Herpes on my hands

[directguy]

I became infected with herpes three months ago after sex with a prostitute. For the most part, the outbreak is raw, red skin at the base of my penis (I used a condom). Later, just below the penis head, I also got a puffy patch of raised skin about the size of a quarter with two small circular slightly bloody open sores. They appeared directly on top of a major blood vessel. They quickly healed over though.

Now my big problem. I believe the virus is now on one, and likely both hands. I showed my dermatologist my left hand about three weeks ago because I was scared. I pointed out a small puffy patch on the top corner of my index finger on the tip (which I think may have first occured a few weeks before and I dismissed as a callous), and two others on the palm. He said he didn’t see anything and told me autoinculation’s very rare. Three weeks later, I began to see and feel more of them, now on both hands and fingers, always on the palm side. I clearly see subtle blister-type formations, some slightly raised and others not, and tenderness from some of them, especially the ones on the fingertips. At first I thought I’d spread it by washing my genital region using just my hands and Dove soap (my dermatolgist told me this was okay during my initial outbreak.) Then, last week, I remembered I’d very briefly fingered the woman with my index finger. I’m now thinking this was likely the source.

So, my questions are:

1) What are my chances of getting a positive confirmation through testing? I’m wondering when to go back to my dermatologist, since my hands have largely cleared up again.
2) How do I wash my hands now? Am I at risk of spreading it further by rubbing my hands together with soap? Especially since at 3 months I'M STILL TESTING NEGATIVE for the igg HerpesSelect tests. I’ve only got a positive Igm result so far.

One last point. I’ve been on daily viral suppression with 500g daily of Famciclovir for the last three weeks.

[H. Hunter Handsfield, M.D.]

Comments on the medical situation are welcome on this forum.  Moralistic ones and messages that challenge people's sexual choices are not.  I deleted your comments here and on another thread.  Please take such comments over to the community forums.  Thanks.

[alltheseyears]

A related discussion, Misdiagnosis of herpes? was started.

[Rustly]

A related discussion, Herpes on hand? was started.

[H. Hunter Handsfield, M.D.]

The additional information does not change my opinion or advice.  You give no evidence that suggests you have genital herpes or any other HSV infection.  Please direct any further questions to your dermatologist.

[directguy]

Thank you for your response Dr. Hunter. Unfortunately, word count restrictions kept me from telling the whole story, which may or may not change your opinion. About one week after what I believed was my initial genital outbreak, a couple of marks appear on the side of my waist, red patches of dry skin, no irritation. My dermatologist said he believed this was excema, although he thought it unlikely this was causing my genital problems. Two and a half weeks later, those marks suddenly spread all over my torso, up and down both sides and all across the chest and stomach. My dermatologist changed his diagnosis to pityariasis rosea. He said it could take up to 12 weeks to clear up. If said it shouldn't flare up again, but two days ago it did, just on the chest and stomach, multiple red patches of varying size and shape. I itched a bit the first day, but already they're much less visible. Also, in the five weeks since the inital widespread outbreak, the marks on the side are healing, but still slightly visible.  

And lastly, the raw skin on the bottom shaft plus the puffy patch of red skin with two open sores that appeared just below the penis head aren't my only genital symptoms. On my penis head itself (FYI: I'm not circumcised), there are a couple of patches of raised skin, darker red in color than the normal skin, that appears for a week, then goes away again. When present, there's also a degree of red splothiness to the head overall. These do cause some discomfort. Again, these first occured after my at-risk encounter and after my possible initial outbreak. And again, I HAD A CONDOM ON, so I've been speculating I spread this to my penis head when washing with my hands. Also, the raised surfaces on the head are similar in size to the raised surfaces I saw on the tips of some of my fingers that caused slight tenderness. My dermatologist didn't see my hands at their worst, so my current plan is to see if it happens again, then go back.

So, taken in total, I'm still worried about herpes, but at least based on your first response, I've opened up to it maybe being something else. Last question, do you still consider herpes unlikely at this point?

[H. Hunter Handsfield, M.D.]

Let's review all the reasons that, taken together, prove you don't have herpes.  First, your description of the penile rash doesn't sound like herpes, which does not cause diffuse red rash.  Second, if a dermatologist can't see anything wrong with your hands, nothing is wrong-- and in particular you don't have herpes of the hands.  Third, the negative blood tests at 3 months prove that herpes is not the cause of any of your symptoms, including the penile problem.  Fourth, genital herpes almost never transfers from genitals to the hands.  Fifth, you can't catch herpes by hand-genital contact.

IgM antibody testing is meaningless and your positive IgM test result does not mean you are infected.  Use the search link and enter "herpes diagnosis", "HerpeSelect", and/or "IgM" for innumerable discussions on this forum about this issue.

You should not be taking famciclovir.  Undoubtedly you have found it makes no difference-- as of course it cannot, since you don't have an HSV infection.

You do not have genital herpes or herpes of the hands, and never did.  If your symptoms continue to bother you, continue to follow up with your dermatologist.

Good luck--  HHH, MD