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Worried About Possible Oral HSV Infection
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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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Worried About Possible Oral HSV Infection

Situation:
• Day 1 – Noticed a small ulceration on top of the lower lip near the corner of the left side of my mouth.  It was white, jagged and a little below the skin surface.
• Day 2 – Accidentally poked myself next to the small ulceration and caused bleeding.  Noticed what appeared to be irritated skin in the area.
• Day 4 – Three ulcerations in a row now present on the top of the lip extending about 2 centimeters from the corner of the mouth, each slightly larger than the other.
• Day 5 – Ulcerations peaked.  A line of red, irritated, slightly ulcerated skin appeared on the upper lip directly above the ulcerations on the lower lip.
• Day 6 – Began to heal with a yellowish/honey colored crust.
• Days 7 – 9.  Clearing up with scabbing getting smaller and less yellowish.
Why it could be herpes:
• Dermatologist said it looked like a herpetic outbreak (on day 6)
• Sores were painful
• Yellowish/honey colored crust during healing
Why it doesn’t seem to be herpes:
• No history of herpes and negative tests for HSV1&2 within the last 12 months.
• Ulcerations emerged over 3 days, not one.
• There were no noticeable blisters during the outbreak.
• Ulcerations were in a fairly straight row on the lip and were not scattered like a typical primary herpes outbreak.
• Dermatologist examined mouth and found no other lesions that would be typical for a primary herpes outbreak.  No other symptoms of a primary outbreak presented.

I am scared by my Dr's "herpetic" comment.  I told him about my negative HSV tests and not finding any other signs of herpes, he presribed mupirocin and clortrimozole.  The one risky recent contact I had was a massage therapist licked my ear 10 days before the outbreak.  It was an unwelcomed advance and there was no mouth to mouth or sexual contact.  The massage proceeded as normal.  Could saliva from that contact passed HSV to me?  Can you pass HSV through other means other than direct contact?  Do my symptoms sound like herpes to you?
239123_tn?1267651214
Welcome to the forum.  Oral herpes isn't an STD, so this is a borderline topic for this forum, so my replies are brief.  For a more detailed response, you might consider posting a question on the herpes forum.

Your symptoms sound typical for oral herpes and a dermatologist's diagnosis of oral herpes is very reliable.  Almost all oral herpes is caused by HSV-1.  And the HSV-1 blood test misses around 20% of infected people -- so your negative test result doesn't change anything.

It is also possible you acquired the infection recently, and that a repeat blood test would be positive in a few weeks.  If it's a new infection, it seems unlikely you caught it from a kiss on the ear; your lips where the ulcers are had to come into contact with the virus.

In any case, this doesn't sound serious.  However, if you develop recurrent oral outbreaks in the future, you can speak with your doctor about a possible prescription for treatment to help prevent outbreaks or to treat them promptly when they start.

I hope this helps.  Best wishes--  HHH, MD
4 Comments
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Avatar_m_tn
Thank you for your quick response.  Just a curious question, if someone contracts HSV1 or HSV2 from giving oral sex, isn't that considered and STD?  It's not the case here, just couldn't help asking based on your response
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239123_tn?1267651214
On one level, if an infection is acquired through sexual activity, the person with the infection of course may consider it an STD.  On the other hand, the world at large doesn't consider oral herpes, or any infection caught by kissing, an STD.  And in general, people don't look at persons with lip sores that look like oral herpes and think "That guy's got an STD."  Even if he happened to have acquired the infection by oral sex (which is rare), it wouldn't generally be viewed as an STD, regardless of how that particular individual thought of his infection.

As another illustration, oral herpes isn't addressed in the STD treatment guidelines issued by CDC, WHO, or the Canadian and British STD recommendations, regardless of how it was caught.
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Avatar_m_tn
Very thoughtful response, thank you
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University of Washington
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