Possible HSV-1 oral?

[SP7]

Thanks for answering my questions. Male, late 40s, just started dating again, concerned about HSV-1/getting cold sores. Previous IgG tests were neg. for types 1 & 2.

3 days ago (Sat.) mild burning/stinging on lower lip. Didn't notice blisters or anything strange. Next day, strip of very minor redness runs along middle of lip for about 1". Lip balm makes it sting more; aloe relieves symptoms. Mon. night saw single-file line of 5-6 very small craters along middle of lip. Not red or destructive-looking, more like pits (<1mm across).

Today (Tues.) each of the small pits is separately crusted over - looks like I have chapped lips. Mouth hurts a little. Feels like the minor crusting will rub off w/tongue or in shower tomorrow. Probably no symptoms then. Questions:

1. Does this sound at all like cold sores? Can it present as a mild case?

2. Went and saw dr. today. He said herpes would have produced noticeable blisters. Also pattern would be a cluster rather than single-file line. Said was chapped lips & pits were nothing to worry about.

3. I know that HerpeSelect test can begin to detect HSV-2 antibodies in some people as early as 3-6 weeks (but 12-16 is better). Is that the same time frame for HSV-1?

4. Two weeks before this I had what looked like I bit my lower lip. Eraser-sized area had blood under surface, but no inflammation. More from possible trauma. Again, no blister & took 2 days to heal. Any concern here?

[Terri Warren, RN, Adult Nurse Practitioner]

I'm sorry, I have nothing new to add to this thread, even given what you've written, until you have western blot results down the road.
Terri

[SP7]

Hi. I wasn't planning to post again until early Nov. w/my WB results & then close out thread. One quick question & update and thanks again for your help.

1. If this does end up being HSV-1, how long can a primary episode of herpes last in a person who was previously negative? Can it go on for over six weeks?

Still no blisters or sores, but I continue to have rows of little (<1mm) shallow craters form on my lower lip, plus some mild burning/stinging. Lip gets very dry. This has been going on for 40+ days with several (over 4) starts and stops. Craters are dry-looking, same color as lips and form a light crust overnight which usually comes off in shower. Then within 24 hrs. of first noticing them, they become more faint and harder to see. But often can see them again 2-3 days later. Very strange.

Two docs looked @ plus my dermatologist. She said cold sores were possible from my description but a lot didn't fit - pattern, timing, appearance, etc. Saw her day after 3rd round of little craters and she said there wasn't much to see. Will try steroid ointment she prescribed for inflammation that she thinks is more likely.

Also took another HerpeSelect test @ 3.5 weeks post-potential expsosure: negative. Will do WB @ 4 mos. and be done!

[Terri Warren, RN, Adult Nurse Practitioner]

1 and 2.  About 4 months
The timing of the western blot is LONGER than the HerpeSelect testing, so don't rush it, OK?

Terri

[SP7]

My doctor's medical building has a Quest Labs on-site, so I will give him the Western Blot code you provided and get that set up. Right now I am 3 weeks post-possible exposure.

1. What is the optimum time frame for the Western Blot to be most accurate for picking up HSV-1 antibody?

2. What is the earliest I could test?

3. Is Western Blot similar to my understanding of HerpeSelect testing, in that: 1-2 weeks = earliest antibody could show up; 3 weeks = about 50% of positives confirmed; 6-8 weeks = 75% or so of positives confirmed; but 12-16 weeks is most accurate?

Thanks very much.

[Terri Warren, RN, Adult Nurse Practitioner]

Its very hard to know about these craters.  They could be herpes, but I agree that they don't follow a typical patterns.  The western blot will help you sort this out, I believe.

Terri

[SP7]

Thanks again for your help. It's now 10 days after I first had mild burning on my lower lip; some burning/redness is still present. A couple follow-up questions:

1. The minor white crusting over each lip-pit flaked off the same day I noticed it (last Tues.). This is what my doctor called chapped lips and said was not herpetic-looking. He said I would have had blisters but didn't. Is it possible for the blisters to come and go so quickly to not notice them? I've been examining my lips a lot. In fact, there are still shallow/faint indentations where each of the pits was.

2. Could you comment on the pattern of small craters I had on my lower lip? They formed an irregular, single row about 1" long and were in single file. Doctor said this was not a herpes pattern and they should have been in a group or clustered. That's partly why he thought it was lip irritation/chapping.

3. Last night and again this morning I examined my lower lip. Didn't see any blisters (but still some redness and stinging 10 days after start). Two hours later notice a single, new small indented circle w/a little white scabbing around edge. What else could these be?

Following up next week w/doctor & dermatologist. Will take the Western Blot per your recommendation in a few weeks. Thanks - I appreciate it.

[Terri Warren, RN, Adult Nurse Practitioner]

1.  Its possible, but if the antibody test is accurate that you did not have HSV 1 previously, I might have suspected a more dramatic presentation at your age and with no antibody to either.  It can, however, be mild.  The ulcers that scab over are a bit concerning, but if the doctor that you saw said it looked more like chapped lips, he is the one right there to make a clinical judgement and its probably correct.  

Yes, HSV 2 can take from a week or two to 4 months to show up as antibody in a blood test, and HSV 1 a similar amount of time.

I'm not at all worried about the blood area under the skin.

The herpes western blot is a better test than the plain ELISA for HSV 1 though we are not yet clear how much better. When and if you retest, I think I would use that one.  The code at Quest labs is 34534 if you decide to do that.

Terri