Is this recurrent herpetic whitlow?

[HopefulIn2018]

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[HopefulIn2018]

Hi Terri, please disregard the string of letters I posted above. I was testing how this works, and didn’t think that it would go through/post. Here is my actual post/questions:

I am a female who contracted genital HSV (presumably HSV 2 but never typed) 15 years ago. During my primary OB, I am almost certain I got herpetic whitlow on my right index finger. At the time, it became very swollen and I had a very painful lesion that started under my fingernail and on the tip of my finger. The doctor at the time said he didn’t think he could get enough of the virus to culture it. He told me it looked like it could be herpetic whitlow, but it was unlikely to come back and I wouldn’t shed through skin as thick as my finger.

For about 12 years, I never had symptoms with my finger. Then about 2-3 years ago, I started noticing that my right index finger would periodically get quite swollen and this swelling would last for a few days to a week or so. The swelling is worst in the middle of my finger, with some swelling at the tip. There is some tenderness (not painful though) and minor redness. No blisters or lesions, although sometimes I get what looks like minor cuts on the top of my finger with the swelling. I’ve not had anything similar on any other finger.

1) Could this be a recurrence of the herpes virus in my finger? Is it possible the virus is activating under the skin of my finger, but it’s not “enough” to push through and cause a blister? I should note that the swelling of my finger happens every month or so, which seems like a lot, as I “only” get genital OBs once a year or so while on valtrex.
2) IF it is a recurrence, could I be contagious when the swelling occurs but no lesions/blisters or breaks in the skin are present?
3) At the time the swelling first started to occur, I was not taking valtrex consistently. Could this have caused the virus in my finger to “wake up” after being dormant for so long? (I’m back on daily, but still getting swelling periodically).

[Terri Warren]

1. It could be, yes, but normally whitlow goes full blast and makes blisters. Without any blistering, it would be hard to know for sure because there is nothing to swab.
2. No, the skin of the finger is so thick that viral shedding cannot happen – the virus can’t get out without a break in the skin. You could have the cuts swabbed the next time this happens to try to get some clarify.
3. Yes, that is possible. Do you notice the swelling when you are taking Valtrex regularly? I would suggest that you keep a calendar for a few months of your dosing of medicine and the presence of the swelling to see if there is actually a relationship

Terri

[HopefulIn2018]

Thanks for your quick response. I will start tracking things to get more clarity. In the meantime, could you clarify the following:
1) I understand the skin on the finger is too thick to shed. Does this include if it’s swollen but no cuts or openings are present? If I were to touch a male’s genitals in this situation, swelling but no openings in skin, can I presume I’m not contagious? What if there is minor redness but no opening in skin?
2) it is hard enough to tell partners about my genital herpes (which I always do before sex). The finger thing is now causing me some distress too, as I’m newly single again. I’ve read that it would be very rare to pass from the finger to the genitals. Is this something I should even be concerned about?

[Terri Warren]

1. Yes. I would presume, without a break in the skin, that there is not virus present, even with redness present
2. No. I don’t think so, especially since we really don’t know if you have whitlow or not. And if it does get confirmed at some point to be whitlow, I still don’t think you need to disclose – just keep it covered during an outbreak and no contaCt with the genitals of someone else.

Terri

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