1. I am concerned about sweat glands because they reside in the dermis, under those extra layers of skin. This makes me worry that even though HSV might not asymptomatically shed on the fingers as it would on mucosal surfaces, it may still infect the sweat glands, and thereby the sweat that's excreted from the skin.

2. I want to clarify why I'm concerned about the methodology involved in collecting data about HW transmission. From what I can tell, in order for hand-to-genital transmission to be adequately demonstrated, the following two conditions would have to be met: 

1. The infected person's only sexual contact 4-12 days prior (standard incubation period) was hand-to-genital contact.

-To illustrate: I have HW as well as genital HSV. If I transmitted herpes to my partner through hand-to-genital contact but also had sexual intercourse around the time of infection, the physician would presumably attribute the infection to genital-to-genital contact. Furthermore, according to the study I cited earlier, almost everyone with HW also has it orally or genitally. This makes a set of conditions such that as long as there was genital-to-genital or genital-to-oral contact during the time of transmission, HW will be automatically ruled out. In addition to this, it seems unlikely that the only sexual contact two partners might have over 4-12 days would be hand-to-genital.  

2. It is established that the person who transmitted HSV has HW (this could be a problem considering so many people contract HW at an early age and so might not be aware of it later in life)

Sorry if this is getting cumbersome!

You refer to the methodology involved in collecting data about whitlow transmission.  What study?  What methodology?  You cite a study - could you share the study reference for me please?

We've gone this over multiple times now and I believe that you've also spoken to a prominent infectious disease physician who has shared with you the same opinion, but you can't seem to believe us or let this go. 

There is no evidence that I know of that suggests that herpes infects the sweat glands in skin.

Let me see if understand your concern clearly:  You worry that because you have whitlow on your hand that you will infect someone by handling their genitals with hands that do not have sores at the time.

Is that correct?

Terri

To answer your first question: I am not aware of any attempts to study whether asymptomatic shedding of HSV occurs on the fingers. Let me try to clarify what I meant:

Earlier, you and Dr. Handsfield pointed out (correctly) that there aren't any reported cases of hand-to-genital transmission. You then cited this fact as a reason to think that hand-to-genital transmission does not occur asymptomatically. Seems straightforward, so, what's the problem? My concern is this: I'm afraid that hand-to-genital transmission might frequently occur even if there isn't any evidence suggesting that it does (mainly because it seems nearly impossible to gather any evidence that such transmissions do occur).

Finally, my only intention in this most recent post was to show why I think it would be almost impossible to demonstrate a causal connection between hand-to-genital contact and genital infection (even if hand-to-genital transmissions happen regularly)

When you say that there isn't any evidence to support that hands shed asymptomatically, I assume you're referring to how there haven't been any published case studies on this topic. But what percent of strange patient visits are recorded in case studies? Suppose someone comes into a Planned Parenthood with a GHSV outbreak, and the only sexual contact she's had in the prior weeks was fingering. Suppose further that the person who sees her is a busy nurse with several other patients. Would this nurse have time to investigate whether this patient's partner has a history of HW and then write up a case study to be published in a medical journal? It seems more likely that the nurse would assume her patient has had HSV for some time and is only now noticing outbreaks (which, to my knowledge is pretty common). This is compounded by the problem I described in my original post last month (and in "2" of the previous post). So, I'm concerned that it's difficult to gather evidence of hand-to-genital transmission, even if such transmission does in fact occur.

I agree that it is not possible to know with 100% certainty that someone has been infected with fingers as fingers are a normal part of sexual expression.

I will say that in 35 years of in person clinical practice, I asked every single patients about the types of sexual contacts that they had had and when and with what sex partner and what part of their body was exposed to what parts of someone else's body.  There was not one person who was diagnosed with herpes by me or any of my employees who had only been exposed to fingers or hands - they all had had either intercourse or received oral sex. 

I know this is very worrisome to you but we've all done the best we can answering your questions and this thread will now be closed, per the rules of this website.

Terri