Non sexual transmission of herpes

[Esthetician]

Let me give you a scenario.  An esthetician is performing a brazilian bikini wax (complete hair removal from genital/anal area).  Esthetician is not wearing gloves and has a papercut on her finger.  The esthetician is not in a sexual relationship with anyone and has not been for about 5 months.  That relationship was the only intimate sexual relationship for the past three years. Five days after performing the brazilian, the esthetician noticed a tiny red spot that appeared to be an insect bite.  She found it first thing that morning (5th day).  No itching but hot to the touch.  Next day it had grown to the size of a quarter and had a small patch of blisters in the center.  The following morning she was awakened by vomiting.  That afternoon she went to the doctor.  The site had enlarged to the size of a silver dollar and the blisters starting to scab and also quite painful.  Doctor looked at it and commented that it looks like shingles.  He cultured the blisters to rule out herpes. He prescribed her Zovirax and stated that antiviral would work for either diagnosis (shingles or herpes).  The culture tested positive for herpes.  In your opinion, is it possible that the brazilian client transmitted the herpes virus to the esthetician?  

[Jessicatan]

Dear Dr Hook, I have HSV 2 and would like to clear some doubts as I've been quite paranoid for some time. Recently I have a couple or two red spots on my thighs, it could probably be due to itchiness but just to be sure.. I accidentally scratched it quite hard today near that spot area. After a few hours I met my baby niece and lightly by accident scratched her. There is no visible scratches on her hands and will there be any risk of transmission? For example, let's say I have herpes on my hands without knowing esp there's a kind of whitlow that lives beneath the nails? Hope to hear from you soon. Thanks.

[Edward W Hook, MD]

I'm sorry but this will have to be the last post as part of this thread.  We have had over 34 exchanges over a 6 week period.  Typically when we cannot ressolve a question or problem within 5 or six exchanges it is time to stop and work through this, in person with a health care provider.  Our site is to provide guidance but that does not take the place of working directly with a health care provider.

As I have said before, you may never know how or where you got this infection.  Your situation may be analagous to that of respiratory therapists who acquire HSV-1 on their fingers in the care of patients.  These are called "herpetic whitlows".  The can (rarely) be spread other places on their own bodies through scratching. They can also spread to others through contact of their lesions with other people.  It is in large part for this reason that respiratory therapists wore gloves long before HIV was recognized.  As I said, there are many possible parallels.  

Could your hyperthyroidism be related to your illness and its severity- I doubt it.  I have never of heard of an association of this sort.  Nor is it mentioned in any textbook.

Are you at risk for encephalitis?  Short answer -no!.

Finally as to the management and extent of your outbreak.  This is yet one more unusual aspect to your problem and, for that reason, it is time to work with a health care provider to sort things out.

Hope this is some small help.  The thread now has to end and further questions will be deleted without comment.  Good luck.  EWH

[Esthetician]

*first cold sore on left side inner top and bottom lips (oral)

[Esthetician]

Hello,,,it's me again.  And I need your help again.  I requested to have the hsv-1 and hsv-2 igg and igm blood test and got results June 11th.  Hsv-2 negative both igg and igm,,,hsv-1 positive igg and igm and the lesion on my thigh cultured posititve for hsv-1.  Since my last post I have also been diagnosed hyperthyroidism,,,I am showing every sign and symptom.  They have me on beta blockers until I see endocrinologist in November.  Now,,,I'm experiencing a genital outbreak and first cold sore on left side inner top and bottom,,,clear blister at the base of left index finger outer towards thumb,,,and the lesion on my thigh was left side,,,thyroid is prominent on left side,,,,outbreak genitally was worse on left side, still experiencing pain only on left side of abdomen and pain in left hip.  I've read that hsv-1 is easily spread,,,and this virus is spreading on me,,,just one day one breakout on my thigh,,40,000mg in 10days antiviral,,within a month two breakouts oral and genital at the same time.  Is it possible that my thyroid could be causing these recurrences by causing internal stress ie increased metabolism?  In the meantime,,I've also requested valtrex 500mg daily.  I just don't want this to spread anymore,,don't want encephalitis for sure!  I'm assuming that I've had genital hsv-1 and just recurred.  I've accepted it...just scared that it's showing in 3 locations!  Any feedback would be appreciated.  Thank you, Esthetician

[Edward W Hook, MD]

I cannot say how you got this. We have established this over the more that 30 exchanges we have had ( a record) .  As to the issue of recurrences, etc, that too is highly variable.  My advice at this point is two-fold: let this play out rather than trying to anticipate what might happen and secondly, it is time for this post to come to a close.  Grace's suggestion is an excellent one - the herpes forum is an excellent source for exchange of experiences and working through issues such as this.  Last reply.  Take care and please don't let this negatively impact you, it is not that big a deal, no matter where it came from (and my guess is you'll never know).  EWH  

[gracefromHHP]

At this point you might want to even bring this over to the herpes forum for more discussion.  

