Occupational HSV2 exposure risk

[Helea1]

Hi Terri,

I’m a nurse who works for a urologist. Today I was assisting in a circumcision for a patient with an active HSV2 infection. I was assisting with the suturing after the foreskin had been removed, and the needle nicked my glove on the underside of my hand. I proceeded through with the surgery, which had multiple complications and was very bloody. When I took my glove off, I didn’t see any blood on my hand at all, and proceeded to sanitize my hands. I checked thoroughly for any cuts on my hands, but didn’t see any fresh ones at all; only old nicks and scrapes that had been healed on the top part of my hands.

I know HSV isn’t a blood borne pathogen, but I am still terrified the virus could have gotten through the nick in my glove and somehow infected me. Can you please advise? I’m really scared and don’t know what to do.

[Terri Warren]

So here is what we would do if you were my employee:

I would absolutely want you to document this event carefully with your employer
I would offer you confidential HSV IgG antibody testing to obtain a baseline herpes status for you right away – like now. Do NOT do an IgM antibody test at all as they give many false positives.
I would encourage you to observe the site very carefully for any symptoms and if any appear to have a PCR done of the lesion immediately.
Then I would ask that you retest is 12 weeks by IgG antibody test.

All of the above should be done in a timely and rapid way.

Having said all of that, as with HIV, needlesticks through gloves rarely result in infection as the glove picks up most virus that might be present. And as you know, this is not a bloodborne virus except possibly with first infection. My only concern would be if you picked up virus from a lesion. I think that is also very unlikely.

Terri

[Helea1]

I have notified my employer, who seems completely unconcerned. My baseline HSV status is negative for both types of HSV, as I’ve had previous IgG testing. I did not come into direct contact with any lesions. The foreskin had already been removed and he was suturing some bleeding that had occurred.

I am now really terrified. Do I need to obtain prophylactic acyclovir?

[Terri Warren]

I honestly don’t think there is any need to be terrified!! If the lesion area of skin was gone, I think there is virtually nothing to worry about.
You could do a week or so of acyclovir at say 800 mg TID – it is quite benign and will not be activated if there is no virus present in your body so you really don’t have anything to lose. But the mode of transmission just isn’t there for you. Really.

Terri

[Helea1]

My employers don’t feel prophylaxis is necessary and don’t feel that acyclovir is warranted. They won’t write me a script for it. I am really beyond scared now. I think I see a spot on my hand where the needle grazed me. I did not have direct contact with the lesions, but the needle was suturing on multiple different locations on the penis after the foreskin was removed. What about residual virus exposure that way?

How long do I need to wait to see if I will contract this virus? I don’t think I can take 3 months of waiting with constant anxiety.

[Helea1]

Terri, if you could answer my subsequent questions I would be so grateful. I really am extremely worried now that I can’t get acyclovir. I’m not sure what to do. How long till symptoms appear? Can I auto-inoculate other areas of my body during the incubation period? I’m afraid to touch my husband and afraid to even wipe myself when I use the restroom now.

[Helea1]

Hi again! Purchased more questions (sorry, getting the hang of this). Could you address the inquiries I posted above?

[Terri Warren]

well, most people develop symptoms within 2-10 days and unfortunately the opportunity to start prophylaxis is past. It needs to happen really quickly after the event to work. There is only a small mouse model to document this, nothing in humans but I do use prophylaxis in situation that are similar to this. I am disappointed that your physicians wouldn’t write your a script just to ease your mind – what harm would it do? Bummer.

Again I feel that your risk is really really low here. You can certainly touch your husband of course. If you are worried about that spot, just cover it with an bandage. if in the remote circumstance that you are infected, it is only on your hand, not genital and it will not migrate to your genitals. You need to talk yourself down here. Remember that this is not bloodborne infection. The needle didn’t even draw blood. There is a certain amount of virus required to infect someone – it isn’t just ANY virus – no way you got enough virus to infect your hand.

cover the spot on your hand and you won’t worry about autoinoculation.

Terri

[Helea1]

I think the spot on my hand is actually a tiny wart. So, I’m not even sure if I did get poked with the needle or not. I’m not sure what or where to even cover! Do I just wear a glove on my hand for 10 days? And basically you’re saying that it is possible to autoinnoculate during the incubation period when I don’t have any overt symptoms at all!?

