[Question #8759] Management of HSV2 non-genital
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40 months ago
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Months ago I had a routine check-up for a rash on my hand and initially had a negative HSV2 titer. The rash came after a break in the skin of my hand due to chronic dermatitis; I should add I am a healthcare worker. The rashes were bullous, white-centered, and had an erythematous base. It was mildly itchy and the rashes lasted at least slightly over a week they quickly resolved after using triamcinolone. However, two follow-up titers due after a workplace injury returned positive both were less than 3 though a IgG supplement from LabCorp also returned positive. Subsequent cultures for feared recurrences, while religiously wearing nitrile gloves, were negative though they were taken outside the twenty-four-hour mark. No recurrences since. The likelihood of genital acquisition is low due to no sexual activity during this entire time.
The Question
1. I am currently still wearing gloves to make sure I do not asymptomatically spread the virus. I am not on valtrex due to other critical medications that can cause kidney problems. Do I need to continually wear gloves to prevent spread to loved ones, sexual partners, etc. Additionally, I was wondering whether it would be prudent to obtain the western blot to confirm whether or not I actually have the virus.
Thank you
Anxious Medical Provider
The Question
1. I am currently still wearing gloves to make sure I do not asymptomatically spread the virus. I am not on valtrex due to other critical medications that can cause kidney problems. Do I need to continually wear gloves to prevent spread to loved ones, sexual partners, etc. Additionally, I was wondering whether it would be prudent to obtain the western blot to confirm whether or not I actually have the virus.
Thank you
Anxious Medical Provider
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Terri Warren, RN, Nurse Practitioner
40 months ago
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If your index value is less than 3, you need a confirmatory western blot as this may well be a false positive.
You mention a workplace injury - was that somehow related to herpes for you to think that this may be herpes?
I know have 65 people who are positive on the LabCorp supplemental test and negative by the gold standard western blot. I would NOT accept this diagnosis.
With negative swab tests and no sexual activity, I am at a loss to understand how this is herpes. Also, steroid creams would generally make herpes worse rather than better as you are diminishing the cellular immune response with steroids that you need to resolve a herpes outbreak.
Terri
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40 months ago
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Thank you Terri for the reply! The injury in question was not directly related to HSV but reflexively prompted an HSV test to be drawn.
Ok, I will go ahead to and get the western blot test. I was wondering in the meantime how likely it is to transmit herpetic whitlow to others without an outbreak? The skin on my hand still has dermatitis but otherwise no traces of anything resembling a herpetic lesion. I am currently wearing cloth gloves around family and loved ones but I do wonder if this is either effective or necessary.
Ok, I will go ahead to and get the western blot test. I was wondering in the meantime how likely it is to transmit herpetic whitlow to others without an outbreak? The skin on my hand still has dermatitis but otherwise no traces of anything resembling a herpetic lesion. I am currently wearing cloth gloves around family and loved ones but I do wonder if this is either effective or necessary.
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40 months ago
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Also, thank you for the insight on the use of steroid cream. Thinking on it I must agree that it doesn't make sense that steroids would make the lesion improve.....eczema on the other hand makes more sense.
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Terri Warren, RN, Nurse Practitioner
40 months ago
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If the skin of the hand is intact, virus will not be shed without an outbreak due to the thickness of the skin on the hand. I think you can safely dispense with wearing of the gloves. And don't forget to get that western blot for clarification.
Terri
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