The thing about genital herpes is -  about half of all presumed newly acquired infections of it - really are just the first obvious recurrence of it.    It's frequently misdiagnosed as being something else even by medical providers.  It's the far more likelier explanation that this was just your first reccurence of genital hsv1 that you noticed  than you had a paper cut, performed a wax on a client and contracted hsv1 on your hand without symptoms and then transferred the virus to your genital area. The virus is easily killed with soap and water so even though you previously were not in the habit of wearing gloves to do waxing in the genital area - I'm sure you regularly wash your hands in between clients.   From what I've gathered from following this thread for the last several days is that you never had any baseline blood testing done for herpes to help you figure out if this was a newly acquired hsv1 infection or not correct?  at this point enough time has passed that even getting a blood test now won't really help straighten that part out.  Anyways the point is - it's far more likely that this isn't something you picked up at work and transmitted to yourself.


grace

[Esthetician]

Did you read from the beginning of this discussion?  I would be relieved if this was the mode of transmission and not asking Dr. Hook all of these questions.  I would know for certain how this happened.  Again, the only skin on skin contact I've had with humans is on the job servicing clients.  My most popular service is the brazilian.  Especially this time of year.  Last June I did 80 if that tells you, not counting the other services that I offer.  That's why I want answers because I know that this was not sexually transmitted since I've not had sex with anyone in 6 months and that was the only person in three years.  The doctor who first examined stated this was an exposure.  I'm just trying to find out how it happened for prevention.

[auntiejessi]

I'm going to let Dr. Hook answer all your questions, but since genital herpes is almost always the result of oral sex, have you given any thought to that mode of transmission?

AJ

[Esthetician]

More questions to throw at you.  I can't let you off the hook, Dr. Hook.  Do you still think it's possible that I contracted this through the paper cut?  How it was transmitted is more of a concern to me than anything.  I accept the fact that it is HSV-1 because I trust your opinion.  I am so afraid of transmitting it to someone else.  Also, I'm planning to go to Orlando in June.  What effect will uv rays have on the lesion site?  What precautions do I need to take?  I'll be with my nieces and nephews and I'm concerned about wearing shorts.  As an adult I made a conscious decision not to wear gloves and now I'm suffering for it.  However children are innocent and I want to be sure to take every precaution known, especially around children.  I'm assuming that I will experience viral shedding from the lesion site.  What is your advice?
Also, I just looked at the lesion.  And the scab from the original blister is still in tact.  I'm not worried about the expense, I have a good job and I'm single.  This is important to me. I don't want this to happen to anyone else in my profession.  I know how to heal scars, so I'm not concerned with that.  This mystery is haunting my soul!

[Esthetician]

Yes we have all learned from my unfortunate and mysterious experience.  Which leaves me to wonder,,,if this is HSV-1, I contracted it at work somehow, which is the mystery.  This should raise awareness on non sexual transmission of herpes, and more studies should be done on this issue.  Especially since we've confirmed I don't do services with my scrub pants down making it possible for someone to have touched my bare thigh.  I just don't want this to happen to someone else.  Not only has this effected me physically being sick from the virus, but this has been very emotionally draining since I have no answers on how this happened.  But, knowing we've all learned something from this does help me continue to deal and keep on living!!!!! I will let you know if anything changes.  

[Edward W Hook, MD]

YOur welcome. Please let us know if things change.  We all are learning from your unfortunatle experience.  EWH

[Esthetician]

I'm grateful to have had the opportunity to discuss this with you.  If this does recur, now I will know what tests to perform!  And I promise I will let you know if this recurs and what the results of the test are.  I kind of hope it does just so I'll be able to do the PCR.  Again, thank you for your being here to answer my questions and your support.

[Edward W Hook, MD]

1.  At this time a biopsy will be of little value other than to make your care expensive and perhaps leave a small scar.  

2.  If this is HSV-1 as it seems to be, it may or may not recur at about the same place it first appeared although with milder recurrences.  It will not appear otherwise.  In all likelyhood, you body has developed an immune response which will keep it localized to the area where it first appeared.  EWH

[Esthetician]

I read some exam test sometimes performed when differentiating HSV and VZV. It mentioned a skin biopsy that could be done, even when there's no lesion.  Or is it too late for this test also?  If I have HSV-1 on my thigh, does that mean that I will start having cold sores on my mouth at some point?

