Did I just get HSV2 on the mouth?

[Zoros_LekLek]

I am pretty sure I did, but want to know whether these symptoms make sense. Everything is harder because I contracted the flu, about three weeks back. I didn’t really get a runny nose, but I did have a pretty bad cough, from the chest, and a sore throat. I didn’t take anything to cure it — just took a lot of vitamin c and zinc. Two weeks or so later, it seemed like it was winding down — so I decided to go out to a bar. Met a girl, brought her home. She had no cold sores on her face, or anything else that looked suspicious. I had sex with her, and used a condom… but I also went down on her. So if this account is right, I contracted herpes from performing oral sex on her.
I think it is herpes for two reasons.

(1) A couple of days later, I worked out in the morning, and just started feeling terrible — sleepy, exhausted, sort of beaten up. I felt feverish, and had a headache. When I looked in the mirror, my tonsils were super, super inflamed, and had white specks on them. And my lymph nodes felt really swollen. My first reaction was — this is strep throat, or somehow my flu came back and is now destroying me again. But it didn’t come back. My throat, while still feeling sort of swollen, had no more white specks the next day; my tonsils were smaller; and I didn’t develop a cough or a runny nose. Weird, I thought. And then:

(2) Two days later, I wake up and I have a small cold sore right beneath my lip. I went over to the mirror, and looked at it, and notice that my lower lip (the lip itself) is feeling sore, and seems to have pressure building. I pressed the lip with my fingernails, and popped the skin — a clear fluid came out. I washed my fingers and lips, then started Googling. And from what I can tell: HSV2 produces flulike symptoms; can be transmitted via oral sex; can latch onto my lips; and creates cold sores just like HSV1.

So the question: does this set of symptoms make sense, and do they point towards HSV2? I know this website is not a substitute for a doctor’s visit — and I’m going to the doctor ASAP. But it would help if I knew what in this was relevant. Is there a specific test I should be requesting, to differentiate between HSV1 and HSV2, or are the flulike symptoms (and the oral sex) enough to pinpoint HSV2 as the culprit? It’s probably too soon for me to have antibodies; but would a swab identify HSV2 right now?

[Terri Warren]

You could have flu like symptoms with either new HSV 1 or HSV 2 infection. How long ago was this?
You most definitely need a swab test from the lesion and I would also encourage a type specific IgG antibody test for HSV 1 and HSV 2. And I would encourage you to do it today and also I would ask them to use PCR rather than culture if possible. Do NOT test for IgM, though. If this picture was taken today, I would think there is a good chance you could get a positive swab and have it typed (be sure to ask for typing). If you can’t get into your regular provider, I would go to an urgent care clinic. You might call ahead and ask about the PCR swab. They can look up herpes PCR in whatever lab book they use.
Did you also kiss this person?

Terri

[Zoros_LekLek]

Slept with this person on Tuesday night. I did kiss her; she also performed oral sex on me, albeit rather briefly. I guess this would still work with an HSV1 infection, since the virus would *want* to get lodged in my mouth, and not below the waist. I have no symptoms below the waist whatsoever.

I got flu-like symptoms on Thursday. Most of the day I just felt completely exhausted, my tonsils and lymph nodes were huge, and I had chills non-stop.

Sunday morning I noticed a bump on my lip, and what seemed to be a cold sore right below it. I squeezed my lip, producing a clear liquid. That night, the lip was swollen and starting to crust, as per the picture. This was yesterday.

This morning, I went to the doctor’s. He was uncertain whether he could still get a swab, but he cut off a layer of skin with a scalpel, and took a sample. He’s also running antibody tests, and tests for other STDs. Clearly, the lesion itself looked suspicious enough that he wanted to run the tests. He also, however, said that the pace of development from sexual encounter to symptom production seemed a bit fast, and made him hesitant to say, one way or another, whether this was herpes. He also said it could be gonorrhea or chlamydia, which I guess can also migrate from the genital area to the throat. Does all this seem accurate to you? Test results will be done in about four or five days, but I’d like to get some sense of what to expect.

[Terri Warren]

Wow, a scalpel? Did you ask for PCR testing? Did he say it if was a biopsy or a PCR test? Can you call and find out?

Herpes will normally show up within 2-10 after an encounter, if it is going to show up.
No, I have zero thoughts that this lesion on your lip would be gonorrhea or chlamydia. Zero. Did he take a swab from your throat for those infections?

Terri

[Zoros_LekLek]

Hey sorry for the delay. I called the girl, she said she tested herself regularly, and absolutely did not have herpes (actually, she called me, wanting to hang out; clearly no guilty conscience there). I also suddenly remembered that I burned my lip quite badly on Saturday, smoking a non-filtered cigarette, which might have explained the burn.