[Helea1]

And sorry, if you could clarify (my OCD
Is really getting the best of me now), I’ll just post my final questions in order:

1) You stated that “no way was there enough virus to infect your hand.” Could you maybe wager a percent-based risk here so I can ease my mind? I really am trusting you and it’s basically the only thing that’s going to get me through the next 10 days without having constant panic attacks.

2) Can I auto-inoculate other places of my body during the incubation period? I have touched my body with that hand (wiping when using the bathroom/touched my husband, etc). Am I now at risk for genital herpes and him as well?

3) If I don’t develop any symptoms after the incubation period has passed, do I need to still obtain a blood test 12 weeks from now?

[Terri Warren]

I think the risk of you getting herpes from the needle stick that you describe is way less than 1 in 1,000. Way less. What stage was the outbreak in? Why did he get circ’d?
You won’t autoinoculate other parts of your body if you develop no symptoms on your hand. If you do, then you need to start being very careful, yes. And I know you are very worried about this so for now just put a bandaid over it.
I think yes, you should obtain a final antibody test at 12 weeks. Just to be absolutely certain as this is a workmans comp issue. I would certainly want that for my employee if it was happening in our clinic.
Wiping yourself or touching your husband now is fine – you have no symptoms. And just so you know, the average time from infection to symptoms is 5.5 days. You are almost there!

Terri

[Helea1]

Terri,

I still have no symptoms on my hand. The outbreak was in it’s healing stages and I believe it was perhaps over 5 days old, maybe even more than that. However, I am terrified of herpes now. I have always bad a phobia of it and now I have unusual vulva symptoms. My anxiety is getting the best of me. I have preciously tested negative for both types of HSV via a western blot (I wanted to be sure of my negative status) and my husband had tested negative for both types of HSV via Elisa. I know it’s not as accurate for Hsv1 but we don’t engage in oral sex, and cheating absolutely isn’t a factor so I don’t know how the heck I could have gotten it.

Yesterday I shaved my vulva and was not very careful. Saturday morning I noticed a tiny red spot after having pain during sex. I got a magnifying mirror and noticed the red tiny bump. I don’t know if it’s from shaving or sex or irritation from repeat self-examination, but it’s now worse this Sunday morning. I can see four tiny red spots that seem to correspond with underlying Fordyce spots. It’s not painful or itchy or anything. I’m terrified it’s somehow herpes. Could you look at a photo of it? It’s just above the black mole in the photo:http://imgur.com/KzcVGKQ.

[Terri Warren]

I really don’t look at photos as viewing and commenting on them is too close to practicing medicine over the internet which I cannot do, sorry. But I can tell you that a person who has a healing lesion that is 5 days old is far less likely to be shedding virus than someone in an early lesion stage.

I have 100% certain that whatever genital symptoms you are having today, it is unrelated to the exposure to the patient with herpes. Really.

What do you suppose the herpes phobia is all about?

Terri

[Helea1]

Thanks for the input Terri,

How likely is it to contract herpes and never develop a primary outbreak after the incubation period has passed? It’s going to be a really hard next 12 weeks waiting until I can get a blood test and I’m hoping that if I don’t develop symptoms that’s at least a very good sign I didn’t contract the virus.

[Terri Warren]

I’m sorry ,but you have exhausted all of your questions. If you have more feel free to renew

Terri

• This reply was modified 7 years, 6 months ago by Terri Warren.

[Helea1]

Ok thank you! Also, I checked the patient’s history and he had had the outbreak for over a week when he was initially seen, and the outbreak had been over 2 weeks old by the time we performed the circumcision. Does this also change my risk level?

[Helea1]

Ok thank you! Also, I checked the patient’s history and he had had the outbreak for over a week when he was initially seen, and the outbreak had been over 2 weeks old by the time we performed the circumcision. Does this also change my risk level?

[Terri Warren]

Oh yes, definitely reduces your risk greatly.
May I ask if his circ had anything to do with his herpes?

Terri

[Helea1]

Now we are not even positive it was herpes (just strongly suspected) because he had balanitis that improved with anti fugal cream. He also had phimosis, which was the reason for the circumcision.