[Edward W Hook, MD]

A PCR test would be higher yield that a culture (and, unfortunately, more expensive) and after 10 days of therapy the culture or PCR would likely be negative.  Again, with all due respects to your dermatologist, false positive cultures are very, very uncommon.  they happen but rarely.  I think the key question is, will the sore recur.  If it does, get a culture or PCR test ASAP.  I know you are anguished over this and wish I had a clearer answer.  Sorry.  EWH

[Esthetician]

This all started on May 12, 2008.  Looking back, I remember pain on the left side of my abdomen about 1-2 weeks before the rash appeared.  I had called my mother and told her I think I have appendecitis, but she told me that would be on the right side.  And for the past 3 days, I've had tingling sensations and pain in my left hip, everything's happening on the left side of my body.  And the lesion is on my left thigh.  
The dermatologist stated it probably was a false positive culture.  He said that does happen. Everyone in the medical field I have seen has told me that there is no "test" for shingles.  I still have an appointment with my ob/gyn regarding possible bloodwork next Wednesday.  It was suggested to me by a client (who's a BSN, RN), to check for other risks, such as HIV and Hepatitis.  Since the lesion is in the healing process, and I've been taking 800mg Zovirax 5x daily (today is 10th day since rash appeared), is it too late for me to have the PCR?  This makes me want to run to the ER right now. I TRUST YOUR OPINION.  I wish I could jump in my car and drive to Birmingham right now so you could see it for yourself!  

[Edward W Hook, MD]

I am worried about this. A culture or PCR is needed.  The fact of the matter is that HSV looks like varicella zoster virus (the shingles virus) clincially when it is on non-genital skin.  I do not make it a habit of arguing against clinicians who have had the opportunity to examine patients who I only communicate with over the net but in this case I MUST differ.  Remember, you had a positive culture already from the lesion that grew HSV-1.  Unless you have another test of the virus from the lesion, I think you should consider this HSV.  EWH

[Esthetician]

He just did a looksee at the lesion.  He also took the end of a woodstick and ran it across above and below the lesion to see if there was a different sensation and there was.  The blisters on the lesion have now crusted and scabed.  He stated over and over that hands down this was a case of shingles and not herpes simplex.

[gracefromHHP]

did they repeat your lesion culture and it came back as herpes zoster at the dermatologist appointment or did he just do a looksee and say it was shingles and not simplex?

grace

[Esthetician]

I woke up this morning to a phone call from a friend/client who's a pharmacist in my local area.  He had phoned a dermatologist and told him about my experience.  The dermatologist wanted to see me right away.  I got there within an hour.  It turns out that I have shingles!  He stated it is difficult to differentiate the two viruses under the microscope during first three days.  He's seen this before many times where there's only one lesion.  He said that was probable due to my age (again I'm 30).  This has been an ordeal!  I have learned a lot through this experience.  I will continue to be assertive with my health.  Since I'm a medical esthetician and deal with the skin, I had a gut feeling it was shingles given the symptoms.  I'm grateful in a way, because I'm changing the way I perform my services.  I will continue to wear gloves!  Thanks again for all your help!  Hopefully this will be the last post I make!  :)

[Esthetician]

Thank you for taking the time to help me make sense of this nightmare.  I'm just curious...what is the protocol for more studies being done on this subject?  Our world has changed.  Eight years ago in esthetics school we were trained to double-dip and were not told to wear gloves except during extractions and lancing.  That hasn't changed.
It needs to.

Thanks again,
Esthetician (who is now wearing gloves during all services!!)

[Edward W Hook, MD]

Thank you for the follow-up.  We all learned something from your unusual experience.  I hope all goes well from here on out.  EWH

[Esthetician]

I just wanted to keep you up to date on this, being there have not been any studies!  I went back today to the medical facility who cultured the site.  They performed a viral culture, so no need to do bloodwork!  It is HSV-1.  She's referring me to a dermatologist because of the fact she's never seen hsv-1 located on someone's thigh before.  So I had to contract this occupationally!  

[Esthetician]

It's me again, I have another question,,,it has been brought to my attention that shingles is sometimes misdiagnosed as herpes.  The doctor did comment that it did look like shingles, but he was perplexed since I only had one lesion (that had tripled in size in 3 days).  He said it was either Herpes or Shingles, and cultured it for herpes.  He never suggested any bloodwork.  I've been in touch with the nurse at my ob/gyn for viral bloodwork.  In your opinion, what is the most accurate way to determine if this is shingles or herpes.  It would be nice to know what it is, how I got it, and I can protect others from contracting it.  If it's shingles, I'll know it wasn't an occupational hazard!