Results came in today, though. I ran out to the clinic the morning before I got this message, and just got whatever the doctor said. Here is what I received:

HSV IgM Ab Standard Range: <10 Titer Your Value: <10

HSV Type 1 IgG Ab 7.89
Standard Range <1.10
Reference Range: Negative <0.90 Value Index; Positive >=1.10 Index Value; Equivocal=0.90-1.09
Your Value: POSITIVE

HSV Type 2 IgG Ab 0.07
Standard Range <1.10
Reference Range: Negative <0.90 Value Index; Positive >=1.10 Index Value; Equivocal=0.90-1.09
Your Value: Negative

HSV Qualitative PCR, Non CSF-Details
Specimen Source: Lip
Result: HSV DNA detected, type indeterminate.

Doctor’s comments: Lip lesion does have evidence of HSV, though unclear if 1 or 2. Given that the antibody testing is negative, it’s possible that your flare of symptoms has preceded your immune system’s antibody response. I will enter a Rx for Valtrex to take for your current flare. I would recommend repeat antibody testing in 3 months to see if you test positive for 1 or 2.

I have two final questions for you. The first: if I’m reading this correctly, the IgG seems to have returned positive for HSV1. So why is my doctor saying that the flare of symptoms preceded my immune system’s antibody response? Why isn’t he just telling me that I have HSV1, on the basis of the IgG and the PCR?

Second question: why did the PCR come back ‘indeterminate’? Is there any chance that I don’t have HSV, or are these tests pretty definitive?

Thank you for everything.

[Terri Warren]

You have a strong antibody response to HSV 1 which means you are infected with HSV 1. How long between the contact with the girl and your antibody test? You can’t type a biopsy which is why we do PCR swabs, not biopsies to diagnose herpes, but that’s water under the bridge now. I think he is wondering if perhaps you contracted HSV 2 on your lip and that’s why he wants you to repeat the antibody test down the road a few months. I would agree with that suggestion. However, I think it is likely that this is HSV 1 and depending upon the timing, maybe not a new infection.

Terri

[Zoros_LekLek]

I think he did a swab, actually, not a biopsy — the scalpel was to scrape off a little bit of the crusted skin so as to get access to the underlying sore. I don’t know if that was a good idea or not, but as you say, it’s water under the bridge.

So yeah, I still don’t quite understand the train of events. I had sexual contact on Tuesday night (around midnight). I did the HSV testing on Monday around noon — so six days later. Is that time long enough for me to get *that* many antibodies? 7.86 seems through the roof, which is why, I take it, you’re wondering whether it’s actually not a new infection. What do you think?

Two more things. One, is that what led me to the clinic was precisely how abnormal all this felt (up to, and including, getting the cold sore). Flu symptoms (fever, chills), a cold sore running up to my lip, the proximity of a sexual encounter with the symptoms… this all seemed suspicious and not normal. I actually don’t remember *ever* getting a cold sore, liquid fluid and all, on my lip, though I’ve had plenty of pimples and similar bumps near or around my mouth, one of which I guess might have been a cold sore. I don’t know. But if this is an old infection, then all this is just so much coincidence — including the flu-ish symptoms and the proximity of making out with this girl and getting a cold sore. Is that correct?

Second: I contacted the girl. She was tested for all STIS and STDs on January 6th, and was negative for everything, including HSV2. She has had only protected sex since then, except for one encounter with an ex-boyfriend whom she knows is clean. She does not think she has HSV2 at all — or HSV1, for that matter. She says her sister and best friend would get cold sores regularly, since childhood, whenever they were sick, but that she’s never had cold sores herself. This strikes me as a potentially ambiguous thought: if she’s had family members getting sick around her, chances are she’s been exposed to HSV1 before. But if she’s never had a cold sore, and didn’t have one the night we met up, then I don’t see how she could have given me HSV1.

So — what do you think? Have I had HSV1 for a while, without realizing it, making this whole concatenation of events (sex-fever-swollen tonsils-cold sore) more or less arbitrary? Did I acquire it from this girl, maybe through asymptomatic shedding or something?

Finally: if I already have HSV1, then aren’t the chances of me getting HSV2 on the lip actually quite low? As I understand these things, HSV2 doesn’t really like the lip anyway, and if I have HSV1 (or have had it for a while) then I have some resistance to it already. Or is it really possible to get HSV1 *and* HSV2 on the same location? (I doubt that I have HSV1 anywhere other than the mouth area).

