[Question #883] Auto-innoculation HSV2, the seemingly impossible has happened

53 months ago
Hello Doctors and Experts, I have been an HSV2 positive for eight years.  I have done much research and seen much of your responses on this subject through Medhelp.  Following the birth of my first child, my periods have been unpredictable, long and frequent despite birth control.  During the end of my last period 2-week long spotty period, I utilized my left ring and middle fingers to masturbate just in the clitoral area.  But did not wash directly after and feel asleep.  In the next 3 days I developed a genital sore, and also noted a shooting sharp pain in my wrist and stinging in my fingers and area between thumb and forefinger.  I developed one sore on the pad of my left ring finger and several small blisters lining the area between thumb and forefinger.  I did not initially think herpes and attributed this to gardening and weeding without gloves the evening before, although I treated with allergy creams.  But symptoms worsened and new lesions formed on my palm and other fingers, then the other hand was affected to the same extent. All with these same prodrome feeling I have experienced prior to and when having a genital outbreak.  I began doubling and tripling my Valtrex, up to 2000 mg each day which quickly shrunk the larger blisters, still with an average of 1 to 2 spots developing on my hands every few days.  I also scratched a pimple near my left temple and in that instant I knew I had done a bad thing.  Within days, a blister appeared in that area with then unbearable shooting pains down my nose and extreme itchiness with blisters on the outside my nose as well, tiny, blunted by the meds.  Veins in my nose extend during this time, becoming visible and inflamed.  I had a friend in college with HSVI lesions in her nose and these same inflamed veins extending from the nostril.  I'm incredibly depressed and my job in the medical field and job caring for my 18 month old daughter has been nearly traumatizing as I fear this could be commutable.  Also, where do I go for help in treating this?  
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
53 months ago
You can't do it now, but the thing that is definitely missing here is a swab test of the blisters to indicate what they are, for certain.  It is highly unusual to transfer HSV from one location on your body to another location, after well established infection.  I'm not saying it isn't possible, it is just extremely unlikely.  It would also be very unlikely to have herpes whitlow spreading in the way that yours has, with 1-2 blisters developing each day on your hands and then spreading to your face.  That's just extremely unusual and something I have not seen in 33 years of practice.  Have you ever in your life had a cold sore on your lip in the past?

Terri
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53 months ago
Hello Terri,
Thank you for getting back to me so quickly.  No, I have never had a cold sore on my lip or anywhere else on my face.  I'm in my 30s.  I do have a larger blister on my thumb right now and several pictures of the others.  The problem being, I doubled my dosage after feeling achiness and pinching in my digits this morning and  then the blister developing, so within a few hours the blister will go down and there won't be anything to swab, I'm assuming.  I did go to an ophthalmologist due to the proximity of the facial blisters (temple, brow, nose) and saw my primary once the blisters were mostly resolved and after I had been on 1000 mg bid for at least 3 days, both were perplexed and couldn't rule out atypical shingles or HSV2, but the allergy cream they had me try had no affect, plus it's on both sides of my face and hands, and the initial whitlow occurred simultaneously with a genital sore.  I've called a dermatologist's office recently who did not feel that this was an acute issue and offered an August appt.  I figured this would be resolved and like the literature suggests, never recur again.  However, my anxious nature and recent depression associated with these symptoms have created an extreme amount of stress, so I can only attribute the recurrence to this. I recall my initial HSV2 outbreak being very painful and drawn out, one outbreak after the other for a month.  It's been over that amount of time in this case.   I noticed your own webpage as well and the video consultations regarding herpes.  Would that be appropriate in this case? 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
53 months ago
Although I would of course be happy to talk with you, I don't think that would be very helpful right now.  Here's what I would suggest : ask your PCP if it would be possible for you to take home a swab test kit for herpes and when you get these things, swab them yourself and return the kit to their office to return to the lab.  PCR is better than culture.  Do you have the kind of relationship with your PCP that would allow this request?  I did it all the time with patients - it gave them the opportunity to catch the lesion quickly and before an appointment could be obtained (ie your derm person).  What do you think?

Terri
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53 months ago
Hello Terri, I went to PCP for swab test yesterday.  She said it was an in-office procedure only and wouldn't allow me to take a swab kit.  She also expressed caution as to the validity of the test as it could produce a false negative.  However, I had a new blister emerging on my left middle finger and a few tiny blisters on my nose which were only a day or so old, so I'm hopeful.  Results in 5-10 days.  Let's just say the swab result was positive for HSV2, I have an 18 month old daughter who is still is diapers, what are the chances of me transferring this virus to her?  In cases of HSV2 whitlow, what is the shedding pattern?  I'm thinking there is no research on this area to really answer that question because Whitlow hardly ever recurs, correct?  Any cases of recurrent whitlow that you've encountered?  A new blister yesterday, another small new one on my left thumb today along with some that are about 5 days into the healing process.  A teeny tiny one on my right middle finger this morning as well.  All of these accompanied by mild prodrome symptoms in the hands.  A few blisters scattered on the face, mostly forehead, nose.  All prodrome, pain improved with 1000-1500 mg of Valtrex but not keeping them away. What other disease process could act like this?  
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
53 months ago
Yup, some providers are reluctant to send swabs home with patients though it befuddles me as to why.  What negative thing could you possibly do with a swab at home? We have people do daily home swabbing every day in research studies.  Oh well, it is what it is.  And yes, the swab test could be falsely negative - that is, it could be herpes but the swab test could be negative, but this gives you an opportunity to get a possible positive. 

With whitlow, the skin of the finger, when there are no lesions, viral shedding does not occur - the skin is too thick.    And yes, I have seen recurrent whitlow.  So did your PCP do a swab test of the lesions?  It looks like that.  And were the swabs taken from your fingers or your nose?  Certainly the nose blisters could be HSV 1 as it within the trigeminal ganglia and would not be completely unexpected. 
I think there are other conditions that cause blistering but a dermatologist would be the best resource for this information.  I'm curious about what your PCP thought was going on.

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Te
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