[Question #874] Herpetic Whitlow

51 months ago
Hi,

I get cold sores from time to time. I'm not sure if they are HSV 1 or 2. I don't have access to the kind of blood testing that would identify the strain. Anyway, I have a question about autoinoculation and herpetic whitlow. I've been getting cold sores for a number of years now, so the infection is not new. With that being said, I was applying some over-the-counter cold sore medication to a sore that I had just acquired. I had cut my finger on the fingertip earlier that day. It's not a really deep cut, but it is definitely noticeable (if that makes any sense). I applied the medication to the lesion with the fingertip that had the cut. I am wondering how likely it would be that I would transfer the virus to my finger given that this is not a primary outbreak. Also, is it only really necessary to worry about autoinoculation during a primary outbreak or first infection? How possible is it to transfer the virus to another part of the body after the first infection has long since passed? I also apologize as I essentially asked the same question 3 times.

Thanks
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
51 months ago
If you have recurrent cold sores, the odds are extremely high that this is an HSV 1 infection, not HSV 2 (I don't know if you have HSV 2 genitally, we are just addressing your concerns about the cold sores right now).  Autoinoculation is a worry for lots of people, but in reality, that happens almost exclusively with first infection when you do not yet have an immune response in place to the virus.  I have seen this maybe once in 33 years of practice, so it is very infrequent for sure.  It's OK to ask the same question three times, I understood it completely that way!  How long ago did you put the medicine on the cold sore with a cut on your finger?

Terri
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51 months ago
Thank you for the extremely quick reply! I applied the medication to the sore with the cut on my finger two days ago. I guess I was perhaps thinking there was some kind of prophylactic measure I could take to perhaps reduce the chances of transmitting the virus to my finger (if one even exists!). 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
51 months ago
No, not at this point, there is nothing you can do, but honestly, I think it is going to be just fine.  Keep an eye on it but I would be very very surprised if you got whitlow form this.  Keep me posted, OK?

Terri
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50 months ago
Hi Terri,

So it's been roughly 17 days since I may have potentially autoinoculated my finger that had a cut on it when I applied some medication to a cold sore that I had on my lip. I'm not that knowledgeable about herpes but I've read that the incubation period is 2-20 days which I take to mean that if I don't experience an outbreak of lesions on my finger by the 20th day then it would be fairly safe to assume that I haven't autoinoculated my finger. Would this be correct?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
50 months ago
Yes, I think that is correct.  It was low risk anyway, quite low risk, and if you've had not anything in the way of finger lesions by now, I honestly think you are good to go!

Terri
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