Wife to husband transmission of Ecthyma contagiosum (Orf)

A 27 year-old man was referred to the dermatology department for two recent ulcerations of the shaft of the penis. There were regularly edged, indurated, eroded nodules measuring 15 and 8 mm in diameter, with fibrinous surface and serous exudate (Fig. 1). He had no pain, no fever and no lymphadenopathy, was recently married and reported that he did not have any previous disease and that his wife was also healthy. The patient was taking no treatment and denied any sexual intercourse with other partners except his wife. He had no other mucous membrane lesions. His wife had no anogenital and oral lesions. Infectious causes were first considered including atypical genital Herpes simplex virus (HSV) infection, primary syphilis (“Treponema pallidum”), chancroid (“Haemophilus ducreyi”) and lymphogranuloma venereum (“Chlamydia trachomatis”). Other hypotheses were aphtae, traumatic ulcerations, pyogenic granuloma and skin tumor. Bacteriological tests were negative for syphilis (Dark field microscopy), chancroid or lymphogranuloma venereum (PCR detection test). HSV culture and PCR detection were negative as HIV, HBV and syphilis tests. He returned with his wife to have the results of these tests and to show us a lesion that developed a few days before the occurrence of his genital lesion on his wife’s index finger. This lesion was very similar to his genital lesions. She put topical treatments including silver nitrate solution that colored the lesion and surrounding skin in black (Fig. 2). She had no pain, no fever and no lymphadenopathy. This digital lesion began as a reddish papule that formed a large hemorrhagic pustule then followed by this erosion and pyogenic granuloma-like lesion. She revealed that this lesion developed 5 days after she prepared the sacrified lamb for the Muslim feast. Her husband did not touch the lamb or any suspected contaminated material. A clinical diagnosis of ecthyma contagiosum (Orf) was made. Spontaneous recovery was observed in both patients within 3 weeks. Ecthyma contagiosum is a viral disease caused by a parapoxvirus of Poxviridae family, a double-stranded DNA virus. It is epizootic in sheep and goats and affects mainly young lambs [1]. It causes a self-limited infection in humans. Skin lesions occur after direct inoculation by infected material or contact with infected animals [2]. The typical lesion is a pustule or a nodule. It is observed on the hand of farmers, meat handlers or after sheep slaughtering for religious feasts. It is usually a benign condition and no specific treatment is required. Orf infection is exceptionally transmitted between individuals through direct contact or infected material [3,4]. Transmission occurs in close family contacts: mother to child, wife to husband as illustrated in this