[Terri Warren]

Here’s my guess about what happened here: I absolutely think you’ve had HSV 1 for a while, if this lip issue is HSV 1. If he did not do a biopsy, and he did a swab test, then that is typeable. Perhaps he did not ask for typing. I would recommend that you call and ask if it can still be typed. They normally hold samples for a while. Next, I think you acquired some sort of flu like sore throat syndrome from her and with that suppression your immune response, the HSV 1 symptoms were able to come to the surface. While it is possible to have both infections in the same location, it would be unusual in the mouth to have both. If she has actually been tested for HSV 2, which may or may not be correct, and she is negative, then unless you had HSV 2 orally from some other partner, you would not get a new infection from the most recent partner. Does all of that makes sense?

Terri

[Zoros_LekLek]

Ok. Been trying to contact him, to no avail, but I’ll keep trying.

As for the rest: I already had a pretty bad flu before I met her. That night, I smoked a ton of cigarettes (which I don’t usually do) and slept like two hours. The following day, I went and worked out very intensely for a couple of hours, to try to get myself back together. Instead, I think my immune system just collapsed. I find it weird that I would develop a cold sore, mostly because I can’t actually remember a time where lack of sleep and stress affected me that way, and I’ve done a lot of not-sleeping, being stressed, and so on. But I suppose the tests don’t lie, and so (given your reading of the test) I assume that I have actually had HSV1 for a long time.

Before this girl, I was in a 3 1/2 year relationship with a single person. I was her second partner ever, and I’m pretty positive that I did not have HSV2 from that relationship.

The girl I saw on Monday is getting STD tests of her own (including IgGs). If HSV2 does not show up for her, then one of two: either we’ve both contracted HSV2 super, super recently; or I just have had HSV1 for a long time, and between the flu, the cigarettes, and the not-sleeping, I just screwed my immune system over and developed a cold sore. The latter seems much more probable, though I will get myself tested again in a few months. I guess my only question then was whether I might not have contracted HSV1 from her. But given your response to how many antibodies I have, it seems like that, too, is totally unlikely.

In which case, I guess it’s this girl that should have been worried about me performing oral sex on her. Curious how these things work out. But I think she and I are (and will be) both ok.

[Terri Warren]

It would be very important to know her HSV 1 status as well as HSV 2. If she already has HSV 1, then I don’t think you need to worry about having given her oral sex. Please encourage that she be tested for both.

Glad this is going to work out for both of you

You have more question on this subscription.

Terri

[Zoros_LekLek]

Right. So my final question is about what I should be doing moving forward. I don’t think I’ll be dating this girl long-term — she’s moving to Europe in a couple of months anyway. So I want to know a little bit more about recurrences, contagion, and disclosure.

I might have had cold sores before, as a kid, but I don’t think I’d ever had a cold sore like this — one that actually included my lip, created transparent fluid, and was just so obviously abnormal. This is part of what made me think that I had only just gotten HSV1 — but the antibodies suggest otherwise. If I understand this rightly, then, for 3 1/2 years I was dating someone else, without developing sores, but putting her at risk constantly (I had oral sex with her, and obviously kissed frequently).

So: should I be expecting further recurrences? I don’t remember getting a flu as bad as this one, either, not for a very long time. So should I be treating this outbreak like an anomaly? Or the beginning of further outbreaks to come?

As for contagion — I again, just have very little sense of when or where I might have acquired HSV1. I tend to be in long-term relationships. Before the girl I dated for 3 1/2 years, I dated someone else for 1 year. I think in six years, I’ve hooked up with a total of two people I wasn’t dating. Neither of them led me to exhibit symptoms, or to have the kind of outbreak I’m having now. Nor did I pass anything onto them. I guess, along with a question about whether I’ll have recurrences, I’d like to know whether I should be thinking of myself as highly contagious, or contagious only during outbreaks, or what.

That leads to the final thought — I did not realize, before googling HSV1 like mad over the course of the last week or so, that it could be (a) asymptomatically transmitted; and (b) infect genital areas as well. This was surprising and terrifying news, and it seems to shift around years and years of my life that, retrospectively, look irresponsible and risky. Would it be right to say, then, that I should be disclosing that I have HSV1 to all partners, prior to kissing them, and certainly prior to having oral sex with them — whether or not I have an outbreak, or have had one for x or y amount of time? That seems rather daunting, but also, I guess, the thing called for by this new development. Thoughts on the matter would be greatly appreciated.

Thank you for everything, Terri. This forum has been a tremendous blessing, and clarified things immensely. You’re doing something great with this forum — I know other people appreciate it as much as I do. All the best!

