[Question #2507] unusual transmission method
 |
96 months ago
|
I have HSV1 on my labia that was swab typed. I thought that
being fingered by a partner was a relatively safe activity, but now I see there
is a risk with active lesions.
My Bf and I have never had intercourse/genital to genital
contact. However, he fingered me extensively and then likely masturbated
himself right after with no hand washing. I realized a few hours later that I
had the beginnings of lesions on me which then developed into a full OB.
About a week later, I observed an open, rounded blister on
his public bone behind a testicle (didn’t get in to have swabbed). It was
yellowish/red and wet looking. None on penis shaft. He was also scratching the
scrotum region vigorously. I had to go out of town for two weeks and when I
returned he didn’t appear to have any more blisters, but was still scratching
his scrotum and surrounding area so vigorously that the skin was mottled red in
some places and sloughing off in chalky white patches in others.
Also, at the same time I noticed the genital blister, I saw
a small, rounded, open blister on the middle knuckle of the finger he used to
finger me with. The surrounding area was not red/swollen and didn’t appear to
cause him irritation. About 2 days later, the middle part made a small brown
scab and was gone the next day, leaving white tissue. Fast forward 4 weeks and
the white tissue is STILL prominent and I can see the faint outline of the
former blister.
He says he has never had a cold sore, but has never been
tested for HSV. He’s always had protected intercourse but has received
unprotected oral. He is convinced he’s had the intense itching and skin
sloughing in the past, though he said he’s never had blisters (he did not
notice the recent ones and out of nervousness, I did not point out the blisters
I noticed on him until after they were gone).
So, I am wondering if the described activity with my
lesion(s) likely gave him genital herpes and herpetic whitlow. I know that you
all have never seen this personally and it hasn’t been documented, but I am at
an utter loss for another explanation for this! Can this just be a coincidence?
 |
H. Hunter Handsfield, MD
96 months ago
|
Welcome to the forum and thanks for your question. Apologies for the longer than usual delay in this reply. Herpes questions normally are answered by Terri Warren, but she tells me she has already discussed this with you through her own website and asked me to reply. It took a day to sort that out.
---
In general, genital herpes due to HSV1 is uncommonly transmitted sexually to partners, unlike HSV2, because outbreak frequency usually is low and asymptomatic viral shedding and infectiousness are uncommon. Also, hand-genital contact rarely transmits herpes or any other STD. OTOH, this contact with your partner occurred at a time you likely were infectious, i.e. just before onset of an outbreak; and certainly it is possible for herpes to infect the fingers. However, I still think it unlikely your partner has caught HSV1 from you based on his symptoms as you describe them. His apparent blister or ulcer of the perineum (behind the scrotum) isn't consistent with having only fingered you. In theory, he could have scratched himself with a contamined fignernail, but this sort of thing is exceedingly rare if it occurs at all. As for his finger lesion, that seems more consistent with herpes because of the location and herpes might be possible. However, it healed much more rapidly than typical for herpes, especially for initial infection, which typically takes at least a couple of weeks. Even recurrent herpes takes at least a week until scabbing over. (Healing was complete after the scab was gone, regardless of whitening of the previously involved skin.)
In answer to your closing question, most likely your partner's two lesions indeed were coincidences, i.e. unrelated to the fingering episode describe, or to any other contact with you. If your partner wants to know whether he has HSV1, he could have a blood test. If positive, it would not say when or where on his body he was infected, and up to half of all adults have positive HSV1 tests, mostly due to distant past infection, often in childhood. But a potential advantage is that if positive, you and he would know he not at risk of acquiring HSV1 from you. Once infected with HSV, people are immune to new infection with the same virus type. (For example, mutually infected couples don't "ping pong" their HSV infections back and forth.) However, if he isn't concerned I would recommend just dropping the whole thing until or unless he has what seems to be a recurrent outbreak.
I hope this information is helpful. Let me know if anything isn't clear.
HHH, MD
------
|
96 months ago
|
Thank you, Dr. Hansfield. Yes, Ms. Warren was extremely helpful, and I apologize for double posting. I've been studying for the Bar all summer and have succumb to the anxiety monster. I have 1 more follow up question--the contact I was concerned about occurred about 7 weeks ago. I gather that results would not be definitive until around 3-4 months, but if he he got tested at 2 months and it came back positive, can I be fairly certain that he didn't contract it from me? Or would that depend upon the antibody range that comes back? Thank you again for your time.
|
H. Hunter Handsfield, MD
96 months ago
|
Thanks for the thanks. I'm glad to have helped.
|
96 months ago
|
Hi Dr. Handsfield,
Since I have one more follow up question, I figured that I would ask a question for myself about Valtrex. I've been taking a daily dose of 500 mg a day for a couple months. When I first started taking it, I was dizzy for a few days. Now I'm experiencing pretty severe depression which is unusual for me. I'm also tired all the time--sleeping 10-13 hours per day (I am an otherwise healthy 25 year old). Much to my chagrine, I just got a prescription for an SSRI which will hopefully help. However, I was wondering if depression is ofen seen in your patients taking daily Valtrex and if so, if there are any alternatives. Thank you.
|
H. Hunter Handsfield, MD
96 months ago
|
I strongly doubt your depression is related to valacyclovir (Valtrex), at least not directly. If your herpes and/or daily dosing antiherpes drug are contributing psychologically, it could be related in that way -- but you're a better judge of that than I can be. It also doesn't cause dizziness -- I'm sure that also was a coincidence or psychological.
