Whitlow HSV 2

[Username1]

Hey Teri,

I was recently diagnosed with HSV 2 with a blood test. No index numbers, it just said positive. I have never had a single genital outbreak but thinking back, I have had blisters that have popped up on my middle finger about once a year. They look like textbook whitlow. My finger will get tingly and itchy the day before Clear fluid filled blisters around the nail and side of finger start to surface. The skin around turns red and directly around the blister a bit purple. Very painful. This last time, one blister even popped up under my nail and caused the nail to lift and crack open. It’s never been swabbed but was told before that it looked like a staph infection. Another time they said MRSA.

My questions are, if I have no genital symptoms but reoccurring whitlow, is there a possibility that the infection is only in my finger?

If it was genital too, would genital symptoms show up along with the whitlow?

Is there a way that I can swab to see if any Hsv is detectable in the genital region?

I’m extremely worried about transmitting genitally since I know shedding in genital region happens without symptoms but finger it doesn’t.

Also I have a question about oral sex. I saw in a study you did a study on Hsv 2 shedding orally but is there any data on acquisition rates? I mean even though whitlow is rare we still have numbers. Does that mean that oral Hsv 2 is so rare that there isn’t an actual number for acquisition?

I also can’t find any studies that talk about length of time and likeliness of shedding. I’m assuming I have had this for years since my husband of 8 years is negative. Can you direct me to anything?

[Terri Warren]

It is possible that it is on your finger only, but we simply cannot be certain. This has to be frustrating for you, not knowing for certain if you have it also genitally.

Yes, because oral HSV 2 is so uncommon, we have no data on transmission and acquisition that is correct. There are no studies that I am aware of that address this question at this time.

I would strongly suggest that you have your finger swab tested for HSV the next time this happens. Be certain to ask that the virus be typed IF it is positive for HSV.

If your husband is negative after all these years, it certainly suggests that viral shedding is rare if you do have it genitally.
I am assuming you’ve had other sexual partners than your husband at some point in your life?

Terri

• This reply was modified 6 months, 1 week ago by Terri Warren.

[Username1]

Hey Teri,

Thank you for your quick response!

Yes, I have had other partners aside from my husband but that was over 8 years ago. I was tested because we decided to open our marriage. What is the likelihood of transmitting and shedding this to a new partner after having this for at least 8 years?

I’m having a hard time accepting this but explaining this to a new person I think is going to be even more difficult at first so I want to get as much info as possible of the actual risks.

So to my understanding so far, oral sex is still relatively safe with Hsv 2 but genital to genital has some risk?

I read in another one of your studies in discordant couples that hsv 2 acquisition for the infected partner on Valaciclovir was only in 1.9% of couples and symptomatic in 0.5%. But the Hsv 2 positive partner at least had some days with symptoms. I have none so I wonder if it could be lower…

Im just trying to get my new partner script together. I want to be honest but want to bring some sort of comfort.

So there’s no way to tell if it’s shedding genitally? When it pops up on my finger, if it was genital as well, wouldn’t there be genital symptoms at the same time as the finger? Can I be swabbed then for both finger and genitals even with no genital symptoms?

[Terri Warren]

Yes, genital to genital sex has some risk, that’s correct.
The stats you quote from the transmission trial are the lowest we’ve seen so I would wonder if it would actually be lower for you, I might guess not.
Correct, there is no simple way to know when or if you are shedding virus genitally. We do often see oral and genital symptoms at the same time, so you could try swabbing when you have finger symptoms, yes, both finger and genitals.

Terri

[Username1]

So after at least 8 years since acquisition with no genital symptoms, what are a the possibility of me spreading this? Is it lower as time progresses? How much lower?

[Terri Warren]

You are asking a very specific question for which we don’t have an answer. We don’t know if at 8 years out there is a lower risk of transmission than at say 5 years out. We just don’t have those answers, I’m sorry.

Terri

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