worried sick

[soveryworried1]

Hi Drs.

Merry Xmas. Hoping you will be able to help me.

Since childhood, I have had coldsores - (for as long as I can remember). When I get a coldsore, I get a tingling in the bottom left corner of my lip, and apply some zovirax cream and it goes. Never turns into a blister or ulcer.

I am a male and have given fellatio 6-8 times to men. The last was over a year ago. I regret these exposures as I have a GF - mistake.

I am worried about the possibility of oral HSV2. Yesterday,the bottom RIGHT hand side of my lip had a little lesion and I manipulated it, I think some blood was extracted from the surrounding area.

If I run my finger over it, it feels like a spot that has been burst and is a little raw and red if that makes sense. When I burst spots, I can run my finger over it and feel the area that has been burst as in there is no skin on top of it. it feels like skin has been torn and it feels a bit like the flesh. Hope that makes sense.

ANyway, I have this little lesion on my right side of my lip - and if I am busy, I forget about it. it is a little red and noticeable when looking at the left hand side of the lip.

1. I am worried about oral HSV2. How rare is it?
2. I have had limited exposures to it, have you seen or heard of a person developing oral HSV2 with such little exposure?

3.if this clears up by 4 days, should I not worry about it being oral HSV2?

This is only the second time I have ever had a little lesion on my right hand side of the lip. The other was a spot and it cleared up. This was in early November. (13 months after the last act of fellatio was performed).

4. So, if this was an initial outbreak, would there be more symptoms?
5. If it is a recurrent one, when would it go away?

Thanks.

[Edward W Hook, MD]

You are being more anxious than you need to be.  This will be the last answer.  

1.  Correct/

2.  Correct, canker sores/aphous ulcers are not HSV.  EWH

[soveryworried1]

Update dr.

II hve been applying Vaseline and any pain I have had has subsided and in fact it is 99.9 percent better ad I think I am only noticing it because I was worried.

1. In light of that information, is that further reassurance that it is not a cold sore as it has vortually gone 1.5 days later- . Presumably cold sores Dnt go in such a short time?

I also have two small canker sore on upper and lower lip inside the mouth. I have read that these canker sores (we call them alphous ulcers I think) are unrelated to the herpes virus. Correct?

Thanks doc

[soveryworried1]

thanks doc. merry xmas

[Edward W Hook, MD]

the answers to these follow-up questions were either already provided or implied in my repsonse.  I'll answer these but lets not get into a prolonged "could this..." exchange.,  it does little good.

1. I did not have an initial cold sore 14 days after. In fact te first lesion I had appeared 13 months after it and this is the second lesion which has appeared 15 months after the last exposure. Does this strengthen the argument that this is not a cold sore?
See above- "The bottom line however is that his is unlikely to be HSV-2. "  I thought that was pretty clear.

2. It is cold where I am (united kingdom) can the cold cause irritation in te corner of the lips?
Cold dry weather can cause skin irritation, particularly around the margins of the lips.  

I am thinking that the redness is due to my manipulation of the skin.

3. Also is it possible that I could have a cold sore on the right hand side of my lip caused by the virus that cases cold sores on te left hand side of my lip? Can the virus spread from corner to corner?
It is unusual for the virus to be present on both sides of the mouth.

4. If you wre me, with limited exposures would you not worry and move on?
To repeat- "What you describe is quite unlikely to be HSV-2. "

5.  And can I continue oral sex with my girl fried ie cunninglingus? .
See above.  Cunnilingus can put your partner at risk for genital HSV-1 if she has never had HSV-1 infection.  

EWH

[soveryworried1]

Thank you doctor. My exposures were me performing fellatio roughly six-eight times.

1. I did not have an initial cold sore 14 days after. In fact te first lesion I had appeared 13 months after it and this is the second lesion which has appeared 15 months after the last exposure. Does this strengthen the argument that this is not a cold sore?

2. It is cold where I am (united kingdom) can the cold cause irritation in te corner of the lips?

I am thinking that the redness is due to my manipulation of the skin.

3. Also is it possible that I could have a cold sore on the right hand side of my lip caused by the virus that cases cold sores on te left hand side of my lip? Can the virus spread from corner to corner?

4. If you wre me, with limited exposures would you not worry and move on?

5.  And can I continue oral sex with my girl fried ie cunninglingus?

[Edward W Hook, MD]

Welcome to the Forum.  I'll be pleased to answer your questions.  The bottom line however is that his is unlikely to be HSV-2.  For reasons that reflect the basic biology of the virus, HSV-2 does not "like" to infect the lips and mouth and is a rare infection, causing less that about 1% of cold sores or lesions which appear to be cold sores.  further, while you don't mention when your exposures were, I should mention that if this were HSV-2 it would have been expected to appear within 14 days of an exposure, not later.  

In answer to your specific questions:

1. I am worried about oral HSV2. How rare is it?
See above - rare.

2. I have had limited exposures to it, have you seen or heard of a person developing oral HSV2 with such little exposure?
The few people who have HSV-2 have typically had multiple exposures as would be expected.  More exposures, higher risk.  That of course does not mean that someone couldn't get oral HSV-2 from a single exposure but it would be most unusual and I have never seen such a case.

3.if this clears up by 4 days, should I not worry about it being oral HSV2?
An initial HSV-2 infection at any site would be expected to be present for at least 10 days and more likely longer.

This is only the second time I have ever had a little lesion on my right hand side of the lip. The other was a spot and it cleared up. This was in early November. (13 months after the last act of fellatio was performed).

4. So, if this was an initial outbreak, would there be more symptoms?
Yes- see comment above.  

5. If it is a recurrent one, when would it go away?
3-4 days, just as for usual cold sores.

I hope these comments are helpful.  What you describe is quite unlikely to be HV-2.  EWH