Intraoral Herpes Outbreaks every week or so

[Bluebutterfly]

I am a 35F with recurrent oral HSV1 cold sores on on my lips since middle school. I usually have a lip cold sore outbreak every 6 months to 1 year. I never took antivirals or did anything special to treat. I have never had any intraoral OB previously but about 3 months ago I had some ulcers on a red base on my hard palate. It showed up about 1-2 weeks following a bad viral cold infection (did not test for COVID). I researched online and it looked most like intraoral hSV or intraoral shingles (rare). It took about 2 weeks to resolve and I went on vacation thinking i was good for a while. Unfortunately, about a week after it healed, i started feeling that same pain, itching in the roof of my mouth-I thought it was way too soon for another OB. I saw 3 new small reddish looking lesions on the roof of my mouth- bit smaller and in a different location than first OB but were still painful and itchy. They eventually healed in ~week. I had another outbreak of small similar lesions in another 1-2 weeks. For last 3 months i have had new sores on my hard palate (one time near the upper tooth on palate) just about every week. It has been killing me because I don’t want to pass it on to my young children or husband (he has never had sores). PCP tested me for HSV 1 and HSV AB and I tested positive for HSV1AB and neg for HSV2 AB (not surprised I was positive given my hx of cold sores). PCP tested VzM IgM and it was unequivocal. I started valacyclovir 500 mg daily for suppression with no improvement. I saw ID who swabbed one of the sores (it was in a later healing state) and it came back neg for HSV which I believe it was not ideal swab. I am not sure it is HSV but i can’t imagine what else it could be. I have cleaned up my diet to be low arginine (no nuts, etc) , taken all sorts of supplements (vit d/c, zinc, monolaurin, gargantina red malgae), and 1 gm valtrex daily for last few weeks and it seems like the sores on my palate keeping coming. Is this HSV and why so frequent

[Bluebutterfly]

my HSV1 igG index was 44.3 and hsv 2 was <0.9
Varicella Zoster igG 727.7 and igM was 0.91.
I do no think this is shingles in the mouth since i have had recurrent sores on my palate for almost 3 months.

[Bluebutterfly]

the reason i ask you if you think this is possibly hsv1 is because i find it very odd that i have had outbreaks on my lips for over 20 years and now all of a sudden they are in my mouth on my hard palate and no outbreaks on my lips in the last 3 months, only intraorally, one after another, with maybe a week, maybe 1.5 weeks at most of being outbreak free. Also some of the red outbreaks are really small and only last a few days that i can see them.

[Terri Warren]

These could be herpes lesions or they could be canker sores, either is possible.
Forget the VZV testing – most everyone has antibody to VZZ from chicken pox or chicken pox vaccine. It doesn’t mean anything in terms of the mouth sores.
If you were my patient, I would give you some PCR swabs to take home to swab these the moment they show up. You should ask your provider about that to get a very timely swab.

It would be unusual for intraoral HSV 1 not to respond to suppression so I’m a bit skeptical about these all being herpes but best to find out with PCR swabbin.

Terri

[Bluebutterfly]

I got the swabs from my the lab that my doctor ordered to pick up and will swab them and await the results. I am in the medical field and I am pretty sure they are not canker sores because they do not look like classic canker sores, plus i don’t get sores anywhere like on my cheeks, it is only on my hard palate which is more likely to be herpes.

Also, i have noticed some itching in my vulvar region off and on, lasting for a day or up to 3 days, around my urethra and on the side of one of my labia, i looked at it and did not see any blisters or ulcers, just some general erythema which is probably from me itching it. I am wondering if i accidentally autoinoculated myself my touching my private without washing my hand first my finger or while in the shower some of the “infected saliva” got into my private area during my shower. I have never had sores or blisters or anything STD-like in my vulvar area and have tested negative for HSV igG antibodies recently and have only been with my husband for 15 years who is negative for everything and has only ever been with me. What are the chances that i accidentally infected my privates with HSV1?

Also, back to my original question i mentioned i was sick with most likely covid. I had my ID doctor orrder COVID antibody test and it was positive so we are thinking I probably had COVID a couple weeks before i started having all these mouth sores. I have read COVID is destroying people’s immune system and that long haul covid can be due to reactivation of latent viruses such as EBV and HSV. Did you ever hear of something like this and do you think this is a possible explanation for the high frequency of my outbreaks (assuming they are in fact herpes outbreaks)?