[Terri Warren]

It is true that the virus can be transmitted while no symptoms are present and can be transmitted to the genitals via giving oral sex.
I think you are looking for a previous partner to have given you HSV 1 perhaps, but a more likely scenario is that you acquired it as a child from someone kissing you with a cold sore and you’ve had it for years without either recognizing it or realizing it.
The experts vary on how and when you should disclose this information. I would say certainly before giving anyone oral sex. The kissing is more difficult to state in black and white. I don’t even have a strong feeling about that one, truthfully.

You are most welcome.

If you like our services, please review us on Yelp and Google. You can post reviews with only initials or first names.

If you have you more questions, you can certainly renew your subscription.

Terri

[Zoros_LekLek]

Hey Terri,

So it’s been about a month since our last exchange. I got an outbreak on March 2nd, which sparked the conversation above; today is April 9th. In that time period, I have gotten two new outbreaks, and believe I am developing a third right now (my lips are burning, and the edges of my mouth feel tingly). Together with that first one, which we talked about on this sight, that means I’ve had four outbreaks in five weeks.

I’ve been pretty stressed over this period, mostly over my work. I also contracted a cold a week and a half ago. But the main trigger seems to be sleep, or the lack thereof — each outbreak has come immediately after a night of staying up late and sleeping very little (five hours or so).

I’ve always been a night owl. During college, and even graduate school, I slept at the library for weeks on end, on public couches, with lots of noise around me, and bad lighting. Now it seems that even sleeping in my room, in darkness and quiet, but for less than I should, is enough to trigger an outbreak.

This makes me think that the HSV1 infection is actually a very recent one, and not one I contracted as a child. Maybe from making out with someone, maybe from sharing a dish or something. Would you agree? When I got tested, the IgM values were quite low, which seemed to imply that this was an old infection, rather than a new one. But I believe you’ve mentioned, in other posts, that IgM is unreliable and not to be trusted much anyway. Given what I’m describing here, it seems this really *is* a new infection — right?

I am asking for two reasons.

(1) I need to figure out if I actually need to make active changes to my lifestyle in order to stop these outbreaks from coming at me with this kind of a frequency. Once or twice a year is one thing — but getting four outbreaks in five weeks is just insane.

(2) The doctor told me that if I was having ‘lots of flares,’ which he defined as ‘multiple times a year,’ I should perhaps consider starting ‘long term suppressive therapy.’ I want to know what you think of that possibility. Should I start long term suppressive therapy? Are there any risks? Would it maybe be a good idea to do long term suppressive therapy for a few months, while my body gets used to living with HSV1? Or is it rather the case that I am just more susceptible to HSV1, such that I should take long term suppressive therapy *forever,* not just for the next few months?

So, yeah. I’d like to know whether you agree that this is a newly acquired virus, rather than one contracted in childhood; whether you think suppressive therapy is a good or bad idea; and whether there is anything I should keep in mind when considering this kind of therapy.

Thanks very much!

[Terri Warren]

Yes, I think this is a new infection rather than an old one
And yes, I think suppressive therapy would be an excellent idea.
And we do not see any long term problems at all with this medicine.

Terri

[Zoros_LekLek]

Could you explain the deal with suppressive therapy a little bit more? Is this something that I would do for a year, and then see where I stand with it? Is it the kind of thing I’d be doing for the rest of my life?

Phrased differently: is the frequency of outbreaks a result of the infection being recent, of my organism being inherently (and irrevocably) more susceptible to outbreaks than other organisms, or a combination?

I hate the idea of having to take pills forever from now on. Will my body get used to HSV1, and stop producing this many symptoms, or will it only do so with suppressive therapy?

[Terri Warren]

I think the frequency of your outbreaks is likely due to the infection being recent and your immune system not yet knowing quite how to handle the virus effectively.

In terms of suppression: yes, you could do it for a year and see how it goes when you stop. This isn’t like an antibiotic where you have to finish an entire course or bad things can happen. If, after a year, you ended up still having frequent outbreaks, you could stay on the medicine or stop. These outbreaks aren’t dangerous, they are just unpleasant for some people, for a variety of reasons – cosmetic, work issues, etc. Your body should get more skilled, over time, at dealing with viral activity, yes.

You still have one more question on this subscription – please feel free to ask.

Terri

[Zoros_LekLek]

Thank you, Terri.

I have one more question. Should I assume that, because I am getting frequent outbreaks, I am also exhibiting more viral shedding? That is — am I especially contagious right now that my body is less skilled at handling viral activity? I’d assume that more outbreaks is a sign that the virus is more active (or my body cannot handle it properly), and so that would also mean more asymptomatic shedding. Is that correct?

[Terri Warren]

Yes you are likely also shedding more, both symptomatic and asymptomatic, during the first 6-12 months of infection.

Terri

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