Aa
Herpes Whitlow confusion
Hi,
I'm asking this question in this forum rather than the Herpes forum since I want to follow-up on a post made here.
My female partner and I engaged in mutual masturbation and protected intercourse one evening. I know I had a hang nail at that time. Several days later, my finger became inflamed down to the first knuckle with a huge blister at the cuticle. Around the same time, my partner began to have significant pain in her vaginal. Once she was able to see her OBGYN, he confirmed the diagnosis of Herpes. I saw my GP and he diagnosed my finger given the situation as Herpes Whitlow. We are awaiting test results.
The time line:
-protected intercourse and mutual masturbation
-a few days later symptoms on finger and vagina of partner (we can't remember which came first or if they were concurrent)
-partner has high fever 3 days after sex
-I have a huge (small orange size) and painful swelling under my arm of the infected finger (lasts around one day) 4 days after sex
-female partner diagnosed with genital herpes
-I was diagnosed with herpes whitlow. I have no genital nor oral symptoms.
Her OBGYN and my GP are not that well versed on this, and the information on the Internet is contradictory. I recognize that Herpes Whitlow is rare and there isn't much literature on the subject.
My question concerns a prior post by Dr. Handsfield. In post 477021, he indicated that Herpes Whitlow is usually associated with new infections. You also mention transmission is possible via fingering but unlikely, and that Whitlow is usually the result of auto inoculation. Given that I've had no genital nor oral symptoms, AND yet I've had the classic symptoms for Whitlow and lymph node involvement under the arm. The questions are:
1. What are the chances that I only have a Whitlow infection, i.e. what should I tell future partners (if any) since I presume there is no way to rule out a genital nor oral infection.
2. Any clue as to who was infected first (not that we care much)?
I'm asking this question in this forum rather than the Herpes forum since I want to follow-up on a post made here.
My female partner and I engaged in mutual masturbation and protected intercourse one evening. I know I had a hang nail at that time. Several days later, my finger became inflamed down to the first knuckle with a huge blister at the cuticle. Around the same time, my partner began to have significant pain in her vaginal. Once she was able to see her OBGYN, he confirmed the diagnosis of Herpes. I saw my GP and he diagnosed my finger given the situation as Herpes Whitlow. We are awaiting test results.
The time line:
-protected intercourse and mutual masturbation
-a few days later symptoms on finger and vagina of partner (we can't remember which came first or if they were concurrent)
-partner has high fever 3 days after sex
-I have a huge (small orange size) and painful swelling under my arm of the infected finger (lasts around one day) 4 days after sex
-female partner diagnosed with genital herpes
-I was diagnosed with herpes whitlow. I have no genital nor oral symptoms.
Her OBGYN and my GP are not that well versed on this, and the information on the Internet is contradictory. I recognize that Herpes Whitlow is rare and there isn't much literature on the subject.
My question concerns a prior post by Dr. Handsfield. In post 477021, he indicated that Herpes Whitlow is usually associated with new infections. You also mention transmission is possible via fingering but unlikely, and that Whitlow is usually the result of auto inoculation. Given that I've had no genital nor oral symptoms, AND yet I've had the classic symptoms for Whitlow and lymph node involvement under the arm. The questions are:
1. What are the chances that I only have a Whitlow infection, i.e. what should I tell future partners (if any) since I presume there is no way to rule out a genital nor oral infection.
2. Any clue as to who was infected first (not that we care much)?
MEDICAL PROFESSIONAL
Very interesting. Indeed it is unusual to acquire herpes by hand-genital contact -- but please note my use of "unlikely" in the other thread, not "impossible". Despite its rarity, that probably is what happened.
Except in health care providers, most herpetic whitlows probably occur in association with a primary oral or genital infection. "Except in health care providers" is an important qualification: herpetic whitlow is an occupational hazard in people who have unprotected contact with patients mouth or oral secretions, e.g. dentists in the days before dentists routinely wore protective gloves. Fingering a person with genital HSV infection is a similar exposure. It is rare enough that I have never seen such a case, but that doesn't mean it cannot happen.
To the specific questions:
1) Your GP's diagnosis probably is correct. The occurrence of regional lymph node inflammation is typical. Presumably the diagnostic test was a culture or perhaps a PCR test for HSV from your finger lesion.
2) Since you have neither genital nor oral symptoms, almost certainly your infection is limited to your finger. That means you caught it from your partner. It is not a realistic possibility you were infected first; you would have had to get a whitlow somewhere else and then transmitted the infection from your finger to your partner's genital area. That is exceedingly unlikely.
You don't say whether you are being treated with antiherpes drug like valacyclovir or acyclovir. I hope so; if started promptly it would signficantly speed healing.
Thanks for posting an interesting question. Please return in a few days to let us know the test result and how things are going.
