Possible Transmission to Hands on Partner (Herpetic Whitlow)

[BestWishes]

Hi Terri

I’m F/40 with GSHV2 since 2014. Been on Valtrex 500 mg for the past 2 months.

I just had my partner fingering me couple of hours ago.
Mostly on the clitoris, not going into vagina. No protection

I had a discomfort on the leg, I thought I was just too tired.
To my horror, now I feel one sore lesion near the rectal area.

I feel bad I missed the sign of leg discomfort and had exposed my partner to the risk of touching the genital area during OB

1. What is the chance of me transmitting?

2. He has no open wound in the hand, he washed hands right after. Contact happened about 5-10 minutes. I don’t think he rubbed the lesion, but cant be too sure. Without direct contact, the genital including the clit is very infectious too?

3. Even with disclosure, the thoughts of transferring is unbearable. I’m very uneasy during and after sex. I read that herpes whitlow incubation is 2-20 days. This will cause me losing sleep for the next 20 days. Years and I have not come to terms into this issue. How can I work on this?

3. Does it have to be open wound like cut on the tip of finger? The skin on the corner of the nails can be quite sensitive and sometimes may have small cracking. But main contact is with the tip of finger. I worry fluid may be involved in the upper finger. Is it possible transmission way too?

4. Any extra precaution to prevent transmission apart from abstain during OB, use protection and anti viral? Does cleaning up before and after the intercourse help? Can we Use of lubricant to reduce frictions?

5. Please advise on how to manage the transmission while trying to conceive?

6. Is female condom more effective in preventing transmission than the male one?

7. The statement that “70% transmission is from someone with no apparent symptoms”. Does it mean that 70% transmission happens during the non outbreak times? So it is very highly dangerous to have intercourse during the no symptoms?

Thank you.

[Terri Warren]

1. What is the chance of me transmitting?
Very close to zero. If the skin on his hands was intact with no breaks, I’m not worried about transmission at all.

2. He has no open wound in the hand, he washed hands right after. Contact happened about 5-10 minutes. I don’t think he rubbed the lesion, but cant be too sure. Without direct contact, the genital including the clit is very infectious too?
I think you’re fine. We don’t know specifically if the clitoris sheds virus

3. Even with disclosure, the thoughts of transferring is unbearable. I’m very uneasy during and after sex. I read that herpes whitlow incubation is 2-20 days. This will cause me losing sleep for the next 20 days. Years and I have not come to terms into this issue. How can I work on this?
You can take my advice and know that the intact skin of hands does not get infected with HSV 2.

3. Does it have to be open wound like cut on the tip of finger? The skin on the corner of the nails can be quite sensitive and sometimes may have small cracking. But main contact is with the tip of finger. I worry fluid may be involved in the upper finger. Is it possible transmission way too?
I really don’t believe so, no

4. Any extra precaution to prevent transmission apart from abstain during OB, use protection and anti viral? Does cleaning up before and after the intercourse help? Can we Use of lubricant to reduce frictions?
Cleaning up after intercourse MAY be helpful but we just don’t know. Lubricant to reduce friction may be helpful for you to reduce the possibility that friction triggers an outbreak

5. Please advise on how to manage the transmission while trying to conceive?
there are some options, including artificial insemination either at home or in a clinic, increasing the dose of antiviral medicine during fertile periods,

6. Is female condom more effective in preventing transmission than the male one?
Probably

7. The statement that “70% transmission is from someone with no apparent symptoms”. Does it mean that 70% transmission happens during the non outbreak times? So it is very highly dangerous to have intercourse during the no symptoms?
It is not highly dangerous to have intercourse with no symptoms, it is just possible to transmit virus when no symptoms are present.

Thank you.

[BestWishes]

Thank you Terri
We can leave the issue of herpetic whitlow behind. 🙂

Follow up questions about point no 5 on the trying to conceive:
Increasing the dose of the antiviral during fertile period. How much of the dose can we take for this? And how long is it save to do that? probably for a week or two weeks? or can we actually increase the dosage for prolonged period like let say 1 year?

