Auto-inoculation, can I spread my herpes by touching it?

The quick answer is Yes, but that answer is quite vague and lacks explanation. I hope you’re sitting down.

Auto-inoculation - The act of self-infection with a virus (herpes simplex), that previously exists within the host. This occurs by touching an open lesion and scratching another area of the body or directly touching areas of the body that consist of mucosal membrane surfaces (e.g., mouth, vagina, anus, inside of the nose and the eyes). An example of this would be; using your fingers to pop an outbreak open and directly introducing the virus to breaks in the skin on your cuticles. 

According to some data, many doctors and some scientists have stated that Auto-inoculation is most likely to occur soon after primary infection when antibody titers are still increasing. But is this truly applicable? And does this answer encompasses the entire population of people infected?

I would say no, considering the simple fact that not every person who has contracted herpes simplex has a great immune response to it. Some people experience outbreaks more often than others and this can be a good indication that this persons immune response is not up to par or favorable enough to provide optimum protection.

When we look at the population of people who carry herpes simplex, it's pretty clear that many share common symptoms. While most of the human population are entirely unaware they carry the virus, others will suffer severe and extreme symptoms. Interestingly, the virus has not changed, but the only variable here is a person's immune response to this viral infection. 

When we talk about Auto-inoculation, many assume that because they have an established antibody response to herpes, this means they are entirely protected from new infections.

However, when we look at the true nature of the virus and the different levels of symptoms that take place in-between individuals (who never experience symptoms and those who do), it's clear that this so-called antibody protection is not always favorable and can vary due to an individuals immune response or lack thereof. 

But I was told my antibodies protect me...

"Antibodies are never 100% perfect. Some people think they are, but in many cases, they don't PREVENT infection, but severely mitigate what may come from an infection. So prophylaxis in a disease setting may merely mean preventing signs/symptoms/disease, not necessarily preventing exposure and a modicum of infection."

"The ability of antibodies to prevent infection is proportional to their level, and even then, it's dependent on how well and where they bind. It turns out its basic chemistry of a binding reaction, which depends on the affinity and concentration of the interacting partners.

Antibodies can't be everywhere at the same time, but repeated stimulation can raise the concentration level to take care of part of that chemical binding equation.

But even if the antibodies bind a virus particle with high affinity, they may still be reacting with a non-essential epitope, meaning the fabulous antibody reaction is for naught; the virus still evades that element of the acquired immune response.

Also, the same could be said for cellular responses, or any other element of the specific immune response; much like individual soldiers in an army, if one is to combat an invader, the sheer number of protectors that all have the proper recognition of the invader AND have the right weapons to fight the invader must be present at a high enough level exactly where the invader is trying to enter in order to staunch an invasion.

TL;DR: more competent soldiers (e.g., antibodies) at the right spot and the right time, otherwise the pathogen can slip through."

- Barry Margulies, Ph.D. Associate Professor of Biology, Molecular Virology Director, Towson University Herpes Virus Lab Department of Biological Sciences Towson University Maryland

What about Shedding?

Regardless of our antibody response, the virus still has the ability to reactivate from latency, and shed viral material during episodes of being asymptomatic. Dr. Halford can explain...https://www.youtube.com/embed/i1bCXuxfxzk

It's the opinion of many scientists that people who are entirely asymptomatic will still shed the virus 10% of the time during the year. Many individuals who are either unaware of their positive status or those who never experience symptoms can still shed the virus (according to the numerous studies). These intervals of shedding can last 5 minutes, an hour, days, or even a week.

These episodes will take place in the absence of outbreaks and whether or not there is enough viral material to infect another person, can never be determined. Many studies will still indicate the chances of passing on the virus during this time are still quite low. However, the argument can yet be made about making that determination of being asymptomatic.

You will read that many shedding studies will use the term "asymptomatic." Still, the point is arguable that a person was simply unaware they were symptomatic and that that small area of redness or pimple they were experiencing was, in fact, an outbreak. Therefore that person was not asymptomatic in the least.

This is one of the many reasons why most scientists believe that asymptomatic shedding is how most herpes infections are transmitted, unknown to both parties involved. {1} There is also a great deal of evidence to show that a person's antibody response to the virus isn't always protective and is not always favorable. Protection is never 100%. {2}

It is clear that discussing subjects like this on social media, they will always be met with opinions and arguments. As an example, this particular statement has surfaced more than a few times...

"I've had herpes for over 20 years, and I have popped blisters with my bare hands and never experienced any new outbreaks, I'm doing just fine."

Whether or not any of this is true, I would never suggest that this behavior is a great idea. The act of directly touching and popping a herpes blister, bare-handed and omitting the washing of hands sounds a bit crazy to me. Everything about this looks like a laundry list of "Things you should not do." But hey, it's your body and your choice—still, a terrible idea of tempting a virus that bears no prejudice whatsoever and gives no quarter. There are many reasons as to why you shouldn’t play around with a live outbreak or have sex during symptoms. I discuss some of them here: Herpes Type or Strain, what's the difference. and here What is the risk of getting herpes?

Many of us assume that if we see an outbreak (in one area), this must be the only area that is infected, but there's no way to know that for sure. It's interesting to mention, that people who have never experienced an outbreak (but test positive for herpes), will assume that their type (HSV-1 or HSV-2), has positively identified the location of the virus on their body. Still, there is no way to know this definitively; it's really just a guess. And let's not forget you can get either type of herpes anywhere on the body, or that 50-78% of all new genital infections are HSV-1.