Best wishes-- HHH, MD
Except in health care providers, most herpetic whitlows probably occur in association with a primary oral or genital infection. "Except in health care providers" is an important qualification: herpetic whitlow is an occupational hazard in people who have unprotected contact with patients mouth or oral secretions, e.g. dentists in the days before dentists routinely wore protective gloves. Fingering a person with genital HSV infection is a similar exposure. It is rare enough that I have never seen such a case, but that doesn't mean it cannot happen.
To the specific questions:
1) Your GP's diagnosis probably is correct. The occurrence of regional lymph node inflammation is typical. Presumably the diagnostic test was a culture or perhaps a PCR test for HSV from your finger lesion.
2) Since you have neither genital nor oral symptoms, almost certainly your infection is limited to your finger. That means you caught it from your partner. It is not a realistic possibility you were infected first; you would have had to get a whitlow somewhere else and then transmitted the infection from your finger to your partner's genital area. That is exceedingly unlikely.
You don't say whether you are being treated with antiherpes drug like valacyclovir or acyclovir. I hope so; if started promptly it would signficantly speed healing.
Thanks for posting an interesting question. Please return in a few days to let us know the test result and how things are going.
Best wishes-- HHH, MD
My partner did not have any blood work. HSV-I was confirmed by lesion culture. Her OBGYN told her that the blood test was not accurate enough (same thing the OBGYN told me when I told her I was negative), and there was no need for her to have the blood test.
My finger was improving when I saw my GP since it was about a week out. It continued to improve with meds. It could be bacterial or viral. We'll never know for sure since I wasn't able to get a culture done in time.
It doesn't really matter to either of us where and when. It was more of a mystery that we hoped to solve. The important thing is that she is getting better, and we're fortunate that it is HSV-1. Hopefully, she won't have any more out breaks and she can't pass it to me genitally (if my finger is not Whitlow).
I'll follow-up with a blood test in a few months and post the results for completeness. In the mean time, thank you for your help. It helped us through a very difficult time. It is amazing to me that so much about viral infections remain a mystery to us after so many years. Thanks again for some clarity.
My finger was improving when I saw my GP since it was about a week out. It continued to improve with meds. It could be bacterial or viral. We'll never know for sure since I wasn't able to get a culture done in time.
It doesn't really matter to either of us where and when. It was more of a mystery that we hoped to solve. The important thing is that she is getting better, and we're fortunate that it is HSV-1. Hopefully, she won't have any more out breaks and she can't pass it to me genitally (if my finger is not Whitlow).
I'll follow-up with a blood test in a few months and post the results for completeness. In the mean time, thank you for your help. It helped us through a very difficult time. It is amazing to me that so much about viral infections remain a mystery to us after so many years. Thanks again for some clarity.
MEDICAL PROFESSIONAL
Antibody levels do not vary with recurrent oubreaks and are not different between persons with symptomatic or asymptomatic infections. There is no scientific debate about this. A positive test for HSV antibody indicates active infection, whether or not there are symptoms, and a negative one means someone isn't infected, if sufficient time has passed for the test to becom positive. The term "carrier" might be used by some clinicians for someone infected without symptoms, but it is unrelated to blood test results.
I'm not sure why the ObG is skeptical about a herpes whitlow. I am skeptical about paronychia (usually a bacterial infection) in you plus HSV-1 in your partner's genital tract; too much of a coincidence. How is your finger doing? If substantially better on valacyclovir, and if you're not taking an antibiotic, that supports herpes. I still expect your follow-up blood test to be positive for HSV-1, which will confirm herpes for sure. Do it about 3 months from onset if symptoms. You could be tested earlier, but it sometimes takes that long.
The peculiar aspect here is your partner's negative blood test for HSV-1. That suggests both you and she are having your initial infection, which cannot be unless one of you was exposed to another source in the previous couple of weeks. We already discussed how unlikely that is for you. You're in a better position than I am to judge whether your partner might have experienced cunnilingus by another sex partner; oral sex is the only likely source for a new genital HSV-1 infection. However, another possibility is that she just has a false negative blood test. That's not all that rare.
I'm not sure why the ObG is skeptical about a herpes whitlow. I am skeptical about paronychia (usually a bacterial infection) in you plus HSV-1 in your partner's genital tract; too much of a coincidence. How is your finger doing? If substantially better on valacyclovir, and if you're not taking an antibiotic, that supports herpes. I still expect your follow-up blood test to be positive for HSV-1, which will confirm herpes for sure. Do it about 3 months from onset if symptoms. You could be tested earlier, but it sometimes takes that long.
