Herpes - oral or genital or something else?

[Sinbad1977]

Hi.  I had unprotected sex and oral sex with a female aged 30 years old a week ago.  I gave and received oral sex.  Since then, 2 days later, I started a horrible sore throat with redness at the back, specifically on the right hand side of my throat (no tonsils as had these removed).  These then developed in to small ulcers that are red round edge and then white spots in middle, look more like flat white spots than blisters.  I've had cold sores in past but only on my lips and very infrequently.  My partner has never had any symptoms of herpes (oral or genital) and has not so much as had a cold sore.  My throat is so sore and very hard to swallow and the white spots are still clustered in one small area, with nothing elsewhere on penis or lips or mouth.  The doctor I saw two days ago suggested it could be the cold sore virus (herpes) as canker sores unlikely as they would be randomly spread not clustered.  He prescribed 200mg tablets of aciclovir five times a day for 5 days.  I'm two days in but no change.

Could I ask the following:
- could it be herpes?  if throat is it likely to be HSV1 or HSV2?
- I've had cold sores before but not recently, so would it suggest as sounds like an initial infection that its HSV2?
- could it just be canker sores?
- my partner has never had symptoms or signs of herpes or a cold sore, can this mean its unlikely herpes?  she has had unprotected sex with ex-boyfriends before, but never signs or symptoms, so could she still have herpes?
- will I always be contagious even when its gone and should worry about oral sex in future?

Thanks!

[Terri Warren, RN, Adult Nurse Practitioner]

If she is IgM positive, that isn't significant.  If she is HSV 2 IgG positive, that means she is infected.

So did you end up having a swab of these lesions to know that you are HSV2  positive?  Did I miss something here?

If you know that you have HSV 2 orally, then it will not spread to the genital area, no.
Again, if you have had a positive HSV 2 test from the throat, the related symptoms coud be herpetic, but it just doesn't sound like it to me.

Did you end up getting an antibody test?

Terri

[Sinbad1977]

Terri
The person who I had the sexual encounter with has had their blood test results back and is double positive (both HSV1 and HSV2).  I get my results on Monday.
She was IgG negative and IgM positive (or whichever way round that the doctor said it wasn't acute and was asymptotic).

I have had cold sores previously in my life, so this acute outbreak I have had would suggest I have a rare case of HSV2, correct?

I have questions, as this person is not my partner and I am single.  Please could you let me know your thoughts on:

- if exhibiting no symptons orally, can I still spread HSV2 by kissing or by oral sex (cunningligus)
- can this spread to my genitals or is this unlikely given outbreak (acute) has been in my throat?
- I now have lost the ulcers at back of throat but my gums (well not technically my gums, the are above by gums) is very sore, painful and swollen/inflammed.  It also feels very dry.  My tongue continues to tingle at tip (but no sign of ulcer).  Is this gum inflammation an effect of HSV2 or is this likely to be something else?

Thanks in advance for your help!

[Terri Warren, RN, Adult Nurse Practitioner]

I've personally never seen herpes only on the tongue.  A very common condition for the tongue is called geographic tongue, where there is swelling in various areas and not in others and often redness and tenderness.  Also, there can be fungal infections of the tongue.  Throat cancer would not be present as an acute problem, and especially not just on the tongue.  If this continues, I would recommend that you see your dentist.  They would be perhaps a better resource than the STD clinic.  I'm sorry I can't help you more with this question.

Terri

[Sinbad1977]

Terri. Please could you answer this question. I'm into my fourth day of taking acyclovir. The ulcers are the same, pain is the same and my Tongue is very irritable, swollen feeling, feels almost like it's got cuts at back of it.

How long does the acyclovir take to start working? If it is herpes should it have lessoned things by now?  I only have a five day course, should I go back and get more?

Thanks

[Sinbad1977]

Hi, sorry, one other symptom actually is that my tongue feels very tingly towards the back and almost like it has little cuts on it, very irritable and swollen almost.  Does this come with herpes?

Thanks

[Sinbad1977]

Hi Terri
Thanks for the response.  Went to STD clinic today to be tested.  Throat swab was taken of the ulcers and I get the results in a week.  I have no other symptons but the clinic specialist said "it looks herpetic".  I'm confused because you said "unlikely".  The acyclovir has been taken for 3 days now and the site of ulcers shows no sign of improvement.  Is this a sign it might not be herpes?

Could it be throat cancer is my other worry?
Thanks

[Terri Warren, RN, Adult Nurse Practitioner]

It could be herpes, though unlikely, and I'm curious about if it was swab tested by the person who prescribed the acyclovir?  That could have given you the answer you seek.  Cold sore virus (HSV 1) doesn't cause canker sores, canker sores are caused by reasons we don't know.  HSV 2 infection rarely occurs in the mouth, though it is possible.  You wouldn't get new HSV 1 infection since you have it already.  It could be canker sores, but they rarely occur in the throat.  

Your new partner could have herpes and not know it, yes, certainly.  

I think the best strategy here is to have your partner get an IgG type specific antibody test and see what her status is.  If she is negative for HSV 2, then you don't have HSV 2 in your throat.  You already have HSV 1 (the recurrent cold sores), so that isn't a worry.  Do you think she would consent to being tested for herpes via blood test?

Terri