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Oral sores, headache, dizziness, and neck aches
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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Oral sores, headache, dizziness, and neck aches

Hi,
I'm a 28 y.o. m student at a major university and my problem started almost one year ago.  It started with dizziness (feeling faint and lightheaded and can't balance standing up, but no feeling of room spinning) and headaches. It progressively got worse for about 10 days to a point where i barely could get out of bed.  I finally went to a hospital and was observed overnight. I got a CT scan because i had alteration in consciousness and diagnosis was chronic sinusitis.  I was prescribed sinus rinses and a regimen of z-pack. I felt those treatments didn't work. It took about a full month to recover

A few months after i noticed i started getting tiny sores in my mouth periodically especially on the corners of my mouth and the buccal mucosa. A few days later after the appearance of the sores i would get the dizziness and headache again. It feels miserable and i can barely function in my day to day professional work. I get these headaches usually around the temporal area but sometimes also parietal and frontal areas and also neck and shoulder aches. My muscles get weak with my hands feeling trembly. During one of my attacks i went to the student hlth clinic. I requested a hsv blood test and i was + for hsv-1.

Since then i've been getting mouth sores quite frequently maybe 1-2 times a month.  I think i may have contracted hsv-1 when kissing or engaging in oral sex with a sexual partner i barely knew. My dr. at the student clinic put me on valtrex 1 gm q day for one year for "suppresive therapy." I stopped after 2 months. Now the dizziness, headaches, neck aches, and muscle aches are back along with mouth sores and also photophobia with bright light seeming to fade in and out with a pulsating rhythm.

I want to know if these symptoms are due to the hsv-1 virus and what is the long term prognosis. What else can this be? Do i have something more serious like viral encepahlitis?  Will i have to live with these horrible debalitating symptoms for the rest of my life?
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Welcome to the forum.  I'll do my best to answer.  Oral herpes is not an STD, but OK for this forum.  Still, you might consider also asking the question on MedHelp's herpes forum, which covers all aspects of herpes in addition to genital HSV and sexual transmission.

Recurrent oral herpes outbreaks are almost always outside the mouth, on the lips or elsewhere on the face.  Almost all episodes recur in more or less the same place each time.  In one person it might be right side of the upper lip, and the next might have his or her outbreaks on the left side of the chin, and someone else might have outbreaks next to a nostril.  Further, it is uncommon for oral herpes outbreaks to recur more often than every 2-3 months; usually it's no more than once or twice a year.  Finally, recurrent herpes is not associated with any systemic symptoms:  no fever, no headache, and certainly not muscle aches, trembling etc. Just the localized blisters that then become open sores or scabbed lesions that heal over 1-2 weeks.  And herpes doesn't cause sinusitis or sinus-like symptoms (nasal congestion etc).  Also, presumably you stopped taking valacyclovir (Valtrex) because it wasn't helping.  Is that right?  If so, it is further evidence against herpes as the cause of your symptoms.

For those reasons, I very much doubt that oral herpes explains any of your symptoms, including the sores in the mouth.  Perhaps your doctor prescribed valacyclovir (Valtrex) as a trial, in the hope it would help, not because s/he was convinced herpes is the cause.  However, you don't say enough about it.  Did s/he diagnose herpes?  

Your positive HSV-1 blood test doesn't change any of this.  Almost certainly you have asymptomatic HSV-1 plus some other cause of your symptoms.  If you have HSV-1, with or without symptoms, it is not valid to suspect any particular sex partner as the source.  HSV-1 is just as frequent in virgins as in people with multiple sex partners.  Most asymptomatic infections diagnosed in adults were acquired in childhood.

As for other explanations, for sure you don't have encephalitis.  But we don't speculate on this forum about causes once an STD is excluded (and certainly there is nothing in any of this that suggests any STD).  You should continue to work with your doctor about it.

Good luck--  HHH, MD
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H. Hunter Handsfield, M.D.Blank
University of Washington
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