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!
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