Also, (I really am having a herpes catastrophe this week) my coworker has a scabbed over herpes outbreak that’s about a week old and she was sipping out of a drink from a straw. I was leaning over her desk to grab a paperclip and pulled my hand back and the tip of the straw just scratched my arm. Ugh!!! I immediately wiped it with a super-Sani wipe and scrubbed it down with hot water and soap. It didn’t draw blood but oh my gosh am I now at risk for this too!?!

[Terri Warren]

No, that second experience is zero risk.

Terri

[Helea1]

Okay, even if it broke the skin? It scratched my arm but she said she hadn’t drank from the straw for a while and wasn’t even sipping from the side that had the cold sore. Even if there was virus on the straw I immediately got it with the Sani wipe which says specifically that it kills HSV.

[Terri Warren]

I think you are overestimating how easily herpes is transmitted. It takes a certain volume of virus to infect someone (j. schiffer, Interface, June 6, 2014) and I just don’t believe you are going to get that with the experience that you describe – besides, how much damage can a straw really cause to skin? I think this is an unnecessary worry.

Terri

[Helea1]

Enough to leave a little red mark. I see what you’re saying about how contagious (or apparently how not very contagious) herpes is. I just assumed that a tiny amount of virus would be enough to cause infection if it entered broken skin. So even if my skin was broken by the straw (which it was, just enough to leave a red mark) that’s still not really enough to cause infection? I have just read conflicting information about transmission via inanimate objects like straws, drinking glasses, etc. Could you clarify on this matter?

[Terri Warren]

I’m sorry but you are out of posts on your latest subscription

Terri

[Helea1]

Hi Terri,

I’m now 18 days post-exposure. Today, the tip of my middle finger began to feel a little sore midway through the morning and now that I focus on it it almost feels like it’s tingly?? I’m not sure if it’s from biting my nails or banging my hand, etc. I’m 3 days from the end of the incubation period and up until today, didn’t have any signs or symptoms 🙁 Do you think this is a sign I’m getting an outbreak this late into the incubation period?

[Helea1]

Terri,
Oops, forgot to clarify. The “possible” needle stick (never any signs of an actual penetrating injury) was on my palm, not my actual finger. Also, I can see where I chewed on it earlier without even thinking of it. Does this help explain the symptoms I’m having? It doesn’t even hurt if I don’t focus on it.

[Terri Warren]

I do NOT feel that this is a sign of infection, no. I know you are being superobservant and that’s both a blessing and a curse. obviously, if you show up with blisters anywhere, you should be seen.

Terri

[Helea1]

Hi Terri,

Okay. My finger turned out to be fine. I’m now on day 19 post the possible exposure. If I don’t develop symptoms within the next two days, can I be relatively certain I did not acquire the infection?

[Terri Warren]

I’m sorry, you’ve had 17 posts and have paid for only 15. if you have more questions, feel free to renew.

Terri

[Helea1]

Hi Terri,

This is my last round of questions. To reiterate, it’s now 23 days post-exposure and I never developed any symptoms. However, I was researching and Dr. Handsfield at medhelp indicated you can acquire HSV infection and never develop any symltoms or have a primary outbreak. So my questions are:

1) How possible is it I still could have acquired the infection and never have developed any symptoms?
2) Are these “asymptomatic” cases truly asymptomatic, or are the outbreaks so mild in some people that they don’t notice them?

[Terri Warren]

It is absolutely correct that you can acquire genital herpes without any symptoms, but in your case we are talking about something completely different. We are talking here about a possible puncture wound and I believe in this case, you would have symptoms at the site of exposure. Also, as you suggest, people really most often do have symptoms but they attribute those symptoms to something else or they are mild enough not to be considered a problem.

I don’t think advice that we would normally give about genital or even oral herpes applies to you here.

Terri

[Helea1]

Okay, so with no symptoms now 24 days after the possible exposure (I never had a confirmed puncture wound), can u be pretty sure I didn’t acquire the infection? I have had weird nerve pain in the same hand on and off, but it could be that I slept on my hand weird. Is neuropathic pain a sign of infection?

[Terri Warren]

Yes, you can be reassured about this now. Neuropathic pain can occur in people who have herpes but it can certainly occur for other reasons too. I wouldn’t jump to herpes as an explanation at this point, no.

Terri

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