I recently went to a massage parlor and received a hand job from a provider / masseuse. Towards the end of the massage I grazed her arm and felt that she had a rough rash on her lower forearm . It felt grainy and I noticed afterwards, once the lights were turned on, that it was a pinkish color. I'm a confirmed HSV-2 carrier and am afraid that maybe she may have had a cut or something else present that may have potential lead to contact with my glans / urethra while she was massaging me. She did use lots of oil but while I was laying face down and she was stimulating me I did not see any red spec (blood). Lights were also dim though. This all occurred in the bay area in California. I'm within the 72 hour window until 6pm today for PEP. Would it be wise for me to go to a clinic and request the medication? No HSV breakouts present on my body during the act. I did shave my pubic region a couple of days prior so maybe I had micro-cuts in my pubic area? Am I overthinking this. Again, my only concern is that she may have had blood on her hand or a cut or something and possibly made contact with my penis or entered through micro-cuts that I may have had from shaving. No visible cuts on me though. 

Thanks

Most women, even masseuses or commercial sex workers do not have HIV.  Further, sexual transmission of HIV required penetrative sexual contact and does not occur through the sorts of casual contact with rashes that you describe.  Nor does it occur through entry through nicks or cuts which might occur as a result of shaving or other activities of daily life.  Even if she was infected (again, unlikely), contact of your skin or a cut with genital secretions without penetrative sexual activity is a no risk event..  This was a no risk event.  I see no medical or scientific reason for concern or testing of any sort.  

Hope this information is helpful as I know you are feeling time pressure.  Feel free to follow up if there are specific questions.  EWH

Thanks for your response. I'm not sure that I can do this but I figured I'd ask. I have another sexual encounter scenario with a commercial sex worker which I'd like to ask a question on. As I had recently shaved ( approx. 2 weeks ago), I had some red spots develop on my upper pubic area and lower belly button area. I'm not sure if it's razor burn or an HSV-2 outbreak. I've noticed that I get these at times after I shave. Anyways, sex was short because I'm conscious of transmitting the disease and really didn't want to have intercourse but I wasn't able to resist my temptation. I justified it by the fact that my HSV-2 levels were a IGG 2.59 and that they're possibly a false negative. During PROTECTED intercourse we did 2 positions and intercourse in each position didn't last more than a few minutes. Is it possible that if I was truly having an outbreak, would she be able to contract it if her unbroken skin contacted my red spots? Her genitals at no point made contact with my red spots. My lower pubic area is completely clear, and as I said, these spots were located starting at the middle of the area between my penis and belly button and extended upwards. Her pubic area and her buttocks did contact my red spots as a result of the positions we performed. Does HSV-2 have to make contact with a mucous membrane to infect? Or can it be transmitted through unbroken skin? 

Thanks

The lesions you describe do not sound like Herpes.  In heterosexual men the majority of HSV lesions occur on the penis.  The location of your lesions, in the mid and upper part of the pubic hair area, as well as the fact that you’d recently shaved is far more compatible with folliculitis which is not at all uncommon following shaving the pubic hair region.

Finally, addressing your question about transmissibility, direct contact of skin with an active lesion can certainly lead to transmission of infection.  The contact does not need to be with mucous membranes.  Herpes can certainly be transmitted through unbroken skin.  Friction does appear to increase the likelihood of transmission although most single direct contacts with herpes lesions does not lead to infection.

If you want to investigate the herpes issue further, Terri Warren who is available through this same site addresses most questions regarding herpes. Just make sure the word herpes is in the title.

Hope this helps.  EWH 

I will reach out to Terri on a separate request and will reference this thread.

1. Assuming I have HSV-2, is it possible for HIV to be transmitted through unbroken skin that is asymptotic virally shedding HSV-2? I always use protection so I'm sure my risk is definitely lowered but I want to know if there's a chance. 

2. During the last encounter with the sex worker that I described, there was mutual masturbation involved. I fingered her quite a while (5-8 min) with a finger that I later realized had a cut on it. My cut was not bleeding at the time. The cut is located at the top / side of my thumb. She was NOT on her period but there definitely was a lot of vaginal secretions produced on her end. I would like to add that I started PEP 7 days ago after the encounter with the masseuse (Initial post on this thread) because I knew that I was going to have intercourse with sex workers this weekend (bachelor party in Tijuana). Do I need to request additional PEP medication to get me through the 28 day window period from this masturbation exposure? I'm going to fall 5 days short of a complete 28 days from this exposure.  I'm only concerned with the possibility of her secretions possibly transmitting HIV into my system through the cut on my hand. The cut was not incredibly deep, but it was not shallow either. I tend to bite and pick at the skin on my hands when I'm stressed so it was caused by me. I was prescribed Biktarvy. 

1.  Yes, IF you have HSV-2 (and personally, I am not convinced you do), the virus can be shed to others through asymptomatic shedding from unbroken, intact skin.  Condoms certainly lower the risk of that occurring.

2.  If you had approached me regarding a prescription doe PEP, I would have declined to prescribe it reasoning that your risk was too low and the potential downsides of the medications (side effects, cost, delays in useful information from subsequent testing) far outweighed your risk for infection.  The presence of a recent cut on your finger would in no way change that assessment.  You certainly do not need additional PEP.  

I hope this final response is helpful to you.  I think you are worrying far more than you need to.  EWH