Mono/STD's

[virgogirl73]

Hi doc.  This is a follow up to a post from a couple of weeks ago entitled sore throat/std’s.  I have a recurring really bad sore throat and tested positive for mono yesterday.  According to the dr. I have a lot of lesions in my throat and started to get them on the roof of my mouth.  I questioned her as to whether they could be std related and she said the only thing she could think of was maybe herpes, this was before my mono test came back positive.  I know I have read on this board that std’s wouldn’t cause a sore throat except for maybe gonorrhea, did I read that wrong?  Is it possible to have mono along with an STD, I just think it’s strange that I have all these lesions on the roof of my mouth, most of them just started to appear today.  Secondly, I am still concerned about hiv even though I have minimal risk (I think) and the dr. said it was a waste to be tested since I already tested positive for mono and that’s what all my symptoms are from.  I read that if you have mono you have an increased white blood cell count and if you have hiv you have a low blood cell count, so is it possible to have both?  I have two infected blistering pimples on my face, which may be cold sores, but they are not attached to my lips, and are wondering if they are infected just because I have this mono virus.  I’m still concerned about hiv but am pretty much bed ridden for a while now so I can’t get hiv tested elsewhere.  Do you have any thoughts on the situation?  Thanks for your time.

[H. Hunter Handsfield, M.D.]

All your symptoms indeed could be due to mononucleosis.  If your doctor did a specific test for mono and it was positive, the diagnosis probably is accurate.  While classic mono is due to a specific virus (Epstein Barr virus, or EBV) other infections also cause mono-like illnesses, which likely explains your childhood diagnosis.  EBV infections are most common in childhood and the teen years, but first infections often occur in adults.

There is no reason you couldn't get both mono and HIV, herpes, or another STD at about the same time or even at the same exposure.  It sounds like your HIV risk indeed is low.  However, sore throat, fever, and mono-like symptoms are the main manifestations of primary HIV infection, so it is reasonable for you to be tested; and the same symptoms could be caused by herpes.  Based on your implied risk history, the results of either HIV or HSV tests almost certainly will be negative, but why take even a small chance of missing such important diagnoses, especially HIV?  And you'll sleep better knowing for sure the test is negative.

I can't comment further on your specific symptoms.  The white blood cell count can be high, low, or normal with mono/EBV and with several other infections.  You should discuss those details with your doctor.

Good luck--  HHH, MD

[virgogirl73]

Sorry, one other thing.  I guess I’m just questioning the mono diagnosis because my mom told me I had it when I was little and I heard you can’t get it twice plus I’m 31 years old and it’s a “teenage” disease. I've never had worse throat pain in my life or these strange lesions in my mouth so it's hard for me to be convinced that it's just mono.  There is not much written on the details of mono, just severe sore throat so of course I need to jump to conclusions!

[kobeb0824]

Hey doc sorry to post on someone else's thread but I have a similar situation. I have also had a very sore throat for 2 months now. last exposure was 3 months ago I had unprotected vaginal sex for 2 or so minutes. I tested negative for Hiv out to 9 weeks. One at 2,5, and 9 weeks. Is 8-9 weeks enough to rule out hiv? I'm scared because I have never had a sore throat that lasted this long. I'm going to planned parenthood next week, I was wondering what I should test for. I took  antibiotics a few weeks ago, it got better but came back. What can it be, can you give me some advice? Thanks .

[H. Hunter Handsfield, M.D.]

Negative test at 9 weeks makes it almost 99% certain you don't have HIV.  No STD would be likely to cause sore throat persisting so long.  See what the PP provider says.

HHH, MD

[kobeb0824]

Thanks doc,I'll do that so would you reccomend testing for Hiv at pp? I doubt I need to it would just be for peace of mind, what do you think?

[H. Hunter Handsfield, M.D.]

If you will sleep better knowing you have another negative test beyond 9 weeks, there's no reason not to do it.

HHH, MD

[virgogirl73]

Well the saga continues.  I went back to the dr. yesterday and I have some kind of infectious disease on top of the mono.  Her best guess, oral herpes.  Again, I mentioned hiv testing and she said not necessary.  To find out about herpes she did a throat culture which won't be back until next week.  I also did more blood work yesterday because in order to treat that she needed to check my liver, spleen, etc... sound about right?  I have blisters on the top and sides of my mouth and a few cold sores on my face.  The dr. spoke with an infectious disease friend of hers and he said that would be his best guess but he won't know for sure until the tests come back.  It looks like I won't know for sure what is going on until next week.  My question is if you have any advice on home treatment in the process.  The blisters in my mouth are okay but my throat still hurts which I'm sure is also from the mono but I'm more concerned with the ones on my face.  I'm getting tingling sensations on other parts of my face, sometimes close to my eyes which concerns me, so I'm waiting for others to show up.  Any creams I can use or how can I get down the swelling on the blisters/cold sores on my face?  Thanks.

