Herpetic Whitlow Transmission and risks

April 27, 2012 8:41 AM

Considering dating / having sex with someone with Herpetic Whitlow (HSV-2 type) and have questions about transmission risks.

A potential partner I have just met has disclosed to me that she has Herpetic Whitlow caused by HSV-2 and I have a variety of questions. I think if I were monogamous, I'd be okay accepting the potential risks, but I have other partners and I have to consider their health and disclose information to them, as well.

She contracted the condition while working in the dental field and was not aware of it for some time. She did have a subsequent partner, months later, who had HSV-2 in the genital region. She has never had a genital or oral outbreak. How likely is it that she would have asymptomatic shedding in those regions? What are the transmissions rates of herpetic whitlow and how is it spread? Does it sometimes shed asymptomatically from the hands, as HSV can in other regions, or does the fact that it's not a mucus membrane make that less likely / not a factor?

posted by anonymous to health & fitness (6 answers total)

My understanding (and it would be nice if someone can correct me) is that the contagiousness of HSV is actually not very well characterized and it's really not super well-known how contagious people are in between outbreaks. It doesn't help that many people who have the virus never show any symptoms and so it's not even really well known what the overall rate of HSV is in the population, though I think the figures I last heard (for the U.S.) are somewhere around 1 in 5, which is obviously very high.

I've heard that the anti-virals the people sometimes take for HSV can reduce contagiousness considerably, but I've never seen a trusted source that said "if you kiss/have sex with someone with HSV while they are/are not having a breakout, your chances of acquiring the disease are xx%". Minimizing contact, barriers, the aforementioned medication... you can mitigate the risk somewhat but it'll always be there. It's not like HIV where you can use a condom and be reasonably sure that as long as it doesn't break, you're OK.

I've always felt like the herpes thing is kind of a crapshoot. You can get it even if you're careful, because it's spread by contact and a lot of people don't even realize they're contagious. Fortunately the disease isn't too awful, though I guess the primary outbreak (which not everybody has) can be pretty painful, because the body doesn't have a lot of antibodies to fight the virus yet. And of course there's the social stigma, which in my opinion is probably the worst thing -- maybe tied for worst with the fear of infecting someone else and how that could restrict your future choice of partners.

Anyway, I think this might be one of those questions where the answer is "nobody really knows". Kudos to you for being careful and responsible. I note that you said above that you are aware of the need to disclose your choice in the matter to your other partners, which should be a no-brainer but is nonetheless more than a lot of people would do.

I hope that someone can come along and give a better and more knowledgeable answer to your question, because it's one that I've always wondered about too and I've never been able to get a straight answer to it, which is super frustrating as someone who tries to be sexually responsible and likes to have clear-cut information to use for decision-making.
posted by Scientist at 9:13 AM on April 27, 2012 [1 favorite]

You might also try these two other other AskMes about herpes transmission. You will note that the advice in them is all over the damn map, which I think is probably partially due to general ignorance about STIs (this is a better-informed crowd than you'll find most places, but there are still plenty of people willing to give you "authoritative" advice who are either misinformed or underinformed on the subject) and partially due to the fact that herpes transmissibility is a really hard thing to predict accurately.

If it were me, I would think about what the consequences would be fore me if I did contract herpes, and then go from there. There's probably a smallish but not insignificant chance that you could contract HSV from sexual contact with this person, so you should plan for what happens if you do. Also you should keep in mind that if you have contact with this person while continuing your relationships with your other partners, you could contract HSV and spread it to them before you are aware that you have it.

STI tests for herpes aren't very good (they detect antibodies, meaning they detect exposure but not infection, so if you had a brush with it but your body successfully destroyed the infection before it could take hold you'll still test positive) and likely would give a false negative unless you wait a while after the infection for your body to build up some antibodies (much like HIV tests have a window of ineffectiveness immediately after a new infection starts). So if you're continuing to have sex with your current partners while also having sex with this new partner, you could potentially spread it to all of them before you know it.

I would even surmise, though this is just speculation, that you would be at your most contagious immediately after infection as your body would not have had time to mount a defense. Also the sores start out fairly minor, you wouldn't just wake up one day with a full-blown primary herpes infection. You might mistake it for a rash or a zit at first, if you're not careful/have a slight case of denial. So the risk of infecting your other partners would be hard to mitigate.

Good luck, this is a tough call to make. I would lean toward not having sexual contact with this new potential partner, especially if you want to continue having sex with your current partners. If you want to be monogamous with this person then it's up to you, but where you've got other partners in the equation I wouldn't personally be comfortable exposing them to the risk of infection, even if they themselves made a fully-informed and conscious decision to accept the risk. I just wouldn't want to be the guy/girl that gave them herpes.

Oh, and I should have said this earlier. I realize that none of my advice specifically addresses the transmissibility of a herpetic whitlow. The thing is, I think that's kind of a red herring. People can be contagious even if they're totally asymptomatic, and it's so hard to say exactly how contagious that I wouldn't really consider the whitlow part of the equation. The error bars are too wide, there's no good way to tell.
posted by Scientist at 9:38 AM on April 27, 2012 [1 favorite]

Herpes transmission rates are actually extremely low. Contrary to what Scientist wrote, there actually have been plenty of studies on it and they find very, very low rates of transmission. But it's still possible.

If the person takes regular antivirals and is not currently having an outbreak the risk of transmission is exceedingly small. However, seeing as there is no cure, you should still be sure you're willing to take that risk, however small.
posted by imagineerit at 11:15 AM on April 27, 2012 [1 favorite]

If she has HSV-2 herpetic whitlow, she's not going to have shedding from her mouth or genitals. The infection is limited to her finger (or thumb, whichever the case may be) and nervous system. Although there's no guarantee, assuming she has a normal immune system, it's very unlikely she'd ever get an HSV-2 infection in another location since she's now seroconverted and has produced antibodies against the virus.

She may have recurrent outbreaks on her finger/thumb and could have shedding from that area at that time. I've never seen data regarding transmission rates involving herpetic whitlow from one individual to another. Many cases are caused by auto-inoculation - i.e., someone with HSV transmitting the infection from their mouth or their genitals to their finger/thumb prior to seroconversion. The only transmission rates I've ever run across involve auto-inoculation, primarily in children.

If this happened at work, I assume her treatment is being covered through workers' compensation. She could take oral or topical anti-virals during an outbreak that they should pay for. What has her doctor said about transmitting the disease to others? Could she contact her doctor to ask about protection during an outbreak?
posted by pecanpies at 1:10 PM on April 27, 2012 [1 favorite]

You probably know this if you have done some online research, but HSV1 is typically the oral herpes, and HSV2 is typically the genital herpes type. So, it would be unlikely that the whitlow came from the dental work if it's HSV2, more likely from the previous partner.

If she gets prodromal symptoms like tingling in the finger, my understanding is that starting a script of acyclovir during those symptoms can abort the recurrence before there are any lesions. If she manages to stop all the outbreaks in this way then the risk for you would be minimized. I would suggest she ask her doctor about this if she isn't using acyclovir for this purpose already. There is not thought to be any viral shedding of HSV from the finger once about 2 weeks have passed and the lesions have crusted over and begun healing. So to answer your question, no, there isn't believed to be asymptomatic shedding of the virus.
posted by treehorn+bunny at 7:27 PM on April 27, 2012 [1 favorite]

To add to previous points,
I suggest getting hold of some antivirals to hand and if there's contact between finger and exposed flesh like eye or penis, then you can take a pill quickly. Also, new skin to glue down the skin on her fingers if she gets those bits near the finger that peel back.
posted by jago25_98 at 1:41 AM on April 28, 2012