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Herpes simplex virus type 1 (HSV-1) is a common cause of cold sores around the mouth. Herpetic whitlow is an infection on the fingers involving exquisitely painful blisters that are caused by transfer of the virus from other areas of infection, most commonly cold sores or fever blisters, to the hands and fingers. However, some individuals do not have symptoms but can still transmit the virus. Fire fighters may repeatedly encounter HSV infections as these are among the most common maladies affecting humans.


Mode of Transmission:

Direct Contact


Examples of Transmission:

The herpes virus is quite contagious and is transmitted in three ways:

  • Direct contact of open skin (a wound) with a herpes lesion

  • Contact with saliva that is contaminated with the herpes virus

  • Self-infection (for instance; nail biting in someone who has oral sores or fever blisters



Avoid direct contact with herpes sores





Signs and Symptoms:    

Herpetic whitlow Signs and symptoms following an incubation period of 2-20 days and may include:

  • Pain, burning, tingling in infected finger

  • Redness

  • Swelling

  • Blisters or Vesicles filled with clear fluid, that will resolve by first crusting and then healing in 7 – 10 days

  • Lymph nodes in the armpit may swell and become painful

Oral herpes infections are largely responsible for occupational exposure and appear as:

  • Blisters or ulcers in the mouth, gums, lips, throat and face

    • Blisters are filled with clear fluid

    • Skin around the blister is raised, red and painful


Complications that may occur with any herpes virus include:

  • Recurrence of the disease throughout a person’s life.

    • Recurrent episodes are typically triggered by stress, excess sun exposure, surgery, hormonal changes, and other illnesses.

  • Bacteria can infect the skin before the blisters heal if the skin is contaminated.

    • Never try to cut out any of these blisters as this may spread the infection or lead to a bacterial infection in addition to the viral one.

  • The virus can also spread to other areas of the skin and body.

    • A troubling fact is that “Herpes infection of the eye is a leading cause of blindness in the United States, causing scarring of the cornea.”


Immediately Following Exposure: 

  • Skin exposure (non-intact), immediately go to the sink and thoroughly wash the skin with water and soap for at least 15 minutes.

  • Skin wound, immediately go to the sink and thoroughly wash the wound with soap and water and pat dry.

  • Splash to eye(s), nose or mouth, immediately flush the area with running water for at least 15 minutes, and then immediately go to the ED because can lead to blindness.

General Post Exposure Treatment: No treatment currently exists that will cure herpes infection. Antiviral medications such as acyclovir, famciclovir, and valacyclovir may help the symptoms go away sooner and decrease some of the pain. Any blisters near the eyes require professional medical attention and evaluation. Herpetic whitlow will resolve without treatment but medications for symptomatic relief are available. 

Paperwork Required (If an injury occurred)

  1. The City “Report of Employee Injury” form

  2. Medical Service Order- RM -67 (when medical care is required)

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