HSV-2 Transmission Via Whitlows Finger and Risk Re Same

[mds22]

I was diagnosed w/ HSV-2 herpes (Whitlows) on one of my middle fingers via a cell culture in 1996. There’s never been any sign of herpes anywhere else other than that finger. I had a few outbreaks the 1st year but the frequency has decreased greatly; my last outbreak was about 3 years ago and about 2 years ago before that. I've had many, many long-term sexual relationships since my first outbreak, remained in contact with them, they know my condition, and never received any word of infecting any of them. I stay vigilant of outbreaks, double-dose w/Acyclovir at any sign, and keep my finger away partners' genitals. Given my history and risk-protection practices, I think my risk of infecting others is nil or negligible, but am not sure and have questions: (1) What is the risk, if any, of infecting myself elsewhere on my body via my finger? (2) What is the risk, if any, of me infecting a partner with HSV-2 via any other part of my body (e.g., tongue, penis, etc.)? (3) Will a finger cot during sex remove all risk of infecting others w/HSV-2 during same? (4) What is the risk, if any, of others' infecting me with HSV-2? (5) What is the risk, if any, of me infecting another through casual contact w/my finger (e.g., shaking/holding hands, touching breasts, other contact w/"skin" only) if I'm not in an outbreak (NOTE: I wear band-aids and/or finger cots during outbreaks). I hear herpes transmission requires a significant number of herpes cells under the right conditions (e.g., a transmission area that's moist, warm, exposed, and sufficient time for the virus to transmit) such that it is difficult to spread by casual contact with undisturbed skin, unlike a vagina or an exposed wound not protected by skin. (6) Given my history and risk-protection measures, do I pose anything more than no or a negligible risk? (7) If I was on Valtrex, do you think it’d be safe to engage in finger-genital contact with partners or should I still try to abstain from same?

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  I'll try to help.  You obviously have learned a lot about herpes in general and HSV-2 in particular, so I won't try to make any general educational comments but will go straight to your questions.

1) People usually are immune to new HSV-2 infections, once one part of the body is infected.  For that reason, the large majority of auto-inoculations (self infection of a new area of the body) occur during the initial infection, before immunity has developed.  Although there is a theoretical risk you could auto-inoculate your genital area, the chance is very low and I wouldn't worry about it.

2) You say nothing about your initial infection, but if it involved only your finger, the odds are strong that no other area of your body is infected.  If not, there is little or no risk of transmission except from your finger.

3) Probably a finger cot would provide a high degree of protection.  I cannot say whether or not it is total protection.  

4) No risk.  People with HSV of either type are immune (or at least very resistant) to catching the same type again, anywhere on the body.

5) To my knowledge, there has never been research into asymptomatic shedding of HSV-2 in relation to whitlow.  If there is any risk of HSV-2 transmission the way you describe, it probably is very low -- maybe no risk at all in the absence of recurrence of the whitlow.

6) Probably just a neglible risk, maybe none.

7) Valtrex would lower whatever risk there is.  Whether it makes the risk zero, I cannot say.  I suggest you inform partners of the potential risk, then let them participate in decisions as to whether to use that hand in sexual contact.  But it seems to me it should not be difficult to limit genital contact with partners to the uninvolved hand plus your genitals and mouth.  With that precaution, there should be no risk of transmission.

Best wishes--   HHH, MD

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