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Sore throat and herpes
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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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Sore throat and herpes

Last week I had what I thought was a zit on the very for top of my upper lip almost near my nostril.  I tried to pop it but nothing happened and then it just became irritated and bigger and has a yellow looking scab over it.  On sunday I woke up with a sore throat.  By the evening I had a fever.  I went to a minute clinic and did a strep test and a flu test both of which came back negative.  They didn't prescribe me anything and just said take tylenol and gargle salt water.  My fever has been at from around 100 to almost 104 since Sunday.  My throat has gotten worse and it is very painful to swallow.  Today I went to an actual doctors office.  The doctor said she thinks is a viral infection and prescribe to me some antibiotics, prednisone, and an oral lidicaine for the pain.  She made mention that my throat was very red and there was an area that looked like an ulcer.  If it were just these conditions without the sore on my face I wouldn't think anything of it but things worries me.  I have no had sexual interaction with anyone but my girlfriend.  We have been in a monogamous relationship for 5 years.  I have no issues in my groin area or my penis.  It is all completely centralize to the fever, my throat, and this sore on my upper lip.  I'm really worried it's herpes
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239123_tn?1267651214
Welcome to the STD forum.

I think you are right to be concerned about herpes as a possible explanation for your symptoms.  That doesn't mean you have it, or even that it is likely -- only that your symptoms are compatible with a new oral HSV infection.  They aren't entirely typical; usually there would be multiple sores in the mouth and more than one lesion outside.  Still, the combination of your symptoms, including an ulceration in your mouth or throat, is suggestive and you definitely should be tested for it.

Therefore, I recommend you immediately phone your doc's office back and see if an HSV swab was done -- and if not, ask her whether she thinks it's a good idea, i.e. swab(s) from your throat and facial lesion for PCR (preferably) or culture for HSV.  (You could print out this reply and discuss it with her.)

The main reason it's important is for treatment purposes:  most viruses don't respond to any available treatment, even though prednison can help the pain.  But the anti-herpetic drugs (e.g., valacyclovir, acyclovir) are highly effective, but only if started as early as possible.  And the drugs are virtually without side effects, so it is safe to start treatment while awaiting the PCR or culture results.

If it turns out to be herpes, it would not be considered an STD.  Oral herpes is usually acquired by kissing, not by other forms of sex.  You could have caught it from your girlfriend, if she has oral herpes -- or from someone else in your environment.  Have you been around young children?  That's a common source both for herpes and for other severe kinds of viral pharyngitis.

And by the way, another possibility here -- in fact, perhaps the best bet -- is that you have a garden variety viral pharyngitis, plus recurrent oral herpes of the face.  There is a reason oral herpes is often called "fever blisters" or "cold sores":  infections like this trigger outbreaks.  Half of all adults have HSV-1, so you could have been infected for years without knowing it.

I'll be interested in hearing more after you have spoken again with your doctor, and/or if HSV testing is done.

Regards--  HHH, MD
12 Comments
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Avatar_m_tn
Thanks for the quick reply Dr.  I'll be contacting my doctor tomorrow about the test.  They did not do a HSV test I know that.  Both places I have been to both thought it was a viral infection but I didn't even think about the sore on my upper lip until tonight.  My girlfriend did tell me that when she was a little girl that she had a bad break out once of cold sores all over her lips.  My sister also had the same issue when I was younger.  I work at a college directly with students constantly and I also attend classes at the college so I am around a lot of people all the time.  My girlfriend was very sick last weekend with a bad fever and flu symptoms but no sore throat.  I hope it is pharyngitis because it would be nice to not have to deal with this again but from what I have read this first time with the herpes is the worst time.

Thanks for the advice and I will update with any news that I get.  
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239123_tn?1267651214
Since your partner had a similar illness, that increases the odds this is just a garden variety respiratory infection.  Or perhaps infectious mono -- both your and your partner's symptoms sound consistent with that.  And your doc may suspect mono, which is commonly treated with prednisone.
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Avatar_m_tn
Yes my doctor actually did do a mono test but it came back negative.  I've been reading up a lot more on herpes and am understanding a lot more about it.  I grew up in a strict baptist home and I'm feeling baptist guilt about it because herpes has always been considered something bad to me that only promiscuous people get.  

