[Question #10048] Herpetic Whitlow Shedding
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26 months ago
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A few months ago, I was diagnosed with herpetic whitlow on my left index finger. My main concern is that asymptomatic shedding might occur on my fingers in the way that asymptomatic shedding occurs on other infected parts of the body. The current medical consensus seems to be that no such shedding occurs, and this conclusion is based on the fact that there is no evidence suggesting otherwise. However, I worry that if fingers did shed asymptomatically, it would be difficult to gather evidence demonstrating that they do. My reason for thinking this is that the vast majority of people who have herpetic whitlow also have either oral herpes or genital herpes (this is based on the only large-scale study of HW I could find, which I have attached above).
To illustrate the concern, suppose someone has HW as well as genital HSV. If this person transmits HSV to a sexual partner through fingering, it seems the assumption among most doctors would be that he transmitted it genitally, and not through his HW. Even if this wasn't the assumption, it would be extremely difficult to draw a causal link between his HW and the transmission, given the fact that he already has GHSV. If I am correct here, this seems to put us in a situation where we can't currently know whether fingers infected with HW shed asymptomatically because we can't accumulate any evidence one way or the other. This makes even casual contact like handholding concerning to me, because if HW does shed asymptomatically it would be like my partner touching my genital area without washing her hands. Obviously, I am concerned about sexual contact like fingering as well.
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Terri Warren, RN, Nurse Practitioner
26 months ago
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I do understand your concern. We don't worry about asymptomatic shedding from intact fingers because the skin is too thin for the virus to leave. It is the same as why we don't worry about people who get buttocks lesions with genital herpes spooning with their partners. The reason HSV 2 is a sexually transmitted infection is because the skin/tissue of the genital area is just a layer or two thick so virus can easily come off there. The same is true with the oral area. In order for you to have contracted herpes whitlow on your finger, there has to be some sort of break there - torn cuticle, cut, something. It would not not have gotten into your finger without a portal of entry.
BTW, exactly how were you diagnosed with HW, swab test, visual exam?
Terri
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26 months ago
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Thanks so much for your response! I was diagnosed with a swab.
I do have a few follow-up questions. From what I can tell, there aren't any studies that have measured asymptomatic shedding in fully keratinized skin. Based on what you said, it seems like most doctors believe there is a strong presumptive reason for thinking that thicker skin blocks the virus from shedding. But if there aren't any studies that have demonstrated this, isn't this belief still in the realm of the speculative?
Also, even though most of the hand is fully keratinized, isn't the skin directly around the cuticles quite thin?
I don't want to come off as tedious or argumentative, and really do have the utmost respect for what you do. Just trying to understand!
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Terri Warren, RN, Nurse Practitioner
26 months ago
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Got it.
You may be correct about lack of studies but biologically, I think all clinicians would agree that thick skin does not allow for shedding. A negative is sometimes difficult to prove. And I don't think the skin around the nail is much different than the other skin of the finger. I'm afraid I don't have much more information about this for you. I would be happy to ask another of my colleagues for an opinion about this and get back to you.
Terri
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26 months ago
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Hi Terri,
Thanks for your reply! I have total respect for your knowledge and experience, but if you don't mind consulting another colleague, I would be interested in a second opinion! Thanks for offering :)
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Terri Warren, RN, Nurse Practitioner
26 months ago
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I checked. My colleague is in agreement with me. Hope that is helpful
Terri
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