[Question #8680] Massage parlor incident

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41 months ago
Hello Doctors. 6 days ago I had protected sex with an Asian masseuse at a massage parlor. I always thought protected sex was safe for all STDs unless the condom broke. Now I know that is not the case for some infections and I am freaking out. I have been monogamous with the same woman, who I adore, for 17 years and the thought of getting herpes is causing me significant fear.
My concerns/questions are as follows:
1) I definitively know that I do not have HSV1 or HSV2 prior to this exposure based on testing 17 years ago. Does not having HSV1 put me at higher risk for acquiring HSV2?
2) I shaved my genitals the day prior to this incident. I suffered a few small cuts at the base of my penis. Does this increase herpes risk?
3) The anxiety is causing me not to sleep. I have only slept a few hours in 6 days. Does  this increase my herpes risk?
4) This experience was vaginal sex with a condom that lasted for ~5-7 minutes. When I pulled out I noticed the condom had slipped upward. Approximately 1/3 of my penis was unprotected. Does this condom slippage increase my risk since more penile skin was exposed?
5) it has been 6.1 days since the exposure. I know the incubation is 2-12 days, but am I partly out of the woods? Would most herpes breakouts have happened by now?
6) can I resume unprotected sex with my wife?
Thank you!
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Terri Warren, RN, Nurse Practitioner
41 months ago
My concerns/questions are as follows:

1) I definitively know that I do not have HSV1 or HSV2 prior to this exposure based on testing 17 years ago. Does not having HSV1 put me at higher risk for acquiring HSV2?
It doesn't make you at higher risk of acquiring HSV 2, but if you did acquire HSV 2, you most likely have some symptoms when you did so.

2) I shaved my genitals the day prior to this incident. I suffered a few small cuts at the base of my penis. Does this increase herpes risk?
A bit,  yes

3) The anxiety is causing me not to sleep. I have only slept a few hours in 6 days. Does  this increase my herpes risk?
No, it just makes your  immune system more challenged.

4) This experience was vaginal sex with a condom that lasted for ~5-7 minutes. When I pulled out I noticed the condom had slipped upward. Approximately 1/3 of my penis was unprotected. Does this condom slippage increase my risk since more penile skin was exposed?
Condoms reduce transmission from women to men by 65%.  Having the condom slip down a bit increases your risk only slightly. 

5) it has been 6.1 days since the exposure. I know the incubation is 2-12 days, but am I partly out of the woods? Would most herpes breakouts have happened by now?
You are definitely approaching "out of the woods" in terms of symptoms, 

6) can I resume unprotected sex with my wife?
We don 't have those kinds of answers.  I know you said you were tested 17 years ago, but really?  Are you sure you were tested for HSV 2 that long ago?  I would be really surprised, but that is not completely out of the question.

The chances of you acquiring HSV 2 at a single encounter is very low, especially using a condom.  While it is possible, the risk is quite low, given all of these things you told us about.  Especially if you have no symptoms thisf ar out. 

Have you ever had a cold sore or are HSV 1 positive.?