[monkeyflower]

Didn't your doctor give you Valtrex or some other antiviral? For one thing, the fact that you feel tingling around your eyes would concern me, since you can get ocular herpes. I would definitely ask your doctor about this, and if she doesn't know, seek a second opinion. But if it were me, I'd do it soon (like today), so you don't have to suffer as much.

I hope you feel better soon!

[H. Hunter Handsfield, M.D.]

Monkeyflower is right:  if your doctors suspect herpes, they should have started therapy with one of the antiherpes drugs, valacyclovir (Valtrex), famciclovir (Famvir), or acyclovir (Zovirax and generics).  By the time the culture result is available, it probably will be too late for the drug to benefit you; and the drugs have virtually no side effects and would not interfere with diagnosing other conditions. I suggest you call back and insist on on treatment; if your PCP doesn't do it, call the ID specialist directly.

In the meantime, you could purchase one of the over-the-counter sore throat lozenges that contains benzocaine; it should reduce the pain from the lesions.

Good luck--  HHH, MD

[virgogirl73]

Thanks for the suggestions, the dr. told me she had to wait for the blood results today though before she could start any medication.

[H. Hunter Handsfield, M.D.]

I don't know what blood test would confirm that your problem is or isn't herpes and would therefore affect the treatment.  But if it's only a matter of waiting part of a day, it shouldn't be a big deal.  But I still think you should insist on anti-herpes treatment, unless your doctor things herpes really is a long shot.

HHH, MD

[virgogirl73]

I'm not exactly what the blood tests were for.  The dr. kept mentioning the blood tests were to make sure my kidneys, liver, etc... were okay before starting any other medication.  Of course I called for the results this morning and the dr. isn't in until 1:30 so I have to wait but am going to insist she prescribe me something because I don't want this to get worse plus it's painful along with the fact I still have mono.  I just don't know what else it could possibly be.

[virgogirl73]

Blood tests came back and I have a problem with my liver enzymes which could be related to me being anemic or the mono.  Dr. wasn't too concerned, says she will test again in three months.  Dr. says she has to wait for the throat culture to come back to prescribe anything for my possible herpes condition but after some begging and pleading I was able to get some samples of Valtrex so hopefully that will help.  If not, we'll just have to wait and see what the throat culture reveals.

[H. Hunter Handsfield, M.D.]

Mono often cause liver abnormalities, usually mild.  I'm sorry you had to beg for treatment.  If your mouth sores and sore throat don't start to improve after 2-3 days of Valtrex, that will be a pretty good indication herpes isn't the cause.  Post another message after the weekend and let me know how you're doing.

HHH, MD

[virgogirl73]

Hi doc.  I'm doing pretty good this morning.  I am able to sleep and eat so it's getting better.  My sores seem to be clearing up and I haven't gotten any new ones.  I don't know if it's the Valtrex working or the fact that this is the first time I've slept in about a week so I have to wait to see what the throat culture reveals.  Hopefully I will have that back today or tomorrow. I need to know how much of this is mono and how much is something else so I can get back to my normal life.

[virgogirl73]

I just heard from the dr. and the culture came back positive for Herpes 1.  She said there is no need for more Valtrax or meds that I'm done with that and it just needs to take it's course.  I have a ton of questions but I guess I'll have to wait for my appt with her on Wednesday.  Can you advise on any good websites or anywhere I can do some research, there is so much info on the internet I'm very confused and overwhelmed.

[monkeyflower]

I believe your doctor may be mistaken about HSV and Valtrex, because it's for HSV1 too... I would really look for another doctor to work with you on this.

[H. Hunter Handsfield, M.D.]

It's good the sores are clearing up, but like monkeyflower I am confused by your doctor's advice.  Valtrex is active against HSV-1 and is probably the reason you are improving.  If you stop treatment now, there is a high likelihood you will relapse.  Clarify with your doctor that she really wants you to stop therapy.  Normally treatment should be continued for at least a week after symptoms start to improve.

HHH, MD

[pitcho12]

Hello Doctor,
        I was recently diagnosed with mononucleous. My WBC is below 3,000 and I have a general feeling of maliase. That very day, I noticed two vaginal sores on the inside of my labia. I've only had one sexual partner, my boyfriend of over 5 years. He denies any genitalia sores and well as maintaining he has always been faithful, which I believe. The sores aren't very bothersome. They small and white with open areas but they have been slightly bleeding. I called my doctor and she saw me right away. She took a sample of the ulcerations and sent them to our lab for testing. She said that upon physical examination, they appear to be gential herpes but she noted that she has seen pts. with mono having open sores in the genital region. What's your take on it? Thank you!