Contract Herpes Whitlow

[dg65]

HHH MD,

About 15 months ago, I got back together with my girlfriend after having been broken up for a two months.  The first time we went out after being back together, I cut my right middle finger in the car.  It seemed so minor.  It got so bad within the next few days, that I figured it was an infection or that something was still in my finger from the cut (I cut it on a chord under the seat).  Anyhow, it lasted for a few weeks and I figured that it was done with.  It came back twice more before I went to the doctor and was told that it was Herpes whitlow.  My girlfriend is now accusing me of getting herpes from some other woman and giving it to her (Her symptoms show up on her face).  My questions are:

1.  If I wasn't sexually active with anyone else during our break up and only sexually active with her during the few days before it got so infected, how was it contracted?

2. Is it common to get whitlow from sexual contact?

3. Can the virus be spread without phyiscal contact?

4. If so, could I have touched something where the virus lived and then when I got the cut it infected my finger?

5. How long could the virus have been on my finger, waiting for the cut to infect me?

There are so many conflicting things on the internet regarding the subject.  I know I could not have got it from sexual contact from another woman.  Unfortunately, she has some questions.  I would like to ease her mind about it.  Also, her accusing me made me think that maybe I got it from her.  At the end of the day, I know the truth that it was impossible for me to have contracted through sexual contact with anyone else because there was not any.  I have it and there is nothting I can do about it.  I just want some peace of mind and clarity for her.  I do love her and don't really care if I got it from her or she got it from me.  I do care about the peace of mind that clarity on the subject will bring.

Thanks for you help,

DG

[H. Hunter Handsfield, M.D.]

I forgot to comment on the statement of your partner having lesions on her face.  If that's herpes, it sounds like she was infected first and your finger infection came from her.  But I suppose it could be the other way around, depending on whose symptoms begain first.  Even that won't give a clear answer, though.  If your early symptoms were due to some other infection or injury, and then you had contact with your girlfriend's face or mouth, you might have caught HSV from her even though your symptoms began first.

Having multiple lesions on the face, not just the mouth, is also atypical.  Maybe her problem is something else entirely.  She needs to get a professional diagnosis, if that hasn't been done.  

[H. Hunter Handsfield, M.D.]

Herpes does not cause widespread lesions like you describe in your partner.  Whatever caused her lesions, it wasn't HSV.  (Possible exception if she has the rare condition called eczema herpeticum, which happens when HSV infects preexisting widespread eczema.  But this is something for a dermatologist to address.)

Beyond that, I have no further comments.  I won't speculate about the impossible-to-answer question about where you got your whitlow.   As I said in my original reply, knowing whether it was caused by HSV-1 or -2 would help to sort it out.  Otherwise, you're going to need to accept the fact that you're never going to know for sure.  Sorry.

[dg65]

Thanks for your insight.  Although my mathmatical mind wants there to be one answer, I understand that there are too many variables to allow for certainty.  I know that it did not come from me having genital herpes nor from another woman that I had sex with since I don't have genital herpes and I wasn't having sex with anyone else.  The only two possibilities that I can't rule out then are either I got it from my girlfriend or possibly from my ex (I call her my baby mama).  The only signs that I have seen of her having them were the pimple like bumps she had on her forehead but she also had some around her mouth.  We both thought that she was just having a minor break out of pimples.  But now that I remember she also had some on her hand above the knuckle.  Those happened after my finger incident and we laughed about my finger causing it since we didn't know what was wrong with my finger (Originally we just thought that a piece of chord that I cut my finger on was still in the finger and causing it).  But thinking back on my three years with her she has had a few times she has broken out on her face but I don't remember the hand ever breaking out before.  On the flip side, my ex has had cold sores in the past.  The only way to rule that possibility is to understand how I might have contracted it from her.  I know that in the short time between cutting my finger and realizing that there was something worse in my finger that I didn't come in direct contact with any cold sore that she had. (I didn't stick my finger in her mouth).  I guess that leaves me with two more questions.

1.  If she did not have any cold sores at the time I got infected, is it possible for her to have given it to me somehow?  Maybe by touching the same glass or handing me anything that she might have touched understanding that the virus can't live more than a couple of minutes

2. Same question if she did have cold sores at the time.  

I understand that you can't give me a definitive yes.  I guess I would just like to find the most probable answer and rule out things that just couldn't have happened.  It will give both my girlfriend and I some peace of mind.

Thanks,

DG65

[H. Hunter Handsfield, M.D.]

Few solid data are available about herpetic whitlow.It's pretty rare, and a quick scan of the medical literature in response to your question finds only about 20 published articles on it in the past 10 years, none about epidemology or transmission risk.  The last research study that addressed those issues was published almost a quarter century ago (1983) and is badly outdated.  The lack of solid information undoubtedly explains why you find conflicting information:  the less is known about a topic, the more variability you will find, especially on the web.

With that as background, understand that my replies are based on a certain amount of common knowledge and my own judgment, but not much solid data.

In general, it is believed that whitlow develops mostly in people with new HSV infections, either HSV-1 or -2.  Someone who already has longstanding HSV-1 (mostly oral) or HSV-2 (almost entirely genital) is not likely to get a new whitlow.  Therefore, it seems likely that you acquired a new HSV infection.

How did you get it?  Impossible to tell.  Knowing the virus type would be helpful. For example, you would not catch an HSV-1 whitlow by fingering someone with gential infection, but that's the main way an HSV-2 whitlow might be acquired.  If a viral culture wasn't done from the finger lesion, a blood test might sort it out.  Also, many cases are occupationally acquired by health providers.  Presumably that doesn't apply to you, but it might be the explanation if, for example, you are a nurse or other provider who did not use proper protection (gloves) examining an infected patient.

To your specific questions:

1) Maybe you caught it from your girlfriend, as you suggest.  Maybe from contact with someone with oral herpes; this might be most likely if you have contact with small children, who might have oral herpes plus lack of adult style hygiene.  It just isn't possible to know from the information you provide.

2) Sexual acquisition of whitlow definintely occurs, but it isn't common.  When it does, the usual scenario isn't only a finger infection, but alsoprimary genital or oral herpes, i.e. the finger is infected by contact with one's own genital or oral secretions.  But some cases might be acquired directly by fingering the genitals of someone with genital herpes.

3,4) Direct physical contact of the finger with HSV is required.  There might be a theoretical risk of infection by contamination from, say, secretions left on a doorknob, especially if there were a pre-existing cut, hangnail, or other lesion of the finger.  But that's really a stretch and probably explains very few cases, if any.

5) The virus couldn't be present more than a few minutes.  To get a whitlow, the virus probably has to be inoculated directly into a defect in the skin of the finger -- e.g. a cut or hangnail, as I said above.

You may never know the source of your infection.  As I said, determining the virus type might give a clue.  For example, if it's HSV-2 and your partner also were tested, and if her blood test shows HSV-2 infection, you could have caught it from her.

Finally, as to your partner's accusation, there are plenty of possibilities that don't involve sexual infidelity.  If you haven't had other partners or fingered anybody, stick to your guns and explain all this to your girlfriend.

I hope this helps.  Best wishes--  HHH, MD

4)