Non sexual transmission of herpes

[Esthetician]

Let me give you a scenario.  An esthetician is performing a brazilian bikini wax (complete hair removal from genital/anal area).  Esthetician is not wearing gloves and has a papercut on her finger.  The esthetician is not in a sexual relationship with anyone and has not been for about 5 months.  That relationship was the only intimate sexual relationship for the past three years. Five days after performing the brazilian, the esthetician noticed a tiny red spot that appeared to be an insect bite.  She found it first thing that morning (5th day).  No itching but hot to the touch.  Next day it had grown to the size of a quarter and had a small patch of blisters in the center.  The following morning she was awakened by vomiting.  That afternoon she went to the doctor.  The site had enlarged to the size of a silver dollar and the blisters starting to scab and also quite painful.  Doctor looked at it and commented that it looks like shingles.  He cultured the blisters to rule out herpes. He prescribed her Zovirax and stated that antiviral would work for either diagnosis (shingles or herpes).  The culture tested positive for herpes.  In your opinion, is it possible that the brazilian client transmitted the herpes virus to the esthetician?  

[Esthetician]

I'm so sorry for the confusion.  Let me see if I can clear this up.  I am the Esthetician.  I had a paper cut on my finger while performing a brazilian bikini wax and I was not wearing gloves. The infection site showed up on my thigh.  Could I have contracted the herpes virus in this scenario?  If so, is it HSV1 or HSV2?  This client always has cold sores and is anorexic.  I feel sorry for her and that's the reason I service her.  I had always worn gloves while servicing her until this time.  She is the only client I have ever worn gloves with.  I had an intuition that she may not aways practice good hygiene and even suspected drug use.  At the time of this last service with her, I was running behind with a packed schedule, and just did it without gloves.  And, I remember her touching my thigh to get my attention as I was turned to get my wax.  As I said before, she tends to keep her fingers in her mouth.  Is it possible that she could have transmitted the virus to me when she touched my thigh, even though I had on cotton scrub pants?  I'm just trying to figure out how this could have happened since I have had no other direct skin-on-skin contact outside of work.  I'm single, don't have children, and live alone with my dog.  I'm 30 years old.  Also, I work in an extremely humid environment.  My service room is very hot and stays humid since I use a steamer in many services.  My towel cabby stays at 180 degrees inside.  There is no ventilation in my room since it is in the center of the second floor of a building that is over 100 years old. I begin to sweat during my first service of the day.  By afternoon, the temperature in my room reaches 90 degrees. I am usually drenched with sweat by that point. I have had to excuse myself on more than one occasion during a service to go and throw up. Should I get a dehumidifier or portable air conditioner so that my service room is not a perfect environment for viruses, bacteria, etc.?  As of now, the only relief that my employer has provided to me is a big fan.

Believe me, this has been a lesson to me.  I've been wearing gloves with every client since this happened.  It would just ease my mind if I knew how I contracted this.  I'm worried now that I may have spread it to my clients before my symptoms presented.

I think I've covered it all now.  I trust you because of your education and because of the fact that you are in my home state of Alabama.
ROLL TIDE!!

[Edward W Hook, MD]

thanks for the clarification,  I now have a clearer picture of what has happened.  That said, I have no idea how you became infected. HSV does not pass through clothing , even wet scrubs and no part of your client touched your thigh.  In the same way, you have nothing to worry about as far as spreading your infection to your clients unless they are touching your bare thigh (seems unlikely from your description)

I would ask the doctor who did your culture if it was HSV-1 or HSV-2.

I doubt that your environment, while uncomfortable, will contribute to your risk of outbreaks or recurrences.

Again, thanks for the clarification.  I hope this helps.  EWH

[Esthetician]

I plan to call the doctor who performed the culture in the morning.  In the meantime, please let me ask you one more question.  Is it possible that I had the virus on my hand or under my fingernails after the service, went to the restroom and while pulling my scrubs down touched my thigh (had not washed hands at this point), then washed my hands thoroughly after using the restroom.  Could washing my hands have saved them from infection?

[Edward W Hook, MD]

Washing one's hands regularly is always a good idea.  On the other hand, there are no data to suggest that transmission of infection from a lesion to another site through the mediation of the hands occurs.  In fact, what we know about the virus suggests that this would not happen.  I am at a loss to explain how you got your infection unless perhaps it is an infection that has been there in the past and was overlooked and this is a recurrence.  If your culture was positive for HSV-2, this is a possibility.EWH

[Esthetician]

I just called and spoke to a nurse at the doctor's office and she informed me it is HSV-1. The only time I'm working around the mouth of a client is in facials (up til now never wore gloves for facials) or upper lip wax (again, no gloves until now).  I also do microdermabrasion, chemical peels but with these services I always wear gloves!  Just wanted to follow up and let you know what the culture said.  Thank you for all of your help and for taking the time to help me make some sense of it all.  It's just a mystery,,,if I'd been physical with someone intimate I don't think I'd have any questions.  But the only direct skin on skin I have is with my clients (sad but true).  Again, thank you for everything.

[Edward W Hook, MD]

It is a mystery.  That it is HSV-1 is, all things considered, good news.  HSV-1 is less likely to recur than HSV-2 and as far as transmission to others, which is unlikely to occur at all, it is less likely with HSV-1, both becasue recurrences are less common and becasue over 60% of adults already have antibodies to HSV-1 and thus are protected from infection.  Good luck.  EWH