kiss

[billyP123456789]

I am concerned about HSV. 1 week ago, a sketchy girl kissed me deeply on the lips for about 2 min. After, I noticed she had a small red spot on the corner of her mouth (few mm and no ulcer). I thought it was wine. I asked and she thought it was a cold sore.

I had a negative HSV test years ago, so I am concerned that this exposure puts me at risk for primary HSV infection (likely HSV-1). I washed my face and lips with soap and an alcohol hand wash 2 hours after the kiss. I talked with my physician the next day and he thought I had relatively low risk of getting oral HSV infection and started valcyclovir 1g tid for 7 days and said I could get another blood test for HSV titers two weeks after the exposure.

I get acne, especially small pustules on my chin.  Around 4 days after this women kissed me, I had a pretty big outbreak of these pustules (white/yellow) and a bit of redness on my chin about 1 inch from my mouth.  With shaving they have unroofed, oozed serum, and come back, but have not ulcerated like a typical fever blister. A friend who is a dermatologist who treats my acne had a quick look and did not think it looked herpetic last night.  However, I remain very concerned that it is an atypical primary infection and that I could spread it to eye, fingers, genitals. No other symptoms except diarrhea last few days and fatigue, probably from lack of sleep.  I am currently washing my hands a bit like a mad-man.

Here are my specific questions.  1) Can you estimate my risk for having HSV1 from this exposure? 2) Sound like HSV to you? 3) Could I have atypical appearing primary infection (no ulceration) because of the early treatment with valcyclovir? 4) If it is a primary infection how can I be more careful about spreading it – washing/shaving/continuing valcyclovir longer than 1 week? 5) I am hoping that there is a way to be more certain about whether I have contracted HSV1 - How soon would a HSV1 blood test be reliable to rule out a primary infection?

thanks

[Edward W Hook, MD]

Welcome to our Forum.  Your risk of getting HSV-1 from the exposure you describe is low.  Only a very small proportion of exposures to HSV-1 lesions lead to transmission of infection.  The precise proportion which lead to infection in partners is hard to estimate since variables such as the amount of time the cold sore was present, the duration and vigor of exposure, etc are so variable.  It is safe to say however that less than 5% and perhaps less than 1% of exposures of the sort you describe lead to transmission.  

As for the lesions you describe, I agree with your dermatologist friend that what you have does not sound much like HSV and would defer to his assessment since he had a chance to actually see the spots that concern you.  In response to your specific questions:

1.  See above. No more than 1 in 20 (5%) and probably less.
2.  No!
3.  No, this is unlikely.  The utility of your taking valacyclovir in the situation you describe is unknown.  While it might change the course of infection, how that might occur is unknown as well.  What you describe however does not sound like HSV however.
4.  Perhaps surprisingly, when primary infections occur, they tend not to spread.  I would not worry about washing, shaving, rubbing your face, etc.
5.  At two weeks after lesion appearance about 50% of infected persons will have positive blood tests with a gG based type specific test such as the HerpeSelect.  At 3 months the number goes up to about 97%.  

Finally a comment.  I understand that you hope that you did not acquire HSV-1 but, if you did, so what?  I don't mean to minimize your concerns but remember, if you got HSV-1 through this exposure you would be like most people and no longer in the minority.  Presuming you have kissed others, it is almost certain that you have been exposed to HSV.  Life is too short to worry about such things beyond common sense efforts to avoid infection.  At least that's my perspective on this.  Hope it helps. EWH

[billyP123456789]

Thanks for the quick reply Dr. Hook.

I am sorry to report that today I notice a new sign – a small 2-3mm ulcer on the inside of my lip in the corner of my mouth.  You can't see it unless you evert the lip and it would be opposed to the tip of my tooth. It is where the girl's possible cold sore would have been near when she kissed me. Although I frequently get kanker sores, I fear this one may be due to HSV exposure described in my question to you from yesterday - "KISS".

I have a few follow-up questions.

1) With the newly recognized mouth sore, does this sound like HSV now?  I fear it is, however, I do tend to get kanker sores and occasionally chew on my cheek / lips when nervous and am hopeful that this sign may be coincidental
2) Are there any tests – i.e. culturing the sore that would be useful – given my anxiety about getting HSV1.  What about blood tests for IGM tests.
3) What about risks for spreading else-where – any precautions to take for myself and others (i.e. no kissing, no sharing glasses)
4) Will future outbreaks likely be limited to inside my mouth?
5) Any utility for continuing Valcyclovir?
6) The girl that kissed me was very sketchy and probably very high risk for other STDs – Am I right to assume near zero risk for HIV from a deep / french kiss?  The fact that I may have gotten HSV doesn't change that does it?  Guess I am a little worried about that too – if I had a kanker sore at the time might that increase risk for HIV transmission?

My concerns may seem extreme for a kiss, but I am very worried about how this might affect my life - worries about spreading this to others.  i don't look forward to worrying about whether i have an outbreak that i would need to be careful about before kissing others.  I worry about how this might affect me finding a new girlfriend / intimacy.  i am still hoping i may not have gotten HSV and would like your thoughts about it and whether a well chosen testing strategy might clear this up for me.

thanks

[Edward W Hook, MD]

Straight to your questions:

1.  It does not sound like HSV. There are several alternate explanations which you outline.  The only way to know for sure is with a culture or, even better yet a PCR test which is several times more sensitive than culture.
2.  See aobve.  You should not get tested unless you are committed to believing the result (which I anticipate will be negative) and can put this behnd you.  IgM tests are a waste of money. We recommend firmly against them.
3.  Low.  the business of not sharing glasses, etc is an urban myth.
4.  I doubt this is HSV-1.  If it were, most recurrences would be expected to be on the lips, not in the mouth.
5.  No, valacyclovir just obscures things, as I have already indicated.
6.  No HIV risk.  

EWH

[billyP123456789]

Dear Dr. Hook,

Thanks for the help.

One follow up question…  So 24 days after this kiss, I have had no cold sores (I saw my dermatologist after the last post - she said I had a canker sore - it was cultured and tested negative for HSV).  Also, 15 days after the kiss, I had a blood test which was negative for HSV1 IGG, negative for HSV2 IGG and negative for HSV IGM.  

So the follow up question… is about disclosure.  I don’t want to be an undue alarmist, but I also want to honest. I ask my dermatologist if I need to worry about kissing / oral sex with future partners, and disclosure and she said not to worry about it.  Given this history, is disclosure about this kiss / exposure (with no signs-cold sores and with no positive tests) warranted?

Thanks.

[billyP123456789]

To clarify do you think I am at risk for giving someone HSV by kissing / oral sex and do you think disclosure before kissing or performing oral sex is warranted given my history of exposure but negative tests.

Thanks.

[Edward W Hook, MD]

Your questions, including questions about disclosure are irrelevant since you do not have HSV.  The dermatologist told you this, as did I.  Do you want to have HSV?  Why do you keep asking?  Canker sores are common and not caused by HSV.  EWH