The peculiar aspect here is your partner's negative blood test for HSV-1. That suggests both you and she are having your initial infection, which cannot be unless one of you was exposed to another source in the previous couple of weeks. We already discussed how unlikely that is for you. You're in a better position than I am to judge whether your partner might have experienced cunnilingus by another sex partner; oral sex is the only likely source for a new genital HSV-1 infection. However, another possibility is that she just has a false negative blood test. That's not all that rare.
I received my test results yesterday. I was negative for both HSV-I (0.36) and HSV-II (0.89) with HerpeSelect.
My partner's genital lesion came back positive for HSV-I.
Her doctor discounts the Whitlow theory and says my finger is likely Paronychia. My GP says it is possible since he could not culture the fluid.
We still don't have a clue as to how, when, or why my partner became infected. Is it a new infection, old, etc. But, fortunately my partner seems to be improving now with 1G Valtrex x 2 days. That is the important thing.
An interesting point is that the OBGYN indicated that some people can be "carriers" and only go positive on the test shortly after an outbreak. I am not sure I believe this. Is that actually possible?
When should I retest- 2 wks or 4 wks?
Again many thanks for a great service!
My partner's genital lesion came back positive for HSV-I.
Her doctor discounts the Whitlow theory and says my finger is likely Paronychia. My GP says it is possible since he could not culture the fluid.
We still don't have a clue as to how, when, or why my partner became infected. Is it a new infection, old, etc. But, fortunately my partner seems to be improving now with 1G Valtrex x 2 days. That is the important thing.
An interesting point is that the OBGYN indicated that some people can be "carriers" and only go positive on the test shortly after an outbreak. I am not sure I believe this. Is that actually possible?
When should I retest- 2 wks or 4 wks?
Again many thanks for a great service!
She had a fever for less than 12 hrs about 48 hrs after breast implant surgery.
MEDICAL PROFESSIONAL
I'm glad you're on treatment. Your symptoms should start improving pretty soon.
I cannot judge how long your partner might have had herpes. What surgery did she have? If her fever was due to herpes, that's strong evidence she was experiencing an initial infection. But it also is possible that another illness, such as a post-operative infection, could have triggered a genital herpes outbreak in someone who was infected for months or years without previously recognized symptoms.
Your partner's culture should suffice to know the viral type causing both your infections. If her test is negative, you could still have an HSV antibody (blood) test now and again in a few weeks. You can expect a negative result if tested within a couple weeks of onset, converting to positive in a few weeks.
Thanks for the thanks about the forum!
I cannot judge how long your partner might have had herpes. What surgery did she have? If her fever was due to herpes, that's strong evidence she was experiencing an initial infection. But it also is possible that another illness, such as a post-operative infection, could have triggered a genital herpes outbreak in someone who was infected for months or years without previously recognized symptoms.
Your partner's culture should suffice to know the viral type causing both your infections. If her test is negative, you could still have an HSV antibody (blood) test now and again in a few weeks. You can expect a negative result if tested within a couple weeks of onset, converting to positive in a few weeks.
Thanks for the thanks about the forum!
Thanks for the quick response. I'm taking Valtrex 500mgx2 day, and a cream same as my partner.
The doctor did not take a culture since I was a week out. I didn't make the connection between my finger and Herpes until I started to read this forum to help my partner out. I saw a post about Whitlow (never heard nor knew of it). I "googled" pictures of Whitlow, and one looked identical to my finger. So, I went to see my GP.
I will follow-up with test results (culture for partner - her doc said blood test was useless since presentation was obvious and she cultured the lesions, and blood work for me).
One last question- I've seen several places that it is possible to have herpes and not have an outbreak for years. I understand that in these situations the outbreak is not that severe. My partner had a severe outbreak, but there are some complicating factors such as taking a while to see her OBGYN AND have a very dry vagina due to ovarian suppression. Is it possible she's had this a while with no break-outs? She didn't have any lymph node involvement, but she did have a fever but that could have been a post surgical fever.
BTW- Thank you so much for this forum! It really is helping us understand an unusual situation.
The doctor did not take a culture since I was a week out. I didn't make the connection between my finger and Herpes until I started to read this forum to help my partner out. I saw a post about Whitlow (never heard nor knew of it). I "googled" pictures of Whitlow, and one looked identical to my finger. So, I went to see my GP.
I will follow-up with test results (culture for partner - her doc said blood test was useless since presentation was obvious and she cultured the lesions, and blood work for me).
One last question- I've seen several places that it is possible to have herpes and not have an outbreak for years. I understand that in these situations the outbreak is not that severe. My partner had a severe outbreak, but there are some complicating factors such as taking a while to see her OBGYN AND have a very dry vagina due to ovarian suppression. Is it possible she's had this a while with no break-outs? She didn't have any lymph node involvement, but she did have a fever but that could have been a post surgical fever.
BTW- Thank you so much for this forum! It really is helping us understand an unusual situation.
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
