Auto-inoculation for Genital HSV-1 vs Acne

[worriedsick28]

I was recently diagnosed with genital HSV-1 (by blood tests and cultures of 2 bumps).  I was told during initial exams that IF it was herpes, it was likely NOT my first outbreak because it was so mild, though it quickly became more severe (perhaps from picking at the bumps - hoping they were ingrown hairs).  Because I've tested negative for both about 2 months ago, and recently received oral sex from a new boyfriend, I believe this is my first exposure/outbreak.

I am TERRIFIED that when it was more mild or escalating (before I knew), that I was spreading it around.  All the I've read about auto-inoculation (sp?) is that it's "rare" and only typically happens during an initial outbreak.  Since I believe this is my initial outbreak, that terrifies me.  Since my diagnosis I've been agonizing over every large and small bump on my body.  I have tiny red bumps (sometimes with white heads) on my chest, a new cluster of painful red bumps on my mid to lower back around my spine and a large red welt on my cheek.  However, this is not entirely new for me and the current large painful bump on my cheek was present for a week or more (probably more) before I even had what I consider the exposure that preceded the genital symptoms.  HOWEVER, I am CONSTANTLY picking and poking my face and am terrified that IF this is a first outbreak, that I could have transferred the HSV-1 to my face when picking the pre-existing acne.  This is not so easily explained on my back because it's on a place that's hard to reach.

So, my questions are:

1) What are the chances of spreading HSV-1 ALL over (face, chest, back) through auto-inoculation?

2) And - my important question that I have not heard of anywhere is: IF this is my first outbreak and I indeed DID spread it to other parts of the body, when/if I have a reoccurences is it likely, possible, probable that I will have a reoccurence in the FIRST area where it was likely transmitted (genitally) or all the areas it ended up ?????

[anxious6]

A related discussion, Auto-inoculation HSV-1 was started.

[worriedsick28]

I have never been so happy/thrilled to have a question "shut down" before.  Thank you so much again for your feedback.  I stopped putting makeup on the bump/zit on my face and it's healing amazingly quickly - shocking!  I've recently put acne cream on the breakout on my back and it seems to be responding as well.  My genital HSV-1 lesions seem to be improving immensely as well.  So, wether it's the natural course of the virus, the Valtrex, or the fact that my stress level is WAY down due to your reassurance - thank you.

I am in a wonderful mood and feel far less overwhelmed by this "irritation."  Best of luck to all those out there who are struggling!

[Edward W Hook, MD]

1.  I suspect that the reason that your docotor did not wnat to give you valacyclovir is because he/she doubted that your lesions were HSV or would benefit form therapy.  Once again however, I think that the likelyhood that you are spreading your lesions is miniscule at most and very close to non-existant.  

2.  the likelyhood that it is due to HSV is so small that it really is not worth discussing.

3.  Again, let's not go there.  It just is too unlikely to warrant discussion.

EWH

[worriedsick28]

My lesions have not resolved (which has to do with my ongoing concern about spreading).  They started out (about a week ago) looking like 2 ingrown hairs, which I'm guessing is why medical providers thought it looked "too mild" to be a first outbreak.  However, 2-3 days later I noticed a 3rd (all on the outside of my vagina) and what looked like a canker sore on the inside...this is when I started freaking out.  Since then the original bumps have turned into sores and there are a lot more bumps/sores/sore areas on the inside and outside of my vagina.  It's probably important to say that I simultaneously was diagnosed with a combo bacterial and yeast infection and am on antibiotics for that.  I worried that that infection was making it difficult for my sores to heal and potentially more risky for me in spreading it on myself?

I started Valtrex yesterday after practically BEGGING for it (my doctor has been outrageously unsupportive both medically and emotionally as she pretty much suggested I had this coming to me).  I keep having waves where I think it's getting better and then it feels worse.

In the last couple days I have notices more of the bumps/red markes on my buttocks and lower back...but again, it's unclear how much of this could be benign clogged pores.  I guess I'm just stressed because I thought the inital outbreak was a few clogged pores so now I'm worried it's the oppositve.  So, given that I wasn't "picking" at "healed" bumps...

1) What are the chances that I spread the virus to other parts of the body given that my sores are not healed?

2) IF the outbreak on my back IS HSV-1, what is the likely way it got there?  Would it be only explained by my spreading it through auto-inoculation?  Or is it possible for it to simply be a part of the initial outbreak that just took longer to "surface"?

3) (And you likely don't have the answer to this based on your last response but): If I'm one of the unlucky people who has recurrent outbreaks of genital HSV-1, what are the chances that it will reoccur on my back as well (if that's indeed what it is).

Thank you SO MUCH for this site.  It feels like such a wonderful place of support and guidance during a time of such confusion and upset.

[Edward W Hook, MD]

I hope that I can help to alleviate your concerns.   The chances of you spreading your infection to other parts of your body through scratching are miniscule.

I agree with you that if you had a negative HSV blood test 2 months ago and now have culture or PCR proven genital HSV-1, you have probably acquired it recently.  Clinically the severity of a first HSV outbreak due to HSV-1 or HSV-2 can be quite variable. As for whether you might be spreading the virus around your body by picking and scratching, this just does not happen to normal people.   You do not say what you mean by "recent" and  you did not indicate if your genital lesions have resolved but, if they have resolved, it is because your body is fighting the infection. The same immune response that helps to heal herpes lesions will also keep the virus from spreading to other parts of your body, even with scratching an picking.  A far greater concern is that with your scratching you might be causing scarring (HSV lesions heal without scarring) or setting up a situation in which your skin lesions could get a secondary infection.  My advice would be to go see your doctor and explain the concerns.  He/she can examine you and help to sort what is going on.  If itching is a big part of what is going on they may be able to give you some medication to help with the itching.  If the lesions are already infected, they may give you antibiotics.,

BTW, although you did not ask, please also realize the genital HSV-1 is far less likely to recur than  HSV-2 and in the future, once your primary episode has resolved, is less likely to be transmitted to sex partners.  

There is a lot to learn about HSV.  Many answers to questions and information about herpes can be obtained by accessing excellent informational web sites such as the one run by the American Social Health Association (disclosure, Dr. Handsfield and I are both on the Board of Directors of ASHA).  

Hope this helps.  EWH