Possible Oral HSV Primary Infection from Breath Droplets?

[bob1114]

Hi Terri – thanks in advance for your help! Background – have OCD and am having a severe episode due to recent trauma. Almost two weeks ago (Wed) I was going for an appt at an OCD clinic (irony!) and passed two girls in the hall. One of them had what looked like a large red blister forming on her lip, and was laughing. I turned my back and tried not to breathe when I saw it - I recently read that HSV can be spread from breath droplets.

Thurs, slight sore throat, but went away. Sunday I noticed a sore red bump at the above my back molar on the soft tissue that connects the upper and lower jaw. Monday sore throat, fatigue. Red bump developed a white, flat center. Next few days my sore throat came and went, but the ulcer stayed painful and tissue around my molar swelled. Pain radiated into my teeth/jaw when I ate. Had congestion and a slight fever (99.5). Fri went to the Dr, and his immediate response was that it was a canker sore, triggered by a respiratory virus. Then, looked again and asked if I had ever gotten cold sores – I haven’t. He then said it could be a mild primary infection of HSV. He examined me again, backtracked, and said seemed like a canker, waiving off Q's I had about the HSV possibility. He didn't swab it, and I was too upset to think to ask. I know cold sores are common, but major part of my OCD is worrying about contaminating other people. I won’t even go near my husband now - I'm a mess. After a sleepless night, I went to a clinic and got it swabbed by an NP.
Q’s:
1) What are the chances that this is a primary HSV infection from the girl’s breath droplets? (Only possible source - I’m working from home/nearly agoraphobic)
2) Can I trust the results of the culture if neg bc I’d already had the sore for 5 days?
3) I know there is controversy over iGm testing, but since this could only be primary, would it be worth getting it done?
4)Can I find out for sure whether or not it’s HSV?

[Terri Warren, RN, Adult Nurse Practitioner]

I disagree completely with transmission of herpes by droplets.  And thankfully, I rely on medical journals for health information rather than the New York Times.  

This is my final post on this thread.  If this issue comes up again, I'll know where people got it!

Thanks for taking the time to repost.

Terri

[bob1114]

Hi Terri -

Thanks again for your response. The first place I read it was this NY Times in-depth report:

http://health.nytimes.com/health/guides/disease/genital-herpes/print.html

"Transmission of Oral Herpes . Oral herpes is usually caused by HSV-1. HSV-1 is the most prevalent form of herpes simplex virus, and infection is most likely to occur during preschool years. Oral herpes is easily spread by direct exposure to saliva or even from droplets in breath."

It's also referenced several other places that I've seen, these are just a couple I found with a quick search:

http://dermatology.about.com/cs/oralherpes/a/oralherpesbasic.htm

http://healthyliving.msn.com/health-wellness/men/sex/do-i-have-herpes-1

So you believe that a new infection, especially in an adult, can only occur from very direct contact like kissing or sharing personal items?

Thanks again for the information!

[Terri Warren, RN, Adult Nurse Practitioner]

I would be very interested in where you read that herpes simplex virus can be spread by respiratory droplets.  

Can you provide me with websites please?

I would strongly disagree and would like to suggest that they make that correction so others don't worry as you have.

Terri

[bob1114]

Hi Terri -

Thank you so much for your response.

I understand that a lot of this is my OCD, but what started my questioning/obsessing about this specific situation was the doctor saying that it could be a mild HSV primary infection, which was an un-prompted comment based on my symptoms - I didn't go in asking about it. I actually thought it had to do with partially grown-in wisdom tooth, since the sore appeared right above it and caused the tissue to become tender and swollen, as well as pain in my teeth/jaw.

I guess based on the ambiguous mouth sore, sore throat, fever etc, he thought that it could have been "a very mild primary infection" - but then said a it was a very slight chance, and backtracked saying it would be rare to see with only the one sore and diagnosed it as a canker sore. At that point, he didn't ask about my possibility of exposure to the virus in the last little while or other details.

I did get my swab results back, and although the sore was 5 days old, I believe they burst the white head/center when they swabbed it, and it came back negative.

If you say that there's no way I could have gotten it from breath droplets from that girl laughing as she was walking past, then that makes me feel  much better.

May I ask, though, when I've read on medical websites that transmission can happen through breath/respiratory droplets what situations that includes, or what exactly that means? Is that more coughing/sneezing? Extremely close contact? I've seen that language used on several medical sites, but there isn't a lot of details on what it means.

Again, thank you for your answers - I appreciate your response.

[Terri Warren, RN, Adult Nurse Practitioner]

1.  That chances that you would acquire oral HSV from this woman's droplets while laughing is zero.  Absolutely zero.  No question.
2.  I don't know if you have oral herpes or not already, do you?  Usually herpes doesn't present in the mouth, but it can.  Have you ever had an antibody test for herpes in the past?  
3.  Absolutely NOT.  Don't you dare test with IGM.  The IgM is a terrible test and Quest is actually in the process of changing their offerings of IgM to adults for that very reason.  
4.  There is zero risk from the encounter that you describe.  However, if you want to know if you have herpes in general, you can do an antibody test.  If you want  a particularly good test for HSV 1, I would encourage the western blot as it is more sensitive for HSV 1.  

You know this is part of your OCD, right?  It truly is and I'm so sorry this is very difficult for you.

Terri