Terri
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41 months ago
Terri, thanks for your reply. I have never had a cold sore and yes I was tested for all stds over 17 years ago prior to starting my current relationship. This included an IGG blood test for both herpes, which was negative. 
A few more questions/concerns:
1) I am uncircumcised. I understand this increases herpes risk, but the condom should negate that as the head of the penis is covered, correct?
2) After intercourse was complete, the lady removed the condom and sprayed alcohol onto a course cotton towel and roughly cleaned my genitals with it. I feel like this action could have potentially rubbed the virus into my skin by causing micro skin trauma. The alcohol also burned. What do you think about this?
3) She was well lubricated. Does this make transmission less likely as there is less friction?
4) I have been taking high dose monolaurin since the incident. This is an antiviral against lipid coated viruses. Many people swear by it’s effectiveness against herpes. Any chance this could prevent infection from taking hold?
5) i feel like I am safe from most other stds like chlamydia and gonnorhea since I used a condom, correct?
6) I know HPV is also a possibility. What should be my concern level about acquiring HPV?
7) I am inspecting my genitals very frequently and overnight a tiny pink/flesh colored bump appeared at the base of my shaft. It definitely was not there yesterday. It is tiny, about the size of 1/10 grain of rice. I normally would never have noticed but I’m hyper aware right now. Another bump formed about inch above the base. I doubt the condom would have covered this spot either. This bump is a little bigger and is red. It looks like a very small pimple. Could this be the beginning of a mild herpes outbreak? Or is that unlikely? It does not hurt or itch. 
8) I am now 6.75 days post coitus. Would you say most herpes outbreaks occur before 7 days? 
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Terri Warren, RN, Nurse Practitioner
41 months ago
1) I am uncircumcised. I understand this increases herpes risk, but the condom should negate that as the head of the penis is covered, correct?
Correct

2) After intercourse was complete, the lady removed the condom and sprayed alcohol onto a course cotton towel and roughly cleaned my genitals with it. I feel like this action could have potentially rubbed the virus into my skin by causing micro skin trauma. The alcohol also burned. What do you think about this?
I don't think it increased the chances of you acquiring anything, no.  And it might have helped, uncertain

3) She was well lubricated. Does this make transmission less likely as there is less friction?
Perhaps, yes.

4) I have been taking high dose monolaurin since the incident. This is an antiviral against lipid coated viruses. Many people swear by it’s effectiveness against herpes. Any chance this could prevent infection from taking hold?
Not that I know of
5) i feel like I am safe from most other stds like chlamydia and gonnorhea since I used a condom, correct?
Yes

6) I know HPV is also a possibility. What should be my concern level about acquiring HPV?
85% of sexually active adults will have at least on strain of HPV in their lifetime, sometimes more than one strain.  The condom will help with that as well, but HPV is harder to prevent than some other things as it is so common.

7) I am inspecting my genitals very frequently and overnight a tiny pink/flesh colored bump appeared at the base of my shaft. It definitely was not there yesterday. It is tiny, about the size of 1/10 grain of rice. I normally would never have noticed but I’m hyper aware right now. Another bump formed about inch above the base. I doubt the condom would have covered this spot either. This bump is a little bigger and is red. It looks like a very small pimple. Could this be the beginning of a mild herpes outbreak? Or is that unlikely? It does not hurt or itch.
It's hard to say, you'll just have to keep an eye on the area

8) I am now 6.75 days post coitus. Would you say most herpes outbreaks occur before 7 days?
Yes, the average time from infection to symptoms is 5.5 days.

Terri
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41 months ago
Terri,
The one bump I mentioned definitely grew and become slightly sore to the touch. It was red and about the size of an average pimple and is located on the underside of my penis near the base. In the last 24 hours it has shrunk and become much less red. I am suspicious of it because of the timing and location. However, it is in the vicinity of some fordyce spots and looks like it could be one of those, just significantly inflamed. Does this sound like it could be a minor herpes outbreak? Or is an inflamed fordyce spot more likely. Today is day 9 and if nothing sounds like herpes, or any other std, to you then I would like to restart my sex life. Do you think it is safe for me to resume sex with my wife?
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41 months ago
I haven’t heard anything from my previous response for over two days. The spot I was referencing is now basically completely gone. I am hoping it wasn’t herpes. It has now been 11.25 days. I have resumed sex with my wife so hopefully everything is ok and safe.
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Terri Warren, RN, Nurse Practitioner
40 months ago
I wish I could tell you more, but from your description, I just can't know. Normally a herpes sore would be a blister, not just a bump.  Have you had a professional take a look at it?  Condoms reduce transmission from females to males by 65% and a single encounter also greatly reduces the risk.  Also, if it only lasted a day or two, it doesn't sound like herpes to me.

Terri
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