I will still go to give my doctor a call about my concern just so it can be narrowed down.  

I have read that either of the simplexes can be transferred to the mouth or genitals.  Is this true?  My concern is that if I have have either simplex how do I make sure that I don't transfer this to my girlfriends genitals.  It seems like in a short time we could both have herpes both oral and genitally.
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239123_tn?1267651214
Promiscuous?  No way.  Oral HSV is present in half the population -- and it sounds like your sister and girlfriend both have it, and so may you.  Even genital herpes is almost equally frequent in people with average sex lives as in those with large numbers of partners.

If what you fear were common, then everybody would have genital herpes due to HSV-1.  BUt they don't.  This is because people don't get second infections with an HSV type they already are carrying.  Most likely your gf is immune to catching your HSV-1 (if you have it) anywhere on her body, genital or otherwise.  People do not "ping pong" their HSV infections (of either type) back and forth.
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Avatar_m_tn
If it turns out to be HSV-2, would there be concern to give that to my girlfriend?
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Avatar_m_tn
Well as of this morning I have come to my own conclusion that I have a viral pharyngitis and a cold sore on my upper lip.  I do see some new small bumps next to the original mark.  

My sore throat is still sore but has change.  I now have practically lost my voice.

I have read so much about the rarity of getting HSV-2 orally and how most people have HSV-1 already and didn't know that I think I am worrying a little too much about it.
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239123_tn?1267651214
It is unlikely due to HSV-2, but if it were, you would have had to have caught it from your girlfriend -- in which case she is already infected and, for the reasons discussed above, wouldn't catch it again.
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Avatar_m_tn
Thanks so much for the help.  This was a question from girlfriend that she was interested in.  I joked with her to just be sure I would make out her a whole bunch to infect her orally so she didn't have to worry about getting anything genitally! haha
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239123_tn?1267651214
I know you're not serious -- but just to be safe, you and other readers should be clear that you and your partner should take common sense precautions. Her history suggests she may have had oral herpes as a child, and the overall picture suggests that if you have herpes at all, it is HSV-1.  But since none of this is certain, you should avoid kissing her (or anyone else) or performing oral sex until both your facial lesion and sore throat have cleared up.
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Avatar_m_tn
Oh yeah I'm definitely not serious.  There is no way I will be kissing anyone with how sore my lip is and and how sore my throat is.  
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Avatar_m_tn
Just as an update.  My sore throat lasted about 2 weeks before it stopped hurting.  The area in my throat was so specific that I think it had to have been an ulcer.  I have lost some significant weight (30lbs) because I have developed a very sensitive gag reflex from that area in my throat and swallowing has become kind of disgusting because I can feel the food so well over that area.  I did develop some thrush but I was on Amoxicillin for 10 days which can easily bring about thrush.  I do have a slight chest cough now too but it's very mild.  I am still recovering and am extremely tired but I have basically been on a liquid diet for 3 weeks now.  My diet was extremely bad before and honestly I drank way too much alcohol.  My immune system was probably very low.

I think mostly this is to anyone else reading this too as a little bit of a help.  Be very careful when researching things up on the internet and make sure to take Dr's advice.  They know what they are talking about.  It's very easy to look as symptoms and think that we have something we don't.  With my symptoms of sore throat, body aches, swollen lymph glands in my throat, weight lose, cold sores on my lip, it's very easy to look this up and jump to conclusions.  I was reading HIV symptoms and was like, "wow, maybe I have HIV".  BUT, you have to be very careful of reading the symptoms of something and then diagnosing yourself.  My sore throat has caused my weight loss because I couldn't eat solid food.  It just hurt too much.  My lymph glands were only swollen in my throat.  My fatigue is very obvious because of being on a liquid diet for so long.  

Just be careful with looking at only symptoms.  

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