FYI, valacyclovir is just a sophisticated way of taking acyclovir: it is converted to acyclovir as it is absored from the GI tract, so only acyclovir actually circulates in the body. Because val is more readily absorbed from the GI tract, it gives higher blood levels than acyclovir itself. In the early days when both drugs were developed, thousands of people were given either drug or placebo. No serious side effects occurred, and minor ones -- like headache, nausea, dizziness, and anything else you can think of -- were rare and occurred with exactly the same frequency with drug or placebo. The bottom line is that acyclovir and valacyclovir are among the safest of all drugs. Even major overdosing isn't a problem: it would be difficult to give someone enough of either drug to make them ill. In any case, there are no alternatives except famciclovir (Famvir), but it is a nearly identical drug and definitely no better or any less likely to cause side effects.
Having said all that, I question whether you really need to be taking any drug. It is usually not very helpful in people with genital HSV1. Even without suppressive treatment, outbreak frequency for gential HSV1 is low, with many people having no more than 1-2 outbreaks a year, often for only a year or two, then none. And asymptomatic viral shedding is uncommon, so even without treatment, genital HSV1 is rarely sexually transmitted to partners. So you might be able to stop the drug without any effect on either outbreaks or partner protection. All this is very different than genital HSV2, for which ongoing treatment usually is the best option.
That completes the two follow-ups and replies normally included with each thread, but I'll leave this open a few more days in case you have any last comments or concerns.
--- |
96 months ago
|
Okay, thank you very much for your kind and thorough response. I actually only looked up side effects of Valtrex today on a whim to see if there was any connection between it and my recent depression. I saw that it is listed as a side effect, but I will of course take your word for it that it is rare/doesn't occur at all.
My gynecologist recommended that I take daily Valtrex because I've had approx 6 outbreaks since February 2016 which were lasting for around 3 weeks. It also makes me nervous not to take it because the only definite trigger that I've identified for myself is sex/friction in that area. So what has occurred in the past is that if I have sex/friction in that area for a few days in a row I will get an outbreak quite suddenly and then risk exposing my partner (which was the exact scenario that brought me to this forum). Given that, if you still think that daily Valtrex is not particularly helpful in my situation, then I would just assume discontinue taking it! Thank you again.
|
H. Hunter Handsfield, MD
96 months ago
|
Even when placebo controlled studies show no difference in side effects with placebo vs an active drug, US FDA rules require all symptoms experienced to be listed as potential side effects. So it isn't surprising that depression is listed as an occasional side effect with valacyclovir. But I reitereate there is no scientific evidence for it, and I remain confident your depression, dizziness, etc are not related to the drug.
As noted above, most GHSV1 recurs infrequently, but there are exceptions and apparently you are one of them. With roughly 4 outbreaks per year and having started valacyclovir only 2 months ago, I definitely recommend you continue it for at least 6 months and preferably a year. It will take that long to determine how effective it is in preventing outbreaks.
That said, friction, sex, or minor trauma rarely if ever trigger herpes outbreaks. That history makes me wonder whether all your apparent outbreaks really are herpes. You say the diagnosis was confirmed as HSV1 by swab test (PCR or culture). If that was done only once, e.g. at the time of your initial diagnosis, you might speak with your doctor about retesting a future outbreak as well to reconfirm the diagnosis.
You really should be in the direct care of a physician who understands herpes well. If you have such confidence in your gyn, continue with her (or him). If not, consider finding a local herpes expert. If you have an ongoing even if long distance patient-provder relationship with Terri, that's obviously a great solution as well, but in-person care really would be best.
As you understand, that concludes this thread. I hope it has been helpful. Best wishes to you.
--- |
Terri Warren, RN, Nurse Practitioner
96 months ago
|
HI Laura,
Me again! I'm glad you had a chance to hear from Dr Handsfield as well.
I think we would both agree that if you've had six outbreaks in 1.5 years and they last 3 weeks and you have an uninfected partner and you have fears of infecting them, there is no downside to you taking the drug if it makes you feel safer in terms of a partner or your own outbreak patterns. As Dr. Handsfield told you, it's a very safe drug so I don't think you need to worry about that at all.
When you read about side effects on a label, everything is listed that happens in clinical trials so even placebo side effects are reported. Depression is a pretty common side effect of having herpes so it would show up not infrequently in clinical trials of people taking this drug for herpes. I would guess that the frequency of depression in the clinical trials groups is similar between placebo and drug groups.
This is our final comment on your thread. Take care.
Terri
---
Me again! I'm glad you had a chance to hear from Dr Handsfield as well.
I think we would both agree that if you've had six outbreaks in 1.5 years and they last 3 weeks and you have an uninfected partner and you have fears of infecting them, there is no downside to you taking the drug if it makes you feel safer in terms of a partner or your own outbreak patterns. As Dr. Handsfield told you, it's a very safe drug so I don't think you need to worry about that at all.
When you read about side effects on a label, everything is listed that happens in clinical trials so even placebo side effects are reported. Depression is a pretty common side effect of having herpes so it would show up not infrequently in clinical trials of people taking this drug for herpes. I would guess that the frequency of depression in the clinical trials groups is similar between placebo and drug groups.
This is our final comment on your thread. Take care.
Terri
---