Is it possible to have oral HSV-2 only?

[scared788]

I am female and have been prone to cold sores for many years although they increased in frequency about 5 or 6 years ago.  About a year ago I went through a variety of tests due to fertility issues.  When they came back my Dr. asked me if I ever had cold sores and I confirmed that I did.  I wasn't surprised by this question since I fully expected to be positive for HSV-1.   I recently received copies of all of my medical records in preparation of changing doctors and I found that I tested negative for HSV-1 and positive for HSV-2.  The doctor never said anything about this.   I have not had any sores on my genitals but I do get cold sores an average of once or twice a month.  Is it possible to have HSV-2 orally only?  I am very careful about kissing etc. when I have a coldsore and my boyfriend of 4 years has never shown any signs of either oral or genital herpes.     I'm very distressed about this and I won't be able to get in to see my Dr. for several weeks so I'm grateful for any insights you can give me.  What are the chances that I have genital herpes and don't know it?  If it's possible how can I know for sure if I don't have any sores that can be cultured?

[Edward W Hook, MD]

Thanks for the clarification.  You are correct, my message is that while having cold sores due to HSV-2 is unusual, it certainly happens.   I hope my comments helped.  EWH

[scared788]

Thank you for your response.  My concern about the difference was because I can find very little information on cold sores caused by HSV2 - in fact one doctor on one site said he had never seen recurrent colds sores due to that form of the virus.  Since I have recurrent cold sores I was worried that it meant that I also must have the genital variety since that is where HSV2 is typically found.  What I take from your response is that while it is apparently unusual, it is possible to have it present orally only.  Thanks again.

[Edward W Hook, MD]

The situation you describe is most unusual.  If you have recurrent, typical cold sores (and it sounds like you do), you have a herpes virus. For HSV-2 to be the cause of cold sores is unusual but it does occur.  If your lab test was a reliable, type-specific test there are several possibilities including that the results were entered incorrectly or that you have cold sores due to HSV-2.  If it is important to you to know which is the case, it may be worthwhile to repeat the test.  Even better, should you get a cold sore, it would be good to get a culture or PCR test as quickly possible to get a definitive answer.

I note an element of concern in your note as to whether your cold sores are due to HSV-1 or HSV-2 and feel it is proper to ask why it matters.  Either way you have cold sores, either way the prevention steps you describe are appropriate.  Both are just viruses.  I am not trying to minimize your cold sores but really fail to see the distinction between which of these two closely related viruses you might have.

Given that you have symptomatic cold sores and no genital lesions, it would be a bit unusual to have genital herpes.

Hope this helps. Take care.  EWH