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Herpetic Whitlow

What is Herpetic Whitlow?

This is a laceration that appears on the thumb caused by the herpes simplex virus HSV-1 or HSV -2. Herpes originates from a Greek word meaning “to creep”.


This explains one characteristic of all herpes since they have a tendency to move along from one nerve end to the other. They may remain inactive in the body for quite some time before they replicate and affect the patient.  Everyone can be affected by this disease.

There are two types of Herpetic Whitlow.

  1. Herpes simplex virus- type 1    (HSV-1)
  2. Herpes simplex virus- type 2    (HSV-2)

HVS-1 is mostly contracted by medical workers who may have accidentally acquired it in their line of duty.  HSV-1 is the main causative agent of herpetic whitlow with approximately 60% cases and the rest of the 405 covered by HSV-2.

HSV-1 mostly affects fingertips, mouth and lips. This lesion usually affects the fleshy part of the finger tip. Patients with HSV-2 acquired it from an infected person who most probably was HSV-1. [1]

Patients with HSV-2 sometimes do not have an idea that they have contracted it. HSV-2 mostly causes genital herpes through sexual relations.

Both HSV-1 and HSV-2 are lifetime diseases. Patients with HSV-2 are susceptible to contacting HIV infection.

 

HERPETIC WHITLOW
Picture 1: Fleshy part of the fingertip being affected by herpetic whitlow.
Image Source: www.nhs.uk

This infection is very painful and can easily be spread by direct contact. This can be spread even if there are no visible symptoms.

Herpes simplex virus- Type 1 (HSV-1)

Characteristics

It is a worldwide epidemic and it is highly contagious. Someone can acquire it since childhood and will have to live with it for a life time. Mostly the infections are oral.

Signs and Symptoms

  • It is mostly found on the mouth and mostly patient is unaware that they are infected.
  • The patient may have blisters and ulcerations on the mouth mostly known as “cold sores” which are very painful.
  • Ulcerations are recurrent. The rate of recurrence varies from one individual to another.
  • HSV-1 that is found on genitalia is often mild and unidentifiable.

Transmission

HSV-1 is transmitted by mouth to mouth especially through saliva, ulcerations and through exteriors and interiors of the mouth. A person is prone to contracting it through the sores than when they are not visible.

There are minimal chances of individual contracting genitalia herpes if they already have one orally. There are also minimal chances of a pregnant mother transmitting the virus to the unborn child during delivery.

Psychosocial Impact

•    People who have HSV-1 experience social stigma and are uncomfortable being around other people.
•    Genital herpes can affect sexual life of the individuals.

Treatment

There is no cure for HSV-1. Antiviral medications are prescribed such as acyclovir to reduce the impact of the virus inside the patient’s body.

Prevention

  • Infected people should avoid oral contact or sharing objects with others especially those in contact with saliva. They should avoid certain sexual activities such as oral sex. People with genitalia herpes should abstain from sexual activities.
  • For a patient who cannot abstain from sexual activities it is advisable to use protection such as condoms in order not to submit it to the other partner.
  • Pregnant women who have contracted the infection are advised to visit a doctor in order to help them with the situation.

 

Infected person with HSV-1 has blisters on the mouth
Picture 2: Infected person with HSV-1 has blisters on the mouth.
Image Source :encrypted-tbn0.gstatic.com

Herpes simplex virus- type 2 (HSV-2)

It is a worldwide epidemic. It is sexually transmitted. It is estimated that 417 million people had contracted the infection by 2012. This infection is incurable and lasts a lifetime. Survey shows that most affected are women.

This is because transmission from a man to a woman is easier than from a woman to a man. In 2012 it is estimated that 267 million women and 150 men are infected with HSV-2.

Signs and Symptoms

  • The symptoms are very mild and therefore the infected is unlikely to notice it.
  • Noticeable symptoms are open sores and ulcerations.
  • Fever, body aches and swollen nymph nodes are likely to be felt by the individual.
  • Recurrent ulcerations will occur but usually reduce over time.
  • The infected may experience pain on hips, legs and buttocks before other symptoms.

Transmission

HSV-2 is transmitted when a partner has sexual relations with an infected person especially through fluids in the genitalia, skin and anal area. Infected persons are more susceptible to contracting HIV infection.

Infected persons with HSV-2 living with HIV infections have more recurrent symptoms that infected people with only HSV-2.

Psychosocial Impact

People living with HSV-2 have stress and experience social stigma. The sexual life is affected negatively.

Treatment

Since there is no cure for viral diseases, antiviral medication is provided to the patient in order to reduce the impact and severity of the symptoms. Such medication include acyclovir,famciclovir, valacyclovir.

Prevention

  • Infected individuals should abstain from sexual activities.
  • Steady and correct use of condom will minimize the risk of one getting infected.
  • Pregnant women who have contracted the infection are advised to visit a doctor in order to help them with the situation.

 

HSV-2 on genitalia
Picture 3: HSV-2 on genitalia
Image Source: encrypted-tbn1.gstatic.com

References :

  1. Clark DC (2003). “Common acute hand infections”. Am Fam Physician 68 (11): 2167–76. PMID 14677662
  2. https://www.nlm.nih.gov/medlineplus/herpessimplex.html
  3. Berger JR, Houff S. Neurological complications of herpes simplex virus type 2 infection. Arch Neurol. May 2008; 65(5):596-600.
  4. Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
  5. Lewis MA (2004). “Herpes simplex virus: an occupational hazard in dentistry”. Int Dent J 54 (2): 103–11. doi:10.2956/indj.2004.54.2.103. PMID 15119801.
  6. Avitzur Y, Amir J (2002). “Herpetic whitlow infection in a general pediatrician–an occupational hazard”. Infection 30 (4): 234–6. doi:10.1007/s15010-002-2155-5. PMID 12236568.
  7. Herpetic whitlow an occupational hazard, AANA J. 1990 Feb;58(1):8–13. Klotz R.W
  8. Freedberg, Irwin M., ed. Fitzpatrick’s Dermatology in General Medicine. 6th ed, pp.1317, 2063, 2068. New York: McGraw-Hill, 2003.
  9. Bolognia, Jean L., ed. Dermatology, pp.1237-1238. New York: Mosby, 2003
  10. http://infectionnet.org/notes/herpes-viruses/

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