Pathophysiology
- HSV-1: Primarily oral transmission. Infects orolabial region. Latent in trigeminal ganglion
- HSV-2: Primarily sexual transmission. Infects genital region. Latent in sacral ganglia
- Primary infection: Often more severe with systemic symptoms (fever, malaise, lymphadenopathy)
- Latency: Virus persists in sensory ganglia indefinitely. Immune surveillance keeps it dormant
- Reactivation: Virus travels back down sensory nerves. Prodromal tingling/burning precedes vesicle eruption
- Asymptomatic shedding: Virus can transmit without visible lesions
- Herpetic whitlow: HSV infection of the finger — occupational hazard for healthcare workers and MTs
Signs and Symptoms
Hallmark Indicators
- Prodrome: Tingling, burning, or itching 24-48 hours before lesions appear (area is already contagious)
- Active lesions: Clustered vesicles on an erythematous base that rupture into shallow, painful ulcers
- HSV-1: Typically on lips, perioral area
- HSV-2: Typically on genitals, buttocks, upper thighs
- Crusting and healing over 7-14 days
- Recurrences tend to be less severe and shorter than primary infection
Red Flags and Rule-Outs
- Active vesicles or prodromal symptoms: Highly contagious — absolute local contraindication
- Systemic symptoms (fever, malaise, widespread lesions): Reschedule entire session
- Herpetic whitlow on therapist's finger: Therapist should not treat until fully resolved
- Asymptomatic shedding: Transmission possible without visible lesions — standard IPAC always important
MT Considerations
- Local contraindication (active outbreak): Do not touch active lesions, prodromal areas, or recently healed crusts
- Herpetic whitlow prevention: If contact with an active lesion occurs, wash thoroughly. Consider antiviral prophylaxis
- Systemic outbreak: If client has fever, malaise, or widespread lesions — reschedule entirely
- Between outbreaks: Massage is safe and appropriate when no active lesions or prodromal symptoms are present
- Client communication: Encourage disclosure of active cold sores before face-down positioning
- Face cradle hygiene: Sanitize thoroughly between all clients. Use disposable covers when possible
- Therapist self-disclosure: Therapist with an active cold sore should wear a mask or reschedule
CMTO Exam Relevance
- HSV is a lifelong infection with latency in sensory ganglia and periodic reactivation
- Active lesions and prodromal symptoms are highly contagious — absolute local contraindication
- Herpetic whitlow is an occupational hazard for MTs — never touch active lesions
- Asymptomatic shedding means transmission can occur without visible lesions
- Prodromal tingling/burning means the area is already contagious before vesicles appear
Key Takeaways
- HSV-1 (orolabial) and HSV-2 (genital) cause recurrent vesicular eruptions. Latent in sensory ganglia for life
- Active lesions and prodromal symptoms are contagious — absolute local contraindication
- Herpetic whitlow is an occupational hazard for MTs
- Between outbreaks, massage is safe and appropriate
- Standard IPAC protocols are always important due to asymptomatic shedding