HSV 2 risk from oral sex

[CarlosD]

i am a male. I gave oral sex to a stripper on Sunday 5/3. We also made out. At no point were my genitals exposed but she was completely naked. Starting on Wednesday I began feeling a tingling/itching around my lips. I also felt like I had the flu with nausea and dizziness. These symptoms increased Thursday. Friday I began noticing my lips were very irritated looking, especially in the center of my top lip. The irritated spot on my lip was also very painful. My lips during this time really seem dry and cracked all over but just much more so in that one spot. I rarely get chapped lips though. These symptoms increased until Sunday. The spot on my lip seems a little better today but I still feel flu-ish. I’m worried that I contracted HSV 2 from the oral sex. How likely is this?

In late March I contracted what I believe to be HSV 1 orally. The sore during my primary outbreak in March was a black spot surrounded by shiny skin on my bottom lip. It wasn’t very fluid-y so I was unable to get it cultured but I’m very confident that’s what it was. I bring this up because the symptoms I felt during that primary outbreak (nausea, dizziness, mouth tingling/burning) were very similar to what I’ve been feeling this past week. Also, if I already have HSV-1 it makes me think I contracted HSV-2.

I went to planned parenthood today and the nurse practitioner told me not to worry as HSV-2 “really likes the genitals and nowhere else”. She also directed me to your site as a good resource. I’m just very skeptical of her response and I’m trying to figure out how relaxed I should feel. How confident should I feel that I didn’t contract HSV2 orally? My best friend is pregnant with a small child and I’m worried to even be around her right now.

All my blood work has tested negative for both strains but as I understand it, it hasn’t been enough time to test it properly.

Thank you.

[Terri Warren]

I think it is very unlikely that contracted HSV 2 orally by giving this person oral sex. It isn’t impossible, just really unlikely. You’re correct that it is too soon to be tested now; you’ll need to wait at least three months to be more certain, but the odds are so low. The nurse practitioner you saw is right – HSV 2 has a strong site preference for the genitals. Also, without a swab test, it would be impossible to know if any lip lesion that you get would be HSV 1 or HSV 2. So you never had the black spot swab tested? Your description doesn’t sound much like herpes to me. The problem is that the traditional screening test for HSV 1 misses quite a few cases so may not be completely reliable.

If you do happen to have HSV 1 orally, why do you not think that this most recent sensation is a recurrence of your HSV 1?
The best way to sort all this out is to have swab testing done of these oral lesions

Terri

[CarlosD]

I did get the black dot swab tested but there was very little to no fluid and the test came back negative. My doctor said that because I had had contact with my partner hours before her cold sore appeared, followed by flu-like symptoms and painful itching and burning of my mouth 5 days later, that the dot was most likely an hsv1 herpes sore.

The reason I suspected herpes 2 rather than my 1st recurrence of hsv1 is that the sores are all over my mouth. The painful chapped spot in the middle of my upper lip as well as half a dozen white spots on my bottom left lip. My understanding is that since my primary outbreak was a single sore on my bottom right lip that all future recurrences would be located there. So I thought this must be a new infection. Is it possible that I haven’t developed an immunity to hsv1 yet and have been reinfected in a different prt of my mouth? It’s only been 6 weeks since my original infection. Also the timing of getting these intense symptoms right after my encounter makes me suspicious.

My primary care physician today told me that my high consumption of alcohol on Sunday triggered a recurrence. He said it looks like I have classic herpetic sores. I did not ask about the change in location of the sores though. He prescribed me valtrex at my insistence although he said it would do little to alleviate hsv1 symptoms.

Since you seem unsure of whether my primary outbreak of HSV1 was indeed herpes, I’ve attached two photos I took at the time.

[Terri Warren]

I disagree with your doctor on a few points:
1) cold sores can definitely move around to all different places on the mouth – I see it all the time. As do genital lesions with HSV 2.
2) If your initial sore was HSV 1, then the virus is in all those nerves around the mouth and in your face and head. This means that reinfection in the same nerve group doesn’t happen. It just moves to different nerves and may emerge there or wherever it likes in the trigeminal nerve area.
3) Valtrex can be very effective against HSV 1! It is FDA approved for the treatment of cold sores. Not sure why he thought otherwise.

The bottom photo does look like a classic cold sore.

Terri

[CarlosD]

Ok, so it seems like this is just a recurrence of hsv1 and the timing with my encounter with the stripper was just coincidental. Thank you. So mY follow up questions are as follows

1) How careful do I need to be around my pregnant friend and her infant when I don’t have symptoms? Can I kiss her baby?

2) how long after my sores are not visible am I no longer viral shedding?

3) is it recommended to tell my future partners I have HSV1 or is the prelevence of the disease such that I should just warn them if I feel a sore coming on?

4) what dosage of Valtrex should I take to get rid of a sore. I’m confused if it’s 2 g twice a day or 500 mg 3 times a day.

5) will the severity of my symptoms decrease with each recurrence? This last one was so unpleasant and seemed worse than my primary outbreak. Is it possible I won’t have another one at all?

Thank you so much for your expertise and responses. I really appreciate it.

[Terri Warren]

You can kiss her baby if you do not have a cold sore or one starting.
That cannot be known without swabbing every day which is impractical. Kissing a baby on the cheek with normal closed lips is not a risk for transmission. It is the open mouthed partner kiss that present a little risk when there is viral shedding going on.
I personally do think if the relationship becomes sexual and there is oral sex involved, you should disclose this information.
The approved dose for cold sores is 2 grams twice a day for one day, 12 hours apart, for a total of 4 grams in one day.
I suspect you will have more but usually the severity does decrease some over time, but not for every person, unfortunately.

This is your final post on this subscription. If you have more questions feel free to renew.

Terri

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