[Question #2558] Concerned about HSV2 from protected encounter with CSW

44 months ago
There is much conflicting data about HSV2 transmission during protected sex. What are my chances of contracting HSV2 if I am a male having protected vaginal sex with a CSW? She was on top for about 60 seconds and then the sex continued with her on bottom. There was very minimal genital rubbing and the condom did not break. She briefly touched my anus with her finger. The encounter was approximately 10 days ago. I do not have any open sores or lesions but do have what appears to be an ingrown hair bump on my scrotum and have become concerned it could be a symptom. I am also experiencing infrequent, intermittent tingling and itching in my legs and groin area. I have had an rectal discharge that is yellow in color along with some infrequent itching but after examination no lesions or sores and nothing is painful. I thought my lymph nodes might be swollen but this also, has no pain and I realize I might be paranoid. I am a truck driver and have had hemmoroids in the past, the discharge could also be my nerves or symptomatic of that. I have some dark grey and purple discoloration around the opening of my anus. After the session the CSW wiped off my genital area with a warm wet rag, it looked clean, and I then immediately took a shower. I also showered before and did not notice any open skin or abrasions on myself or the CSW although the room was dimly lit when she arrived. I am being told by others that I am panicking and over worrying and that the encounter was extremely low risk. What is your professional opinion? Thank you in advance.
44 months ago
I wanted to add that I've been having some slight sinus, allergy type symptoms but no flu like symptoms. I don't feel weak or sick otherwise, just a little coughing and sneezing here and there, and the stuffy sinus feeling that comes with it when I bend down for example. I am surely hoping this is just my nerves.
44 months ago
My groin area and legs feel as though they are warming up and a little tingly. Not on the skin but beneath the surface. Perhaps this could be stress induced.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
44 months ago
Welcome to the forum. Thanks for your question.

There is little chance you caught herpes in this exposure, and no chance your symptoms are due to herpes. For you to be infected, you would have to assume the sex worker has genital HSV2 (which she could, but probably not much more than a 50:50 chance); that she was infectious at the time (statistically unlikely), and that you were infected despite a correctly used condom that remained intact (plus apparently limited skin-skin exposure above the condom, according to the details you describe). Even with no condom, when one partner has HSV2, the average transmission risk for each episode of unprotected vaginal sex is around 1 in a thousand. For the reasons above, your risk was much lower.

As for your symptoms, I think you have read lists of herpes symptoms and seen things like itching, tingling, etc, as well as headache, fever, and other "flu like" symptoms. What you missed is that these symptoms alone almost never are herpetic. Herpes lesions may tingle or itch, but that's all. And "flu like" doesn't include cold symptoms like nasal congestion etc.

Your anal symptoms also don't suggest herpes, and you were at no measurable risk because your partner touched your anal area. However, anal discharge could be an important symptom -- for sure not from this event, but it's one of the main symptoms of rectal STDs. However, that would require that you were the receptive partner in anal sex, i.e. penetrated by another man. If that has happened, you need to be checked for rectal gonorrhea, chlamydia, etc. Even without such risks, this suggests you may have a perianal abscess or perhaps an infectious complication of your hemorrhoids. Regardless of STD risk, this is something that should be professionally evaluated.

So all is well with respect to herpes and other STDs from the CSW exposure described. I don't recommend testing for anything, except to get your rectal symptoms checked out as just discussed.

I hope this information has been helpful. Let me know if anything isn't clear.

HHH, MD
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44 months ago
Thank you doctor. Would you be willing to review some photos to relieve my concerns? I have a pimple or ingrown hair (a single bump) that did burst on my scrotum. The tingling in my groin and legs is intermittent and all beneath the surface. The anal discharge has subsided but I am feeling a small amount of "burning" again beneath the surface. Perhaps this is all due to nerves or stress but do appreciate your help. My cold symptoms have mostly subsided as well. I could have some redness from examining myself repeatedly over the past week.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
44 months ago
Sorry, we don't examine clinical photos, which comes too close to practicing medicine from afar. We are not licensed to provide direct medical care through this fourm. In any case, herpes doesn't look or behave at all like standard pimples, and the scrotum is not a site at which you would expect a new HSV outbreak to appear. I don't need to see a picture to be confident you had a garden variety pimple or folliculitis.

Whenver someone suspects his or her own symptoms have an emotional or psychological origin ("Perhaps this is all due to nerves or stress"), usually s/he is correct. But if you remain concerned, you should see a doctor in person.

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44 months ago
I am also feeling some itching on my arms, thighs, and hands. I might be getting some redness from the scratching. If it's not herpetic then I am wondering if I could be exposed to another STD that might cause the symptoms. The burning sensation is all beneath the surface. So far I have found no sores or lesions other than the bump which I assume is an ingrown hair on my scrotum. Is it safe to resume sex with my partner, even only oral sex, or should I be concerned?
44 months ago
Thank you so much Dr. I accept your last response as final and close the matter on the forum. If any other symptoms continue I'll get a normal checkup at the Dr.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
44 months ago
Looks like we were typing our last responses more or less simultaneously. I'm glad you're now comfortable with my reassurance -- before the very last comment I was worried you were having trouble understanding or believing my advice! I'll just add that neither herpes nor any other STD causes widespread body itching as you have experienced; and that from the information you have provided, it is entirely safe for you to resume sex with your regular parnter -- of any type, vaginal, oral, anal, whatever you find mutually pleasurable.

That completes this thread. Best wishes and stay safe!
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