Auto-inoculation

[mq123456]

Thank you in advance for taking my question. If you read my past posts you will see I have had quite a roller coaster ride with my recent HSV status. My blood work had conflicting results since my exposure back in June. I had several negative results then a positive herpesselect IGG for HSV1 at 15 weeks post exposure (3.6 value). At Nurse Warren’s suggestion I had a Western blot at 16 weeks which was negative. A follow-up western blot at 8 months came back as indeterminate.

Two weeks ago I had a sore on my lip. I saw my PCP within 4 hours of the sore appearing. He swabbed it and gave me famcyclovier (sp?) to take for the outbreak (1500 mg twice 12 hours apart.) The swab came back positive for HSV1. The sore healed in about 10 days. Thursday morning I developed a single blister on my forearm (this was about 12 days since my cold sore) it was bout 5 mm in diameter. By the time I showed it to my PCP later that afternoon it had ruptured and formed a sore. He said it looked like herpes. I suggested another swab but he said it was not necessary that it was most likely herpes and that I must have auto-inoculated my self from my recent cold sore.

The bilster is gone but the resulting sore is still wet and weeping. It is white with a red hallow around it. The sore is not painful but my arm hurts down the side of the forearm.

My questions is could this be HSV1. How common is it to have such an infection other than oral or genital. Could I have auto-inoculated myself? If it is HSV1, will it reoccur often? The recent outbreak was the first “real” outbreak I had, that is the first typical cold sore. Six months ago I had several blisters on the inside of my lip. A PCR swab at that time came up negative. I have not had any potential exposure since June.  

If my sore is not HSV related can you speculate what else it might be. I am taking the Famcyclovir again so I know a swab is not possible now.

Thank you in advance for your response.





  

[Edward W Hook, MD]

Welcome to our Forum. in reading some of your other posts, I can see that you have had a rather difficult time of things.  It is clear from your culture results that you have HSV-1.  Whether the lesion that occurred on your arm is HSV-1 as well will be almost impossible to tell at this time, particularly if you are taking famciclovir.  Auto inoculation is uncommon in persons with HSV but if it occurs, it typically occurs only at the time of and from the site of the initial infection.  As I understand it, you have HSV-1 and the lesion you describe is a recurrence, not your first outbreak. If that is so, as Teri has told you, it is very unlikely to be  HSV.  Furthermore, if it is, so what. it does not mean you have "more" HSV and on famciclovir, you chance of spreading it to others is close to zero.  If you are worried about this, place a band aid over the lesion.  Recurrences wold be unlikely although every person has their own pattern of recurrence

Hope this helps.  EWH

[mq123456]

My indeterminate western bolt was for HSV1. All tests have always been negative for HSV2.