Help, Did I pass HSV-2 onto my child?

[wantingnot2worry]

Hi,
I recently had oral sex with a man that has HSV-2 and has had it for 10 years.  He has not had an outbreak in two years.  I have always had oral HSV-1 as I have gotten cold sores since I was a child.  About 3 days afterwards I developed fever blisters below my lip which is not uncommon as I was beginning my menstrual cycle and have had little sleep and a lot of stress.  Also not uncommon when I have some trauma around my mouth.  

I woke up on Friday morning with the small blisters and the tingling sensation.  I went to change my daughters diaper that morning and noticed that she had a horrible rash, almost looked like a burn around her upper hip where the diaper tab comes around; kind of followed the pattern of her diaper.  My blisters had not even erupted and her rash or whatever it was had clearly progressed very rapidly, so much so that it was oozing.  My questions are as follows:

1.  Could my fever blisters actually been HSV-2 from him even though he did not have an outbreak?  And if so, could I have possibly spread it to her hip somehow?

2.  If I did spread it to her hip does that mean that my 18 month old now has genital herpes?

Please help me answer these questions as I am going insane with worry.  Thank you for your time.

[H. Hunter Handsfield, M.D.]

Then all bases have been covered with respect to your daughter.

There are no data to estimate the odds you were infected with HSV-2 from that single episode of oral sex, but it has to be too small to measure.  Stop worrying about it.

I won't have anything more to say.

[H. Hunter Handsfield, M.D.]

I wish you had told me that.  The pediatrician's clinical assessment is probably accurate.  However, since s/he raised the shingles issue, perhaps the rash had some characteristics consistent with herpes (shingles and HSV infections look pretty much the same).  If you didn't mention your oral herpes, you might call the pediatrician about it.  You needn't say anything about your sexual exposure; almost certainly your oral herpes is HSV-1 and not related to that event.  Just tell the doc you were in the early stages of an oral herpes outbreak when your daughter's rash started, and that you want to be sure it's not an issue.

A related aspect is that the presence of a preexisting diaper rash, staph, strep, etc would increase your daughter's susceptibility to herpes.  So even if herpes wasn't the primary cause, it would be good for the pediatrician to know about your recent outbreak and perhaps advise you about taking care to avoid infecting the child.  Until her rash clears up, you should be especially careful to keep your hands away from your face until your herpes outbreak clears, and wash or use a disinfectant (like Purel) frequently.

[H. Hunter Handsfield, M.D.]

I'll try to help.  Statistically, it is unlikely your child's problem is herpes, and your description of her rash doesn't sound like it.  Initial herpes on her usually would have multiple individual blisters sores, but it sounds like you are describing a fairly diffuse rash.  Further, nonsexual household transmission of HSV to children is rare.  A garden variety yeast infection or diaper rash is far more likely.  That said, no online provider can make a definite diagnosis.  If you remain uncertain, you need to take her to her pediatrician.  Since it's apparently a fairly severe rash, that might be a good idea.

You are the best judge of whether this oral herpes outbreaks is a recurrence of your old infection or a new due to HSV-2.  Initial infection with either virus type usually is more severe than you describe; if the tingling and lip lesions were typical, then almost certainly it was the older infection cropping up again.

As I said above, parent to child HSV transmission is uncommon, and probably usually result from kissing.  Transmission to the diaper area in settings of poor hygiene probably occurs but is rare.  It's not generally a problem at all for HSV-2, only HSV-1 (leaving sexual abuse aside, of course).

Please do not rely on this advice.  I am an STD expert, not a pediatrician, and I have little direct experience with kids with the rash you describe or with advising parents about household transmission of HSV-1.

Finally, it's too speculative to worry about whether your daughter might have recurrent genital area herpes.  See the doc and get an accurate diagnosis, then cross that bridge if you come to it.  I doubt that will happen.

Good luck--  HHH, MD

[wantingnot2worry]

Thank you for your time and information.  It has been helpful.

[wantingnot2worry]

Thank you for the information thus far.

The pediatrician knew about my outbreak; we discussed treatment options for it because they were bothering me at the time I took her in.  He really didn't feel it was related; she was already far more pronounced then I was at the time.

I am assuming that if I did pass it on to her it would have been during a "shedding" period as I did not have any symptoms until Friday morning when she had already had a very pronounced rash.  So what are the odds that he gave me oral HSV-2 when he has not had any outbreak?

[wantingnot2worry]

I guess I should have told you that I did indeed take her to the pediatrician.  They cultured it for staph and it came back negative for staph specifically, just bacterial in general.

My mind just kicked into overdrive and I wondered if I could have passed it onto her and if that then meant she would have genital herpes.  And since it was on her upper hip area it seemed very strange to me.  Her pediatrician even suggested shingles but said that was very unlikely due to the fact she has never had chicken pox.

If I did pass anything onto her around the hip area it would have been before I even had any sensation I was getting fever blisters.  That would mean it just happened to be on my hand and spread to her when I put on her diaper.  Just seems very unlikely but wanted a second opinion on that.