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Dear Terri,
Hello. I am a massage therapist. I just found out through a type specific blood test that I am positive for herpes type II (igg antibody test have to be greater than 1.1 and I was an 8)and negative for herpes type I. I am asymptomatic. I have never had an outbreak of any kind. I was surprised by my positive result. I have done extensive research on herpes type II and the potentials of transmission for those who are asymptomatic. One of the main studies I reference is Genital Shedding of Herpes Simplex Virus Among Symptomatic and Asymptomatic Persons With HSV-2 Infection by Elizabeth Tronstein, MPH; Christine Johnston, MD, MPH; Meei-Li Huang, PhD; Stacy Selke, MA; Amalia Magaret, PhD; Terri Warren, ANP; Lawrence Corey, MD; Anna Wald, MD, MPH. From this reading I have concluded that asymptomatic people shed 10% of the days of the year. There are other factors such as age, gender, and how long you have had the virus that affect the shedding rate. I also saw that genital shedding was detected in 68.2% of asymptomatic people, I assume the remaining percent either were not shedding during the period tested or they shed somewhere other than their genital region or both.
This is my concern:
I have no idea where I shed from. It could be my genitals, thighs, mouth, arms, hands, or anywhere else. As a massage therapist my concern would be if I shed from my arms, hands, neck, face, mouth region because these are the areas that come into contact with my clients. Arms and hands frequently touch clients through massaging which does create friction/kneading of tissue. The neck, face, mouth are areas that I may touch on accident and then massage clients. Clients often have breaks in skin. Some breaks are obvious and you can work around and some you cannot see, some have acne which most likely the skin is not intact, and many shave legs, arms, face, back, chest which may leave behind microscopic abrasions which puts them at risk especially if I happen to be shedding from my hands and arms. I had a physician’s assistant tell me I can keep doing massage and not to worry about it. But, I truly believe this to be unethical. It was a free blog site and I didn’t really have the ability to inquire further with him. So, I decided I would pay you to please provide me some assistance/counseling/medical expertise on why it would be ok. To me it seems like there is a 68% chance I shed from my genitals, therefore there is a 32% chance I shed from someplace else. Too me, that seems high enough to warrant not putting 10% of my clients at risk. I figure if I shed 10% of days in a year, then 10% of my clients are at risk. It seems as though the reason medical practitioners say do not worry is because the chance of transmission is low. But, to me as a health care provider it seems unethical to risk anyone’s health and 10% really is not all that low. While herpes is not deadly (for most) it is not an easy thing to deal with on a psychological, physical, and sexual level. It negatively impacts many lives and I feel it is wrong to knowingly put someone at risk even if the risk is small.
I am wondering what you would advise me to do in regards to my massage therapy career. And why you would advise it. If you feel I can remain a massage therapist, why, what are your reasons with your medical background and likewise if you feel I should leave the field why and what your reasons are?
I deeply appreciate this service you provide. I do not have insurance and this is much less expensive than my office visit cost to a local clinic and the added benefit is it is your specialty. So, my deepest gratitude to you for this service, I find great value in it.
I’d sign my name, but you said not to. 🙂
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I would advise you to keep doing massage therapy exactly as you have been doing! When we talk about viral shedding, that is shedding from the genitals. People don’t shed from their hands or arms or legs or thighs. They shed from their genitals, and assuming your genitals are not involved in your massage therapy, then your clients are at zero risk! First of all we know that the vast majority of people who are HSV 2 positive shed virus – the numbers are higher than the study that you quote here. I would say the number is over 95% when you use the most sensitive test to look for virus and you look over a four month period. The virus lives in the area innervated by the sacral ganglia, which covers the area from approximately waist to mid-thigh and down the back of the leg. It is not in the arms or hands or face or chest unless a person has herpetic whitlow, which I really think you would already know because you would have blistery lesions on your hands. You tested and got a positive value but you’ve never had symptoms of genital herpes that you recognize. My guess is that you will recognize symptoms soon. Remember that outbreaks can occur on the buttocks, around the anus, the lower belly. But only the genital shed virus because the skin there is very thin and thus the virus can get out easily.
I repeat that you are NOT a risk to your clients. I actually have several patients who are massage therapists, ironically, and for none of them is their herpes a concern, professionally. Zero concern.
You’ve got two more questions to ask me – feel free!
Terri
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You know, nothing you have listed here sounds anything like genital herpes.
For almost everyone, HSV 2 is at LEAST genital; that is, it could be genital and oral (intercourse with and giving oral sex to the same person). If a person has only been the giver of oral sex and never had intercourse, then it could only be oral if they are HSV 2 positive, but that person is uncommon truly. If you have doubt about these test results, you can always get a herpes western blot. Your HSV 2 values are high but if it would make you feel more certain, you can certainly arrange for that to be done.If your infection is genital, you will shed only from the genital area, not the oral area, if that is what you are asking.
And yes, this is only one question, so you have one more to ask.
Terri
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I think asymptomatic whitlow is kind of an oxymoron. Whitlow is defined by symptoms. Yes, I guess you could have oral HSV 2 asymptomatically, but that’s not common and again, most people who have HSV 2 are at least infected genitally. People do not shed from intact hand skin, by the way.
As for the incident with your friend – I do not believe that that presents any risk of infecting him, period. There was toilet paper in-between your hands and your labia, I am assuming. and even if there wasn’t, which there was, not enough virus would get on your hands to infect him. That just isn’t how this all works.
Terri
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Nope, you should ask someone else, please
Terri
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Dentists don’t get whitlow any more because they wear gloves, but when they used to get whitlow because they didn’t wear gloves, it was likely because they had a break in the skin of the hand or broke the skin while doing a dental procedure with those sharp instruments. In your situation, virus just doesn’t seep through barriers in sufficient quantities probably to reach your hand much less get inside your hand. People often ask this question about virus seeping through clothing with vaginal lubrication or semen. It just doesn’t happen. And remember that the virus has to 1) be present in sufficient quantities to be infectious and 2) there has to be a vulnerable entry point in the skin. You had neither.
Even if you had whitlow, which you don’t, there would need to be an actual outbreak on the hands to be infectious to others. While the genital skin is very thin and virus can come out with much tissue barrier, with the thick skin of the hands, the virus has no way to get out. That’s why virus is not shed from thighs or buttocks in the genital region either.
Yes, you would only shed virus from the genital area and if infected orally, very rarely from the mouth. And NO, if you are infected genitally or orally you don’t shed virus from your hands. Completely different nerve group.
Terri
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You are most welcome. We’ll have 22 for dinner at my house so I need all the good wishes I can get! LOL
Terri
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Great idea. I’ll work on that
Terri
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