Strange Oral Symptoms

Dear Dr. H, I ask on this forum because from all I've read you are decidedly a herpes expert (even though my problem is technically not an STD).  3 weeks ago, I kissed a girl (she had no sores/blisters/etc. at the time).  9 days ago, I noticed a slight redness/bump on my middle upper lip (not a blister).  I showed it to a dermatologist who (1) didn't see it at first, and (2) upon seeing it said it wasn't herpes.  I asked him to culture it anyways and to put me on acyclovir (3 * 400mg for 5 days).  Since then, the bump has not evolved whatsoever.  Yesterday, I developed two small red sores on the inside of my cheek.  In addition, the area on the inside of my middle upper lip feels a bit irritated at times.  Other information of note: I recently had two dentist appointments (cleaning and x-rays), although I recall no specific trauma.  I always tested negative for both strains of HSV by herpeselect.  Also, I recently started smoking heavily.  Questions: (1) if this is indeed primary herpetic gingivostomatitis, would the fact that I'm on acyclovir (just in case) not have prevented formation of sores inside my mouth? (2) can herpes present as a bump that doesn't blister and persists for 9+ days? (3) can you fathom a guess at anything else that it could be? (4) finally, can poor dental hygiene (which I am certainly guilty of) cause any of these symptoms?  Thank you for your expertise.  

[H. Hunter Handsfield, M.D.]

A dermatologist's exam is much more reliable than anything I can say.  Before I even get to your questions, it is unlikely you have herpes or that it explains your symptoims (which I haven't read yet).

Now I have read the next statement.  It was wrong of you to insist on treatment for a condition that your doctor didn't think you had, and anyway, if you had oral herpes with symptoms that had been going on more than a couple of days, treatment wouldn't help.  If you had seen me, I would have refused your request for a prescription for acyclovir.

OK, now I have read everything.  The fact that the bump didn't change on acyclovir proves it wasn't herpes, and it sounds like the blood test confirms that conclusion.  To your specific questions.

1) Irrelevant.  You don't have oral herpes.

2) No, herpes cannot behave that way.  You should have listened to the dermatologist.

3,4) I haven't a clue what it might be.  Since it is so hard to even notice, it's probably some sort of normal anatomic variation, like a promiment mucus-secreting gland.  It doesn't sound to me like an oral hygiene problem, but my expertise is limited to STDs.

I suggest putting herpes out of your mind, then follow up with the dermatologist if you remain concerned.  Or visit your dentist to deal with both this question and the oral hygiene issue.  If either of these providers believes nothing is wrong, you can rely on that judgment.

Good luck--  HHH, MD