STDs Expert Forum
Question about HSV
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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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Question about HSV

Hello doctor. I'm a 31yo male. I performed unprotected cunnilingus last Saturday on a girl whose health status I didn't know. 2 days later, on this Monday, I developed a cold sore on the tip of my lip, and some mild flu symptoms like stiff nose. I didn't seem to have fever, nor is my throat swollen. However I felt the lymph on my neck ache a bit (especially when I am turning my head to sides) and seem to be a bit swollen. I'm not sure if it is my lymph but the place hurting feels like a point in the neck near the location of lymph so I guess it is the lymph instead of muscle. When I brush the skin on my neck on the same side of the cold sore, the skin also felt a slight pain, and I couldn't tell exactly where on the skin hurts. I have had cold sore before but never tested for HSV. I have a few questions regarding HSV infection.

1. Does my symptoms sound like HSV?

2. Is it likely I catch HSV 2 from this exposure? Does the first outbreak of HSV look different than recurrent ones?

3. Although HSV doesn't ususally cause big health issue, it may hurt much psychologically on my partner. I learnt that HSV antibody test is not so accurate and is not usually recommended. If I want to make sure that I'm not infected with HSV 2, would it be helpful to take the test? What is the rate of false negative?

4. Will it be more accurate if I go to test during an outbreak, maybe to do a swab and PCR? And if the result is only HSV 1, can I be sure that I don't have HSV 2?

5. Can I have unprotected oral sex with my future partner? If I suspect but not sure whether I had HSV 2, should I inform my future partner about my doubts?

Thank you very much for your time, doctor!
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Welcome to the forum.  Thanks for your question.

The main STD risk from this exposure may be that you exposed your partner to HSV-1, putting her at high risk for genital herpes.  More about this below.  Going directly to your questions:

1) Leaving aside the sore on your nose, your symptoms are not at all suggestive of a new oral HSV infection.

2) The chance of oral herpes, from any single episode of cunnlingus on a woman without known herpes, probably is under 1 in many thousand.

3,4) I would not recommend you have an HSV test on account of either the exposure you have described or your symptoms. If a PCR test from your mouth, or the lesion on your nose, show HSV, the lab can easily determine whether it's HSV-1, HSV-2, or both.

5) I don't think it's helpful to speculate about whether or not you have HSV-2 based on the information you have provided here.  However, HSV-1 is a different story.

Which brings me back to my opening point.  Your comments suggest you have a history of recurrent cold sores (oral HSV-1), and your recent cold sore was a typical outbreak like others you have had.  Is that right?  If so, there is a good chance you were shedding virus at the time you performed oral sex 2 days earlier.  You are ethically obligated to immediately contact that partner and tell her to be on the lookout for genital herpes symptoms.  When you do that, you can also ask her about whether she has known genital herpes.  All things considered, I would judge the risk of genital HSV-1 for your partner is far, far higher than your chance of oral HSV-2 from her.

Of course let me know if I have misunderstood something.  But if not, I'll be interested to hear how it goes after you have spoken with her.

Regards--  HHH, MD
2 Comments
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Thank you for your advise, doctor. I never realize I may have brought her any risk because at the time of the contact I didn't have any symptoms. I have told her about it and asked her to watch out for sore or lesions in the next 14 days. I read in other posts in the forum, that if she does not develop any symptom in 14 days, she does not have to worry about HSV, is that correct?

To clarify my symptoms, I do not have sores on my nose. I only have one sore on the corner of my lips. Nothing else showed up on my nose, except having a stuffy nose which was like having a flu. I did have recurrent cold sores which looked like the description of an HSV outbreak. However during those outbreaks I never had flu like symptoms. Because of these symptoms, I was not sure if it was another recurrent outbreak or a newly acquired infection, and whether my symptoms was coming from a real flu.

Thank you for pointing out the risk I may pose to others. Actually that is very much the question I want to ask. It seems I may have oral HSV 1. But if I can shed virus before I have symptoms, I won't know when I'm infectious. So does that mean I shall never perform unprotected oral sex on future partner? Can I kiss another person during an outbreak? What is the chance of infecting an HSV negative person if his/her mouth or genital area came in contact to a HSV sore?

Also if it is possible, could you kindly explain a bit more about 'HSV-1 is a different story' please?

I know the consequence of HSV and am not quite worried if I caught one. But I do not want to harm my future partner's health. Could you give me some advise please? Please let me know if I need to create another thread for this question. Thank you very much for your help, doctor.
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