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oral hsv question
Hello. Thank you in advance for your advice.
5 days ago I noticed some sensitivity to acidic food on the corner of my right upper lip. I had a cold that week and my lips were dry and the next day I noticed a small linear fissure in that area. It resolved over the next 2 days, however 2 days ago I woke up with a small non tender bump in the same region, which over the course of the day became tender , larger and upon close inspection there were 2 grouped vesicles. This was also associated with intermittent tingling in the general region of my lip and cheek. The vesicles have actually now ulcerated and appear to have begun to heal. I have had 3 separate sexual encounters with females over the past 2 months in which I had unprotected oral-genital contact and latex condom use for sexual intercourse. I had a positive HSV 1 by western blot a year ago, and negative HSV 2, and have never had any symptoms, including any prodromal symptoms. Here are my questions:
1. Although it is quite rare, could this be primary OHSV2 infection?
2. Could this represent a primary subclinical GHSV2 infection with clinical OHSV2?
3. If this is simply an outbreak of OHSV1, should I be concerned about my immunity given I have never had any clinical outbreaks prior to now, and I am in my 30's?
4. Is there any utility in trying to get somewhere to get the lesions cultured?
5. As I am now at least 3 days into having clinical symptoms( longer if my symptoms 5 days ago were prodromal), is there any utility in taking antivirals?
Thank you again for your advice.
5 days ago I noticed some sensitivity to acidic food on the corner of my right upper lip. I had a cold that week and my lips were dry and the next day I noticed a small linear fissure in that area. It resolved over the next 2 days, however 2 days ago I woke up with a small non tender bump in the same region, which over the course of the day became tender , larger and upon close inspection there were 2 grouped vesicles. This was also associated with intermittent tingling in the general region of my lip and cheek. The vesicles have actually now ulcerated and appear to have begun to heal. I have had 3 separate sexual encounters with females over the past 2 months in which I had unprotected oral-genital contact and latex condom use for sexual intercourse. I had a positive HSV 1 by western blot a year ago, and negative HSV 2, and have never had any symptoms, including any prodromal symptoms. Here are my questions:
1. Although it is quite rare, could this be primary OHSV2 infection?
2. Could this represent a primary subclinical GHSV2 infection with clinical OHSV2?
3. If this is simply an outbreak of OHSV1, should I be concerned about my immunity given I have never had any clinical outbreaks prior to now, and I am in my 30's?
4. Is there any utility in trying to get somewhere to get the lesions cultured?
5. As I am now at least 3 days into having clinical symptoms( longer if my symptoms 5 days ago were prodromal), is there any utility in taking antivirals?
Thank you again for your advice.
MEDICAL PROFESSIONAL
You indeed said you were HSV-1 positive a year ago; sorry that I spaced out on that part. You can be quite certain this is a recurrent oral herpes outbreak. If any doubt, see a doctor or clinic, but probably there is no need to confirm it by culture or PCR.
Dr. Handsfield,
Thank you for your reply and advice. The lesions now appear freshly ulcerated and new grouping of vesicles appear to be present along with pain( it really does look like a cold sore). Based on your information this seems likely to be recurrent oral HSV-1 especially given a previous positive HSV-1 serology by western blot a year ago. As per your advice I will seek an evaluation by a doctor who can determine the most appropriate course of action with respect to testing and treatment, and will follow-up with a comment on the outcome.
Thanks again!
Thank you for your reply and advice. The lesions now appear freshly ulcerated and new grouping of vesicles appear to be present along with pain( it really does look like a cold sore). Based on your information this seems likely to be recurrent oral HSV-1 especially given a previous positive HSV-1 serology by western blot a year ago. As per your advice I will seek an evaluation by a doctor who can determine the most appropriate course of action with respect to testing and treatment, and will follow-up with a comment on the outcome.
Thanks again!
MEDICAL PROFESSIONAL
Welcome to the forum.
These symptoms, in the context of a cold, could have been a recurrent oral herpes outbreak due to HSV-1. Half of all adults in the US have HSV-1, and all of them have the potential for recurrent oral herpes even if such symptoms or outbreaks were never noticed before. But initial oral herpes, whether due to HSV-1 or 2, is generally much more severe than you describe, if there are symptoms at all: multiple sores in the mouth (with or without lip lesions), severe sore throat, fever, etc, and all starting within a few days of exposure. To the specific questions:
1,2) This is very unlikely to be HSV-2, whether initial or recurrent.
3) Recurrent herpes is almost never evidence of immune deficiency, even if no previous outbreaks have occurred. If you are otherwise well, this is not a realistic possibility.
4) Direct testing of the lesions by culture (or preferably polymerase chain reaction, i.e. PCR) may help sort this out. If the lesions are still moist and tender, at least a PCR and possibly a culture might be worthwhile, if you can get to a doctor or clinic familiar with herpes in the next day or two. If healing is more complete, you'll have to wait for another outbreak. In the meantime, you could have a blood test. If this problem is oral herpes, you can expect it to be positive for HSV-1 antibody. However, that result alone will not document the cause of the oral lesions you have had.
5) Once herpes lesions have started healing, antiviral treatment is not likely to make any difference. Even if you still were having active, fresh lesions, I would not recommend antiviral therapy based only on a verbal description or this discussion. Any decision for treatment should be based on direct examination by a doctor or clinic experienced with HSV.
If and when you are examined and/or testing (blood, culture, or PCR) is done, please return with a follow-up comment and let me know how it sorts out. In the meantime, I really wouldn't be worried about HSV-1. If it's herpes at all, HSV-1 is much more likely.
Regards-- HHH, MD
These symptoms, in the context of a cold, could have been a recurrent oral herpes outbreak due to HSV-1. Half of all adults in the US have HSV-1, and all of them have the potential for recurrent oral herpes even if such symptoms or outbreaks were never noticed before. But initial oral herpes, whether due to HSV-1 or 2, is generally much more severe than you describe, if there are symptoms at all: multiple sores in the mouth (with or without lip lesions), severe sore throat, fever, etc, and all starting within a few days of exposure. To the specific questions:
1,2) This is very unlikely to be HSV-2, whether initial or recurrent.
3) Recurrent herpes is almost never evidence of immune deficiency, even if no previous outbreaks have occurred. If you are otherwise well, this is not a realistic possibility.
4) Direct testing of the lesions by culture (or preferably polymerase chain reaction, i.e. PCR) may help sort this out. If the lesions are still moist and tender, at least a PCR and possibly a culture might be worthwhile, if you can get to a doctor or clinic familiar with herpes in the next day or two. If healing is more complete, you'll have to wait for another outbreak. In the meantime, you could have a blood test. If this problem is oral herpes, you can expect it to be positive for HSV-1 antibody. However, that result alone will not document the cause of the oral lesions you have had.
5) Once herpes lesions have started healing, antiviral treatment is not likely to make any difference. Even if you still were having active, fresh lesions, I would not recommend antiviral therapy based only on a verbal description or this discussion. Any decision for treatment should be based on direct examination by a doctor or clinic experienced with HSV.
If and when you are examined and/or testing (blood, culture, or PCR) is done, please return with a follow-up comment and let me know how it sorts out. In the meantime, I really wouldn't be worried about HSV-1. If it's herpes at all, HSV-1 is much more likely.
Regards-- HHH, MD
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
