2 weeks ago I visited Asian massage parlour. I lay naked face down and the lady wore lingerie the entire time although it did not cover much but I could not see her genitals. She sat on my buttocks and massaged for probably 5-10mins. No intercourse took place.

4 days later I noticed a ~3 x 3mm round slightly raised red area between my buttocks that was slightly tender to touch. There was possibly a hair coming out of it but not sure as lots ofhair in this area. I dont believe this spot made contact as you have to spread the buttocks to see it. 

I also have had intense burning sensation in this area and rectum and am concerned that this is primary herpes. I know this is a low risk exposure but I cannot think why else I would have these symptoms. I admit to extreme anxiety about this. 

Is there any risk of herpes transmission from this? Have you ever seen such an event causing infection?

Many thanks. 

I know my inner thighs received no contact so I had a few questions regarding this.

I understand prodrome is rare with primary outbreak. Could this burning pain be from all the sacral nerves being irritated as the virus moves up to the ganglia? Or would this not be possible and only occur as prodrome as the virus moves back down to create lesions?

This was a low risk exposure. Although in theory some STDs can be transmitted by genital contact without penetration (primarily those transmitted skin to skin, like herpes, HPV, and syphilis), it's a very rare event. The exposure you descxribe is definitely very low risk, and the single irritated spot doesn't sound like herpes or any other STD. You seem to be aware that if it surrounded a hair, it's most likely folliculitis and not herpes or any other STD. There is no way your rectum per se could have been infected, and if primary herpes causes symptoms at all, and if it were the cause of "intense burning sensation", visible blisters/sores would be expected -- and with internal rectal infection, probably anal discharge. And no, I have never seen herpes (or any other STD) after an exposure like this.

You seem to know all this. As for other causes, I will simply point out that anxiety can dramatically increase the perception of minor symptoms or even normal body sensations that otherwise would not be noticed. That said, it the "burning" persists, I would recommend you see a doctor for direct exam. But I definitely do not expect this would reveal any evidence of herpes or any other STD. This lso applies to your follow-up comment about your inner thigh pain. And by the way, herpes prodrome only is generally absent in initial herpes, it is never as widespread as your symptoms. Prodrome is typically limited to a small area where overt herpetic lesions are about to appear.

As I said, it would make sense to see a physician if your symptoms continue. But I am confident they are not due to herpes or any other STD from the massage event 2 weeks ago.

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

HHH, MD

I have a few follow up questions:

2) as mentioned, I don't think this exact spot had direct contact, but close by on the buttocks cheeks likely did with her inner thigh. Is the primary lesion always at the site of direct innoculation?

3) I have read that shedding outside of the genital area such as the thighs is uncommon in the absence of sores? Also is the buttocks skin usually too thick to allow inoculation?

4) I unfortunately didnt get a swab as I saw no discharge and now is a red mark. Would you recommend testing at 12 weeks? My previous IgG a few months ago was negative.

Thanks for your patience, my rational mind tells me its a low/zero risk exposure but my anxiety with this pain convinced me the pain is from HSV.

2) In general, the virus has to be massaged into the exposed tissues for infection to take hold. That's why initial lesions tend to be most prominent at sites of maximum friction during sex, such as the penile head or corona in men and vaginal opening and labia minor in women.

3) Probably as you suggest -- thicker, cornified skin is less susceptible to HSV. Viral shedding is an issue only for people with established recurrent herpes, which you don't have.

4) Based on your symptoms, which do not suggest herpes, and your exposure, which was virtually no risk, I recommend against any testing for HSV. However, if you would be more reassured by a negative test than by my comments, feel free to have another IgG test 4 months after the exposure.

As for your final comment, all I can do is encourage you to think objectively and act on your rational mind ("left brain", some would say) and do your best to ignore your anxiety driven, irrational concerns ("right brain").

In regards to question 3, I was more meaning is shedding from her thighs/ buttocks unlikely? She had her genitals covered by her underwear so I don't think there was any genital contact.  

The burning pain has alternated between the site near the sore to the inner thighs bilaterally which you suggest is not consistent wirh hsv as its too broad an area.

Many Thanks again for your patience and advice and the time you dedicate to this forum.

The pain is not only in "too broad an area", but is also perfectly consistent with anxiety magnifying trivial symptoms or normal body sensations that otherwise would be ignored or perhaps not even noticed.

Do your best to accept this reasoned, science-based reassurance and move on without worry about this event. Best wishes and stay safe.