch rash along perineum. Didn’t blister. Normal skin had reddened. Mildly sore when touched. Gone within 1 to 2 days.

GP claimed spots mild folliculitis, rectum sensation a muscle spasm and herpes sore would last longer than 1-2 days and likely damp clothing rash from excess mucus & and prolonged sitting on damp area over xmas. Nothing awry from digital examination.

Itchy soreness on buttocks and hamstrings when sitting and fleeting burning or itchy sensations in rectum continues. Remained mild for 15 weeks. Pimples lessened in frequency but continue.

Neg for HSV1&2 in 2014. No risks since.

False fingernails harbour more bacteria and parasites than natural nails. Would rectal swab have been checked for other bacteria than gonorrhoea and chlamydia?

What do you think of my symptoms around Xmas?

Are many of those reporting weeks of itching/burning after a sexual encounter found not to have an sti?

Thanks for your calming thoughts. 54 day test for hiv (4^th gen) & syphilis neg. Only concern is herpes, despite being convinced pimples are not herpes. Herpes spots don’t continuously crop up non-stop over the wide distribution I’ve had for four months. Popped three or four and they were all dry. Initial pimples appeared on my right buttock where the csw placed her right hand which was where the itching started day 3. Her 2 sec right index finger in my rectum was where the mild burning started day 4. She didn’t touch me anywhere else except my penis as I massaged her.

1. Was episode two months after exposure a herpes recurrence? Significant itching followed by two days of burning in rectum, excess rectal mucus and then two days later a rash on the perineum. The slight excess rectal mucus that my GP had seen in ibs sufferers continued for three weeks. The only other time I’d continuous rectal burning was on day 8 and 9. Admittedly, other than the mild burning, there was no repeat as I’d not had the other symptoms before this two month episode. For the first two months I looked twice a day (once a day since) at and around the anus and buttocks and would have noticed anything unusual aside from the folliculitis on my buttocks.

2. Are we looking at CPPS, Tension Myositis Syndrome, Piriformis Syndrome, Leviator Ani, etc., rather than herpes as the cause of the sciatic itchy, soreness affecting my buttocks and hamstrings for the past four months? This has been affecting my lower back for almost the first time in the past few days. Tense muscles irritating the sciatic nerve? Problem is I’ve not been getting any anxiety symptoms for the past month and otherwise feel great.

3. Would you advise a herpes test? Four months is up next Monday. Intention was to order another hsv type specific test but when I read up to 30% of hsv1 negs are false and that up to 50% of positives are false I can see why many counsel against it.

4. Exhaustive searching has not found any reports of herpes from being fingered despite prostate massages being prevalent and only six cases of chronic symptoms and I’m not sure what their outcomes were.  Unusual cases tend to find their way onto the internet. Couple the two together and surely this cannot be herpes which like all viral primary infections are supposed to be self-limiting. Folliculitis can explain most of my early symptoms and can be troublesome to get rid of and can recur.

USPSTF Dec 2016 recommendation stated ‘positive predictive value may be as low as 50%’ for the HerpesSelect test. ‘Screening 10000 persons would result in approx 1485 true positive and 1445 false positive results’. Many doctors perhaps not bothering with confirmatory tests could have left thousands, tens of thousands or more even leading their lives wrongly believing themselves to be HSV positive.

Took test twice, last in 2014, neg HSV1&2, no risks since. Soreness in buttocks and hamstrings continue especially when sitting – sometimes neuralgic – albeit very mildly. Had another three days of excess rectal mucus in early March. Only been four days of continuous mild rectal burning other days have been just a dozen or so fleeting moments of itching or burning – proctalgia fugax. Had that condition before through anxiety.

Anxiety prominent for most of first three months but not since. But know from experience that post anxiety state, mind and body don’t immediately return to a relaxed state. Symptoms can continue especially if a subconscious inner tension is maintained by the daily body checks for sores and obsessive reading of herpes websites continues. Last week thought I saw a paper cut lesion near rectum. Not there the next day and believe what I saw was a fold in the skin and trick of the light.

1.       1. Would you agree that I now need to stop these daily checks and move on as that alone might end these symptoms?

2.       2. Have some focused too much on avoiding HIV alone as I’d ignorantly imagined we called it safer rather than safe sex because of condom slippage or breakage not because of viral shedding?

3.       3. Would you agree that fingers don’t asymptomatically shed virus and that undamaged buttock skin is too thick to be an entry point for hsv infection? (She wouldn’t have worked with an obviously inflamed finger)

4.      4.  Have a lot of respect for your judgment. When you suggest someone is negative you seem to be almost 100% right - can only remember one person coming back as a positive. Way better than the HerpesSelect test. Never going to visit a csw again. If you were me would you feel confident that an HSV infection didn’t occur from this encounter when beginning another relationship?

We say that CSWs are not likely to be carriers of stis than the general population because of their regular checkups. That might be for bacterial infections but a study suggested that 60% of London CSWs are HSV2 positive - about six times the national average perhaps due to viral shedding.

Many thanks for your help and anxiety-reducing comments over the years.