Herpes Medical Question - Unclear

[1jpaulhome]

Doctor, I am curious how HSV 1 or HSV 2 is found in the extremities of the human body; I have read that herpes simplex is confined to the lips, nose, and chin area, and also the “Boxer short” area below the waist region. However, from your forums patient’s herpes questions it can be found in very unusual places, i.e. the foot, arm, shoulder, ankle, knee, even toe. If someone had Type 1 below the waist the on the ankle or knee is this considered Genital herpes.  Or if HSV 2 is on the arm, above the waist how then is the virus spread, and is it considered genital herpes. In many cases the person has no visible symptoms or history in the mouth or genitals of herpes.  Does the virus infect broken skin or does is travel only the nerve pathways. Are anti-bodies against the virus weaker in these extreme areas so it travels to where it is more favorable or is trauma to the skin the cause so the virus enters via this route? Do not understand how this works.....from medical point of view.

[Edward W Hook, MD]

Please read my answer.  HSV infeting the knee is not genital herpes.  Please, do not get caught up in word games.  EWH

[1jpaulhome]

Would you then say Type 1 herpes of the knee,since you scrape or cut a knee let's say is genital herpes or non genital herpes, or would it need to be Type 2 herpes to be considered genital since most cases of Genital Herpes are Type 2 and more likely found in this area? Or would Type 1 go back to up to the Genital region.  Thanks for the clarity.

[Edward W Hook, MD]

I hope I can clarify this for you.  I can understand how the wording might be confusing.  The viruses are HSV-1 and HSV-2 and while there is variation in sites of infection they can occur just about anywhere.  HSV-1 most often causes oro-labial herpes (oral herpes, cold sores) and HSV-2 causes the majority of genital herpes)  Genital herpes can be caused by HSV-1 OR HSV-2 and occurs when the virus occurs pretty much anywhere between the navel and the knees (perhaps it should be called ano-genital herpes but as you are aware, even that designation is not 100% inclusive).  The reason for this designation is because herpes is really an infection of nerves, not skin which is clinically apparent due to its effect on the skin.  The nerves that supply the area between the navel and the knees can also effect the genitals and anus, hence the designation.

Herpes is spread by direct contact.  Transmission is more effective with abrasion, even very minor abrasion and thus is easily transmitted by sex since friction, and therefore abrasion (even abrasion which cannot be seen)  is pretty essential as part of sex.  On the other hand, any site on the body can be infected with a herpes virus is conditions are correct - i.e. direct contact with a site where the virus is present.

Hope this helps.  EWH