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Diagnosed with HSV and first classic outbreak

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I was diagnosed with HSV2 about a month ago, during which I had my first classic outbreak. I got it from my boyfriend, who did not know he had it at the time. I was tested negative for HIV, hepatitis, and syphilis at the time I was diagnosed. During my primary outbreak, I must have somehow touched the sores or the fluid and in the same week one large blister appeared on both my left wrist and left leg at the same time. I was put on Valtrex for 10 days and the genital region cleared up pretty quickly, but the ones on my wrist and leg took longer and I don't think they ever fully healed because there was always a red spot in those areas.

This past Saturday it came back but only on my wrist and my leg, not in the genital area. It started as just itching then by Sunday there was an appearance of a cluster of blisters in each area, where the first time there was only one in each spot. I went for a follow up appointment to my gynecologist two days later and showed him the blisters. But he was not very helpful; he said he only deals with the genital region and I had to see an infectious disease doctor. He gave me a permanent Valtrex prescription to take daily and I've been on it for 4 days so far and did the swab test on my wrist to confirm it was herpes. I could not get an appointment with the ID doc for another two weeks, and Tuesday night the spot on my leg was huge and red and swollen with cellulitis all over the area. It is on my lower calf close to my ankle, but I'd say the entire surface area that is infected is about the size of my fist. I went to the ER and they tried to tell me it was a staph infection despite hearing my story and put me on an antibiotic without answering any of my herpes related questions. It has been 4 days since I'm on Valtrex again and I've kept the area bandaged at all times and worn pants and long sleeve shirts.

Sorry for all the background, but I thought it would be helpful info to best answer the questions I have. I am concerned that for the rest of my life I'm just going to be a walking contagion that can spread the virus to everyone without knowing it, since HSV2 spreads frequently asymptomatically. I know that Valtrex reduces the number of outbreaks I'm going to have, but I'm more concerned with the areas on the exposed parts of my body and want to know exactly which parts are contagious to others and if I'll be able to tell or I will have to keep both areas covered the rest of my life.

My appointment with the ID doc isn't for another two weeks, and I cannot wait that long to have these questions answered because I'm getting sick over this.

1. Will the areas on my wrist and leg always be a site for a breakout, and will these areas always have the potential to be shed asymptomatically?
2. What part of the outbreak is actually contagious? Is it anywhere that is red, or is it mainly just the blister itself? Will bandaging only the blistered area during an outbreak protect the virus from spreading to others or can it spread from any part that is red?
3. I've read that once it is in an infected area, the virus can spread to other parts close by on that same area, so is there a potential that the next outbreak will be further spread out on my arm, thus giving my whole arm and leg potential to shed the virus?
4. Will it always break out in those spots? I find it curious that this second outbreak (or continuation of a primary outbreak) only appeared in those spots and not the genital region.
5. I know women with HSV2 can still have babies, but I'm concerned that if I have it on my wrist that I will never be able to hold a newborn baby. I know obviously if I have visible sores that I should avoid a baby at all costs, but what about when there is nothing there and it sheds without me knowing?
6. Im concerned about it spreading to other parts of my body. I know auto inoculation is rare after the first outbreak, but my wrist is too close to my face for me to be comfortable.
7. What about shaving my legs? I know when there is an outbreak I should avoid the area completely, but when there is nothing there can I still shave over the area or will that spread the virus to other parts of my leg?
8. Manicures/pedicures used to be a huge part of my life. I would never want to infect anyone with this disease. Would it be safe to tell them to only touch my hands and my toes, or is this too risky?
9. My gyno placed me on a permanent Valtrex prescription. Is there a risk associated with becoming too dependent on antiviral meds, or a chance that the disease will become resistant to the medicine? I've also read that being on permanent antivirals can cause the virus to mutate and cause different strains.

Category: Infectious Disease Specialist

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Category: Cosmetic and Plastic Surgeon
 26 Doctors Online


Thanks for posting your query at DoctorSpring. I can understand your concern.

Its definitely herpes that you have got on the leg and wrist.

Its secondarily infected with staphylococcus bacterial infection

You would require to apply an antibiotic cream along with taking valtrex.

Asymptomatic shedding occurs from mucosal surfaces and not from the skin.

Hence the skin on your wrist and leg will not keep shedding the virus and won't be a source of infection to others.

The blister fluid and open sores are contagious, so you have to be careful that it doesn't come in contact with others.

It could be a site of future recurrences.

You can shave the area once the lesions have completely healed.

Manicures and pedicures won't be a problem.

Your doctor will put you on valtrex for a few months and discontinue it after that.

It doesn't cause any addiction and relatively free of causing resistance.

Its safe to take.

Please don't worry, it will get better. Please feel free to discuss further.

Take care.

Patient replied :

Thank you, that made me feel a little better. That is the first definitive answer I've received in weeks.

The ER gave me a 7 day Bactrim prescription for the staph, but I only have 3 days left and as you can see from the picture it doesn't look like it's going away very fast. If it is still red by the time the prescription runs out do I need a refill right away? I am not able to see an ID doc until next Saturday. Will it come back full force if I am off it for a few days and it's not completely gone? Will a topical cream like neosporin (not on the blister itself) help the bacterial infection?

Also, you can see from the pictures the blisters seem to have gone down but this has lasted a full week so far. It also looks like it is spreading underneath the skin, is that possible? On my wrist, when the blisters were broken out it was a very small area, but it looks to me like the redness has spread further up my arm and further to the left of the original breakout.

Other than medicine, is there anything I can do to make it less of a site for future recurrences? If the skin is not easy to break in those places in the future, would it make it less likely for a breakout to happen?

I'm also concerned about how much it spread from the first time. The first time there was only one big blister in each location. I'm sure the one on my leg was exacerbated by the bacterial infection, but each time it comes back is there potential for the site to get bigger every time?

Lastly, do outbreaks on places like the wrist and leg take longer to heal than on the genitals? It has been exactly one week since I first had the outbreak and I have been on Valtrex for 5 days now. During my first outbreak last month, the genital region cleared up within 3 days of taking Valtrex.

I appreciate your help. You are the only person who has listened to my concerns so far.


Thanks for your reply.

Neosporin cream would be beneficial for the bacterial infection.

You need to continue taking bactrim fir a total of ten days. That would be enough to resolve the infection.

The blisters don't spread underneath the skin.

The redness is the bacterial infection which has spread in the surrounding skin.

There is nothing else to prevent recurrences.

Its not necessary for the site to get bigger every time.

Its taking longer to heal due to the superadded bacterial infection.

Take care

Dr. Kruti Jobanputra Banodkar
Category: Cosmetic and Plastic Surgeon
Diploma in Dermatology - Royal College Of Physicians & Surgeons Of Glasgow, UK , 2010
Residency - DNB, Dermatology -  K.J Somaiya Hospital, Mumbai, 2009
Medical School & Internship - MBBS - Dr. D . Y . Patil Medical College, Mumbai, 2004
Dr. Kruti Jobanputra Banodkar and 4 other Medical Specialists are ready to help you

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