[Question #874] Herpetic Whitlow

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98 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
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Terri Warren, RN, Nurse Practitioner
98 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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98 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!). 
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Terri Warren, RN, Nurse Practitioner
98 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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98 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?
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Terri Warren, RN, Nurse Practitioner
98 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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