Sex during possible herpes outbreak

[nvalley2011]

Recently I had unprotected oral protected anal sex with a CSW. I never touched her vaginal area. After the encounter I noticed a severe red rash in two areas, her left groin  and on her underwear line. No blisters were noticeable but possible scabs. Also there were four or five scabbed over bumps on the front of her thigh half way between her hip and knee. When I pointed all this out she claimed the bumps on her leg were bug bites and that the groin rash was a shaving rash. Here is my question. Since my only physical contact was protected and from her backside near her anal area, would it make it unlikely that herpes would be transmitted since the possible lesions or scabs were located on the front of her body away from where we had any skin to skin contact. My only skin contact was my pubic area and inner thigh touching her upper buttocks area. FYI I was recently tested IGG for HSV2 and was negative shortly before this incident. Also from other researching other posts is it correct to assume that if this wasn't an outbreak that my only risks from unprotected oral would be gnorhea and ngu, but real to low risk to worry about. From protected vaginal or anal would be HSV 2 and HPV, but for HSV2 per single exposure is like 1 to 5000 odds? Do you think any testing is necessary?          

[Edward W Hook, MD]

Stright to your questions:

1.) Even if I had skin to skin contact with a lesion or outbreak area during sex there is still less than 1% chance of transmission from this single exposure.
Yes, still a less than 1% chance.

2.)Any initial outbreak would appear for me no later than 10 days
Actuallly the published interval is that nearly all new outbreaks will occur within 14 days.  Most do appear within 10 days however

3.) Intial outbreaks for men almost always appear in and around the penis, not inner thigh etc.
Correct

4.)An igg test will be about 50% accurate a month after exposure. 100% at three months

At one month the figure is between 70 and 80%.  No test detects 100% of infections but those that will be positve will be positve by 6months.

Take care.  EWH
5.)CSW herpes rates aren't that much different than the overall female population 25%.Probably no more than 50%.  

[nvalley2011]

Thanks Dr. Hook,

Just a couple follow up questions for clarification.
1.) Even if I had skin to skin contact with a lesion or outbreak area during sex there is still less than 1% chance of transmission from this single exposure.
2.)Any initial outbreak would appear for me no later than 10 days.
3.) Intial outbreaks for men almost always appear in and around the penis, not inner thigh etc.
4.)An igg test will be about 50% accurate a month after exposure. 100% at three months
5.)CSW herpes rates aren't that much different than the overall female population 25%.Probably no more than 50%.  

[Edward W Hook, MD]

Welcome to the Forum. The description of the skin lesions you describe do not sound like herpes and even if they were, the risk for acquisition from direct lesion contact is low, substantially less than 1% and probably closer to 0.1% (1 in a thousand).  Herpes is transmitted from person to person through direct contact.  If you did not contact the rash there is no meaningful risk for HSV,

You are correct that your main risks from receipt of unprotected sex are gonorrhea and NGU and that this risk is low, If you do not develop symptoms, I would not worry.  

I see no need for testing related to these exposures. EWH