—-

Would like to get to know more about preventing transmission to the partner.

40F/GSHV2 for 9 years – about 4 OB’s on the first couple of years getting.
Reduced to avg of 2 OBs yearly for the past probably 2 years

Consulted with specialist of infectious diseases before, the doctor only gave me 10 tablets of Valtrex to be taken during OB. The doctor mentioned no need to worry about it because your partner will eventually get it. It’s just a matter of time.

The way she puts it seems like there’s no need to bother on the suppression therapy.
Which is pretty depressing.

After reading on your handbook. I started on daily therapy of 500 mg Valtrex mid Jan
Had another OB on mid Feb.
Will monitor if the OB is reduced.

Questions:
1. Is my case considered very active / highly transmissible to a partner?
2. It is mentioned that during the first 3 months period the chance of transmitting is high. As we’re getting serious in the relationship, there will be a lot of intercourse involved. Any extra precautions do you usually suggest to your patients during the crucial time of the relationship?
3. If after couple of months or years probably things is going well and no transmission, can we probably go without one of the therapy, maybe without condoms or without antiviral?
4. Is what the doctor said that it’s just a matter of time that my partner will definitely get it is true?
5. How far are we from finding meds on this?

Thank you

[Terri Warren]

The infectious disease doctor you talk to is indeed quite wrong. Couples go lifetime together without transmitting. I don’t know why they would say such a thing. Two outbreaks a year is minimal in terms of the average number of outbreaks that people with HSV to get. Your case is not highly transmissible but it is possible that you could transmit even while on antiviral medicine though the risk is quite low. I would say if you’re having a lot of intercourse in your partner is concerned about transmission, condoms should be used with every intercourse. As you move into the relationship further, usually condoms are the first thing to go and antiviral therapy continues. I think the most promising research right now is on gene editing is coming out of the Fred Hutchinson Cancer Institute in Seattle.
Terri

[BestWishes]

HI Terri,

Thank you for the response.

1. About the increasing the dose of the antiviral during fertile period during the trying to conceive.
How much of the dose can we take for this? And how long is it save to do that?

2. I have outbreak on genital area only, does it mean that the boxer short area is also contagious? the below the belly button area and buttock and around the area?

3. Regarding your response “Lubricant to reduce friction may be helpful for you to reduce the possibility that friction triggers an outbreak”
I notice that after an intercourse sometimes I have something similar like an outbreak. It is like a sore in the area where the OB normally happens, but I don’t find any lesions there. And it is usually cleared within 1-2 days. I’m actually puzzled and not very sure if it’s an outbreak.
In your experience, could this be the case where frictions is a triggers for OB for me?
Or is it just because the skin there is sensitive so frictions cause it to be irritated?
Should I stop intercourse during this time?

Thank you.

[Terri Warren]

1. About the increasing the dose of the antiviral during fertile period during the trying to conceive.
How much of the dose can we take for this? And how long is it save to do that?
You can do 500 mg twice a day for an extended period of time

2. I have outbreak on genital area only, does it mean that the boxer short area is also contagious? the below the belly button area and buttock and around the area?
No, only the very thin skin of the labia, vulva, and anus would be infectious, and wherever you have an actual outbreak , if it is outside that area. The skin in the other places is too thick to shed.

3. Regarding your response “Lubricant to reduce fr
friction may be helpful for you to reduce the possibility that friction triggers an outbreak”

I notice that after an intercourse sometimes I have something similar like an outbreak. It is like a sore in the area where the OB normally happens, but I don’t find any lesions there. And it is usually cleared within 1-2 days. I’m actually puzzled and not very sure if it’s an outbreak.
In your experience, could this be the case where frictions is a triggers for OB for me?
Or is it just because the skin there is sensitive so frictions cause it to be irritated?
I think it is more likely just sensitive skin from previous outbreaks, but without a swab, it is impossible to know. You could have that area swab tested at some point, just to see.

Should I stop intercourse during this time?
See above.

Terri

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