Eczema and Herpes (HSV-2) Transmission

[seekingredemption]

Dear Doctor,

Approximately five weeks I had an intimate encounter with an ex-girlfriend.  While I resisted intercourse (penetration) after she informed me that she had been in a relationship with an older, married man, the following intimate contact did take place:

1. Frolicking, general apposition of bare bodies and genitalia(but no direct contact, rubbing, etc., of mucous membranes / penis to vagina).

2. I also stimulated ("fingering") her to climax and vaginal fluids covered the end of my finger.

3.  Lastly, she held my penis (shaft only) gently but did not lead to ejaculation.

At the end of the evening I realized that she suffered from extreme eczema, very raw skin, at times broken and oozing.  

Since that night together I have been nearly paralyzed with worry and guilt.  Medically, I am concerned that her eczematic lesions could have transmitted either herpes (HSV-2) or another STD to my genital area by contact of penis shaft.  I have read about correlations between herpes and eczema.  

Also, although I have read many "fingering" questions posted earlier, I have a specific variation that has not been answered as far as I can tell: can such hand-to-genital contact transmit genital herpes via finger?  Why can't a virus like HSV, etc., (I have refrained for posting about my HIV transmission concern; will do so in appropriate forum as requested) penetrate via the soft tissue under fingernail, for example?

Does my exposure warrant HSV/STD testing (no self-evident, identifiable symptoms at this point, but I understand that is no source of reassurance).  

I am more grateful than words can express for your service on this forum.  May God bless you.

In despair,

Seeking Redepmtion

[Thomas212]

A related discussion, Skin Disorder related to... was started.

[paranoidandroid]

Wow. This post is incredibly reassuring to me. I had a very similar encounter with a woman about two weeks ago who, after some hand-to-genital contact, eventually told me she had HSV2. She wasn't experiencing a breakout or anything, but it was still enough to make me panic. After soaping myself up several times, I came home and used some zovirax that a family member has for HSV1 cold sores.

Maybe a little excessive, if not completely unwarranted given the doc's statement, but it seemed appropriate at the time for my paranoia. Nevertheless, I've been hyper-vigilant, often panicky, about the possibility of infection for the past several days.

This information actually makes me feel quite a good deal better. Thanks doc.

[H. Hunter Handsfield, M.D.]

I think I covered both your additional questions and have nothing to add.

HHH, MD

[seekingredemption]

Doctor H.,

In reviewing my own post, I just want to further clarify my ultimate concerns and questions to avoid any confusion:

1.  Your realistic assessment of risk of contracting HSV/STD after exposure to eczema lesions on hands that touch intact skin of penis (shaft)...and

2. the risk of contracting HSV/STD via male hand to female genital ("fingering") contact when finger is immersed in vaginal fluids?  Any concern that virions can enter through soft tissue under the nail or microscopic lesions?

Again, thank you most sincerely for your clinical perspective.

Looking forward to your response,

Seeking Redemption

[H. Hunter Handsfield, M.D.]

Eczema and herpes indeed can interact.  Eczema makes it more likely that an otherewise limited herpes eruption will be more widespread, involving both the eczematous areas and elsewhere (eczema herpeticum).  Now that I think about it, having said that hand-to-genital transmission of HSV (or other STDs) is very rare to nonexistant, this might be a situation in which it might happen.  However, eczema herpeticum is rare, and if your partner had it, she probably would have been overtly ill with really painful eczema--and not likely to be sexually active.  From your description, there is no particular reason to suspect your partner has HSV, let along eczema herpeticum.

I cannot give you a biological explanation why hand-to-genital (or genital-to-hand) HSV transmission doesn't occur.  All I can say is that I am unaware of any proved cases being reported in the medical literature, and I never saw a case in 30+ years working in a busy STD clinic.  I don't think any patient even raise the possibility.  Ditto for HIV infection.  CAN it occur?  Probably.  Does it occur with any measurable frequency?  Clearly not.

You had safe sex.  Put STD out of your mind as a possible consequence.  (Some might question whether even to classify the event as sex--and I don't mean just my favorite president.)  You do not need testing for HSV, HIV, or anything else.

Regards--  HHH, MD