 In most cases, auto-inoculation may not be seen due to a lack of symptoms or lesions. However, a lack of symptoms is never proof that an infection did or did not take place. We are strictly speaking about the probability of occurrence based on the biology and the behavior of the virus. The only way to verify a new infection is to swab the area for the shedding of viral material or to visually identify an active lesion.

I would imagine your doctor would gaze upon you crossed eyed when you ask for a swab test on your hand, when there are no clear signs of an infection being present.

There are many examples of the virus's ability to avoid the antibody response {3} and there is also evidence to show that auto-inoculation can happen quite easily.

A common one is in children who infect their hands from the act of touching a cold sore (this also occurs in adults). This infection of the hands is called Herpetic Whitlow.

These are just a few examples;

 A 4-month-old female infant presented with a vesicular lesion on her left hand present since 1 day. A few days prior to presentation, she had a similar lesion on the lower lip.

https://casereports.bmj.com/content/2017/bcr-2017-220447

 Salivary Mediated Auto-inoculation of Herpes Simplex Virus on the Face in the Absence of “Cold Sores,” After Trauma.

https://www.joms.org/article/S0278-2391(07)00230-3/pdf

 Herpes simplex virus infections involving the fingers and hands have been reported primarily in medical and dental personnel.

https://www.amjmed.com/article/0002-9343(85)90560-1/abstract

"Auto inoculation" may occur very infrequently: a situation in which touching a sore on your lip or other parts of your body, and then touching your genitals may result in developing herpes in that area. A rare complication of herpes can occur when herpes is inadvertently transferred to the eyes. Washing your hands well after contact with herpes lesions, before touching your eyes or put- ting in contacts is an important precaution.

Tell your provider if you notice eye pain, a foreign body sensation, extreme sensitivity to light, redness, discharge, or swelling of your eyes. PDF Brown University

Herpetic whitlow refers to primary or recurrent herpes simplex virus (HSV) infection of the hands or, rarely, the feet. It is seen most often in children less than 10 years old and adults between 20 and 30 years.

The condition typically results from autoinoculation in children with orofacial HSV type 1 (HSV-1) infection, autoinoculation in adults with genital HSV type 2 (HSV-2) infection, or occupational exposure of healthcare workers to patients with active lesions or infected saliva. Before the implementation of universal precautions, dental and medical personnel were among the most commonly affected individuals.

Clinically, patients with herpetic whitlow may complain of prodromal tingling, pruritus, or burning; fever, regional lymphadenopathy, and lymphadenitis also may be noted infrequently.

https://www.sciencedirect.com/topics/nursing-and-health-professions/herpetic-whitlow

Can you auto inoculate yourself and spread HSV-1 it to your genitals?

Unfortunately, the answer to this one is yes. People tend to think of Herpes Simplex Virus 1 (HSV-1) as the "cold sore" virus and HSV-2 as the "genital herpes" virus. But both HSV-1 and HSV-2 are spread by direct skin-to-skin contact, and either can infect the mouth or genitals. So if you were to touch a cold sore on your mouth and then touch your genitals, you could theoretically cause an outbreak down there.

The good news is that medication lessens the duration and severity of outbreaks (which tend to decrease in frequency and severity overtime on their own anyway), so if you are staying on top of your cold sore outbreaks with suppressive medication, the odds of you doing this are very, very small. 

- Credit EDU

The idiom of skin to skin contact is quite vague and lacks definition. More info on what that really means here: Is herpes transmitted from skin to skin contact?
 

Primary and recurrent HSV-1 infections can involve the facial, nasal, ocular, or genital mucosa or digits [7]. An infected individual may "autoinoculation" or self-infect by spreading the virus from one infected anatomic area to another when the virus is being shed [8]. (In one study, 67% of patients presenting with herpes simplex labialis [HSL] were found to have to have HSV-1 on their hands [9]).

Auto-inoculation is more likely to occur with primary (as opposed to recurrent) infections and is more likely in HSV-1 as opposed to HSV-2 infections [7,8]. Patients seen in the emergency department with suspected or confirmed HSV-1 primary infections should be warned of this possibility and instructed regarding fastidious personal hygiene. Sharing of kitchen utensils, kissing, and other oral contacts, including oral-genital sexual activity, should be avoided [4].

Patients should be encouraged to wash their hands frequently [4]. Viral shedding (therefore contagion) begins with the prodrome and can continue for as long as several weeks after a primary infection or for as short as 3 to 5 days after a recurrence [5,6].

There is some concern that an infected health care worker could be a source of nosocomial herpes infection [10]. Literature suggests that HSV-1 and HSV-2 can persist on inanimate surfaces for between 4.5 hours and 8 weeks [34]. Therefore, without proper hand washing, nosocomial transmission is theoretically possible. ("Management of Oral and Genital Herpes in the Emergency Department" by Howard K. Mell, MD, MPH )

So the answer is Yes.

As you can see, there is a great deal of evidence to show that touching an active outbreak and then touching/scratching other parts of your body (or others), is not without risk and a bit of a terrible idea.

Saying I'll be okay because of my antibody response is not entirely accurate and straight-up ignoring the probabilities. I know, I know, it sucks, and I'm sorry for the doom and gloom. 

I think that many of us (including my past self) assume that if something is on my body, it's a part of me, so who cares, right? Unfortunately, it's still a virus that uses us as a host and is still infectious when it presents itself—like the worst roommate ever. 

I think it's important to remember that herpes is not the end of the world and you're not infectious all of the time.

The best advice I can offer is to be aware of your symptoms, do not engage in activity with a partner (if you're experiencing an outbreak), and if you touch an outbreak...wash your hands. :)

Woman photo created by diana.grytsku - www.freepik.com

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