[Bluebutterfly]

tested for negative for HSV 2 antibodies is what i meant to say earlier

[Bluebutterfly]

I have been having what feels like intermittent burning near my clitoris, that gets worse in the evenings, it has been over 3 days. i couldn’t see any sores or blisters, but it still bothers me. I don’t know what else it could be. It is not a yeast infection and it’s only in that one spot around my clit not my entire vulvar region, so how likely is that to be due to laundry detergent or soap?

[Bluebutterfly]

i did not masturbate or do anything manually that i can recall to irritate it other than to inspect it for sores.

[Terri Warren]

Transferring the infection from your mouth to your genital would be extremely unlikely. I think you should take that off your worry list but it would be good to know what is causing the mouth sores. You may need to see an oral surgeon to have a biopsy done of the lesions. It is good to know that the swab tests are negative for HSV 1 but if it will help to reassure you, you could do more swab testing. The fact that you see no improvement on Valtrex also suggests that these mouth lesions are not due to HSV

Terri

[Bluebutterfly1]

Hi Terri. I someone wasn’t able to log in using my old account so I created a new account to continue asking questions.

So I got another 2 swabs done of one of my intraoral sores (both on roof of my mouth on different sides) (same time 2 different sores in my mouth) and one came back neg for HSV DNA and the other one back positive.
1. Do you think that some of these sores could be something else and some of them are HSV? Could it be positive from asympt shedding?
2. Is it more likely that since one tested positive for HSV that they are all caused by the HSV? Why are the HSV sores persistent and recurrent almost weekly to biweekly since January? Isn’t that really rare? It is now my 6th month of this very frequent recurrence in my mouth.
3. Also weird thing is that I always used to get them in my lips and 1x a year so why all of a sudden since Jan they are only inside my mouth?

My husband recently had what looked like one tiny red sore on the side of the roof of his mouth. He said he didn’t feel any pain just felt a small bump and then the bump feeling went away in a day. Well now I’m freaking out that I gave him HSV orally. He and I don’t kiss in many years. We used to kiss in the beginning but we stopped. He tested negative for HSV1 and HSV2 back in 2012 (after we stopped kissing). I do not give him oral sex. We don’t share food or utensils. He accidentally drank one of my cups of coffee back a few months ago. This was during the time I have had very frequent outbreaks in my mouth. I might have had a sore as my mouth was itchy and I saw red sores about 3 days letter in my mouth. I am scared he got it from drinking my cup. He drank it maybe 10 minutes after I had drank it.
4. Do you think this drinking incident led to transmission of the virus?

5. Do you think while talking I accidentally spit into his food or spit (while talking sometimes spit may come out) and into or near his mouth, I may have spread the virus to him? He is getting igG test done tomorrow.

[Terri Warren]

1. Do you think that some of these sores could be something else and some of them are HSV? Could it be positive from asympt shedding?
It could either be positive due to asymptomatic viral shedding or because the lesions are HSV 1.

2. Is it more likely that since one tested positive for HSV that they are all caused by the HSV? Why are the HSV sores persistent and recurrent almost weekly to biweekly since January? Isn’t that really rare? It is now my 6th month of this very frequent recurrence in my mouth.

It is very rare indeed, yes. I would suggest that you consider 500 mg of valacyclovir twice a day for at least 6 weeks and see how you do. If you have outbreaks in your mouth during that time of dosing, be sure to swab test them.

3. Also weird thing is that I always used to get them in my lips and 1x a year so why all of a sudden since Jan they are only inside my mouth?
No clue why this is happening, honestly.

My husband recently had what looked like one tiny red sore on the side of the roof of his mouth. He said he didn’t feel any pain just felt a small bump and then the bump feeling went away in a day. Well now I’m freaking out that I gave him HSV orally. He and I don’t kiss in many years. We used to kiss in the beginning but we stopped. He tested negative for HSV1 and HSV2 back in 2012 (after we stopped kissing). I do not give him oral sex. We don’t share food or utensils. He accidentally drank one of my cups of coffee back a few months ago. This was during the time I have had very frequent outbreaks in my mouth. I might have had a sore as my mouth was itchy and I saw red sores about 3 days letter in my mouth. I am scared he got it from drinking my cup. He drank it maybe 10 minutes after I had drank it.
4. Do you think this drinking incident led to transmission of the virus?
I certainly do not

5. Do you think while talking I accidentally spit into his food or spit (while talking sometimes spit may come out) and into or near his mouth, I may have spread the virus to him? He is getting igG test done tomorrow.
No, that’s not how hsv is transmitted. Please don’t worry about this.

Terri

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