What do you think?

[joel1982]

Good evening, Doctors,

Need immediate advice:

I am HSV2 positive.  I don’t take suppressive therapy and have had the infection for five years.  I have a few outbreaks a year, nothing major.

I started seeing a girl a few weeks ago.  I haven’t disclosed my status yet.  Ideally, I’d like to wait to see where things, the level of seriousness.

One evening last week we were at the beach having a sunset picnic.  We kissed, hugged, all of which I know cannot transmit the virus, and I also touched her buttock and vagina.  I wasn’t having an outbreak at the time, although I could have been shedding, I suppose.

Ordinarily I wouldn’t have worried about this but a few days ago I called to ask her out again and he was suffering from the flu and also mention her buttock is sore because of, what she assumes to be, mosquito bites from sitting on the sand at the beach.

I always understood that fingering does not carry a risk of transmission.  However, in reading online, including this site, it appears it does carry a small risk.  Small is not zero and I worry I could be that statistical outlier.  

I am now very concerned I transmitted it to her.  There are many telltale signs:  1) flu-like symptoms in the summer, something very odd for her 2) itchy mosquito bite lesions in the “boxer short” area  3) all signs within a week of exposure  

I used the portable outhouse on the beach a few minutes before touching her. I typically look at my penis when I use the washroom to inspect for sores, etc, so my hand contact with my genitals was more prolonged than simply using the toilet.  To compound matters, I didn’t wash my hands because no sinks or hand sanitizer were readily available.   I feel like a dirtbag now, but, to be honest, it was always my understanding that oral, genital and anal sex carry the risk.  Am I wrong?

[H. Hunter Handsfield, M.D.]

There are no answers to such questions.  One in a million was a wild guess in order to make a point that it's very rare.  In many years experience in a busy STD clinic, I have never seen a case of herpes that appeared to have been acquired by hand-genital contact.  All people with genital herpes should wash with soap and water (or use an alcohol disinfectant like Purel) after touching the genitals, e.g. after toilet, especially during recurrent outbreaks.  If you do that, you can assume no risk of hand-genital transmission to another person.  And even if you don't, most likely it will never happen.

As you move toward real sex with your new partner, it would be wise to tell her about your herpes well ahead of time. Don't wait until you're getting it on some night and spring it with short notice.  And since you're worried about hand-genital exposure, I see no reason you shouldn't tell her the next time you see her.

That will be all for this thread.  Take care.

[joel1982]

Good news.  The bites on her bottom did turn out to be insect related.  And the flu, et al., is mono.  Go figure.  I let her know about my situation and she seems cool about it all.  I have the figures on transmission with/without suppression, condoms, etc.  But lastly I wanted to know the rates of transmission with hand genital contact over a year.  I read a previous post where you said, 1 in a million.  Does this figure still stand if one of the persons involved in the hand genital interaction (my hand, her vagina) are HSV +?  If I touch my penile shedding and touch her immediately after what are the odds?  Any guesstimates?  

That's all from me.  Thanks for your patience.

[H. Hunter Handsfield, M.D.]

You're asking for more detail than is known.  There has been no research on these questions and there never will be. All we know is that transmission of HSV by hand contact is exceedingly uncommon.  My original reply suggests the likely reasons, but I will not speculate further.  In any case, you needn't worry. When you start having vaginal, anal, or oral sex with future partners, tell them about your herpes.  Otherwise forget it.

[joel1982]

You're great, doc.

One last question

You mention,  "Hand-genital transmission of herpes and other STDs is very uncommon, but it does happen rarely."

For my future reference, how does it happen if I don't have a lesion (whitlow) on my hand?  Could you explain so I don't infect someone in the future?  I typically engage in hand jobs, etc., with women I am dating and have never had a problem, never even thought twice about it, actually.  Should I worry about this now?

[H. Hunter Handsfield, M.D.]

Very unlikely.  Initial HSV symptoms are pretty mych always limited to the site of inoculation.  Nerve travel by the virus can explain outbreaks near but not on the genitals (e.g. buttock) a couple of weeks into the infection, but not in the first few days.  So this is more evidence against her having caught herpes from you.

[joel1982]

Great advice, doctor, thank you.

Follow up:

I didn't massage her buttock vigorous enough to transfer the virus, in my opinion, however I did massage the vagina with some degree of vigour.  Could the virus have travelled along the nerves from the vagina to the buttocks to have lesions surface there?  Or does it always surface where it entered?  Thanks for putting my mind at ease on this issue.

[H. Hunter Handsfield, M.D.]

Welcome to the STD forum.

Your online reading is correct.  Hand-genital transmission of herpes and other STDs is very uncommon, but it does happen rarely.  However, I have never heard of it actually happening in a circumstance like you describe.  If you had visible herpetic sores of the penis, your fingers might have picked up enough virus to transmit it a few minutes later -- but you didn't, and I cannot imagine picking u up enough virus from asymptomatic shedding and having it persist on the fingers in sufficient numbers (for at least several minutes, apparently) to allow transmission.

So despite the coincidence in timing, most likely something other than herpes explains her symptoms.  And herpes doesn't typically cause itchy, mosquito-bite kinds of lesions.  But if her buttock skin problem develops into overt blister or open sores, is at more or less the same spot contacted by your fingers, and if that contact was quite vigorous, maybe it is possible.

I can't give you definite advice about whether or not to discuss this with her at this time.  On the one hand, most likely it isn't herpes and you don't need to disclose.  Personally, if I were in your situation, I wouldn't disclose my herpes at this time.  I suggest you wait to see what happens over at least a couple days. On the other hand, I make no guarantees, and I understand that if it really is herpes, it would be better to disclose your infection now rather than at some later time when the diagnosis becomes apparent.  

Regards-- HHH, MD