Area of infection

I regrettably had sex with a prostitute in amsterdam a week ago. I sort of 'examined her' discreetly, as she examined me. I saw no visible marks or spots, and she was very clean and thorough. However, we had sex in a doggie position, and I noticed two red spots on her butt, which seemed like pimples, but it thoroughly freaked me out, and by the point I noticed them, it was too late. There were no other spots except those two, which were not close to the genital region, but rather in the middle of the buttock, one on each side.

I am very stressed out about the possibility that I've contracted herpes. I have no symptoms as of yet, but am continuously thinking about it since the incident. I plan to have a test in three weeks regardless.

What are the chances that these two spots were herpes lesions? Can they occur in this way? She seemed extremely friendly and confident, and pretty happy in general... not a state someone would knowingly share such a thing. I know one thing though.... the experience wasn't worth the stress I'm going through now, for sure. What are the statistics on probability in this case?? When should I get tested, and retested?

Any help would be appreciated.... and next time, there won't be a next time. Thanks.

[H. Hunter Handsfield, M.D.]

The buttocks are common places for garden variety pimples, the most likely possibility.  Recurrent herpes always occurs on one side of the body or the other, so having a lesion on each buttock means it wasn't herpes. I don't recommend any testing on the basis of this event.

HHH, MD

[yoy]

Spots?  Could be anything- like a pimple does not soundlike herpes  I doubt that the site of recurrene would be there, but th doc will let you know- but I would not lose sleep on this one

[Englishman]

It is possible to purposely infect, say, a toe with HSV, thus making the rest of your body much more immune from it? Sounds like a silly question by I am curious.

[apollo13]

Englishmen, this is a great idea.  

Similarly, wouldn't you want to have oral herpes considering:  1) Most people are asymptomatic; 2) Half the new genital herpes cases are HSV-1 so you would be immune from that exposure; and 3) Oral herpes would provide some immunity to HSV-2.

Any opinion Doc?

[jd1]

Thank you for your response. I had a feeling that might be the case, but judging by the justifiable paranoia on this site (having sex with protitutes isn't exactly a guilt free experience, especially when it comes to catching nasty things), I am not alone in losing sleep over it. I do hope, however, that I didn't pick anything up, obviously, even on my big toe. I'm still due for a test, so what would be the optimal time to get one (test for all stds)?

(Not sure why anyone would want to infect themselves with anything...case in point, but I'd advise you to spare your big toe the agony).

Is there any statistical data of people who HAVE contracted herpes after protected sex with prostitutes? Is it common? I would assume that it could actually be lower risk than UNPROTECTED sex with someone in the 'regular' population, but it would also seem that sex workers would be exposed to it regularly, thus have a high precentage of them who contract the virus. I have seen the statistical data on couples (4% of men contracted out of 144 sexually active couples over a one year period). Any thoughts on the matter?

Thanks again for your response, and please, keep your toes herpes free!

jd

[Englishman]

But once you had herpes of the small toe (if possible), you could have the skin surgically removed so you never have any symptoms yet retain immunity. Am I barking up the wrong tree with this one?

[H. Hunter Handsfield, M.D.]

HSV-1 doesn't protect very well against HSV-2.  On average, there is reduced severity of initial HSV-2 infection if someone already has HSV-1.  But it is nowhere near total, and some people still get dramatic symptoms, and the frequency of HSV-2 recurrences or asymptomatic shedding aren't known to be different.  There are conflicting results of research on whether HSV-2-infecte people have have a lower risk of catching HSV-2 if exposed.  I come down on the side of those who believe there is such a difference.  However, it is mild in degree; certainly nowhere near complete protection.  For people with recurrent HSV-1 infection, control is more difficult than for HSV-2; for example, higher doses of antiviral drugs are required against HSV-1.  Finally, and perhaps most important, although HSV-1 infections usually are mild, devastating consequences sometimes occur.  in the US there are hundreds of cases a year, if not thousands, of herpetic encephalitis, an often fatal brain infection that typically leaves survirors with severe neurological impairment.

In summary, intentional HSV-1 infection to prevent HSV-2 is a bad idea.

HHH, MD

[apollo13]

Doc, What about Englishman's idea?  Intentionally infecting your toe with herpes (perhaps 1 and 2) to acquire immunity against genital herpes?

[Englishman]

Thanks for the reply doc. My cousin got herpetic encephalitis, it almost killed him and has been left with severe brain damage and regular fits, it is tragic. I think it was due to HSV-1, however, the chances of this happening are extremely rare but extremely serious when it does happen. Thanks to everyone for your ideas.

[Englishman]

What about HSV-2 infection of the tip of the small toe to reduce the risk of HSV-2 infection of the genitals, then surgical removal of the tip of the small toe. You imply that herpetic encephalitis is only caused by HSV-1, so there would be no risk by HSV-2 - which is also the more likely genital infection (compared to HSV-1) to aquire. Even if this only offered, say, 30% protection, it could still be considered significant.

If this doesn't work, developing a one-shot for life vaccine must be extremely challenging.

[jd1]

Back to the original question... so you don't think I should get tested after an encounter with a prostitute? Albiet protected sex? Is the chance that small that I picked up anything? She has probably had sex with thousands of guys, all protected (they're very meticulous over there), but still, wouldn't it be somewhat risky even when protected?

jd

[Englishman]

Mate, forget it and move on.

[apollo13]

Jd1, of course you should get tested.  What percentage of prostitutes have genital herpes?  I would guess around 98%.  It's part of the job.  Since you only had one encounter and it was protected your chances go down significantly, but you still had sex with a herpes carrier.  It is a skin to skin disease.  Your condom could only do so much.  Get tested and go to bed at night.  The problem is that you could have gotten herpes from someone else long ago and not known it because your asymptomatic.