Oral HSV-1 primary outbreak

[throwaway1111]

Hi Terri,

I have a bit of a puzzle for you. About 6 weeks ago I came down with a very sore throat, low fever, productive cough, and general feeling of malaise.

Wednesday night I was out at a party and accidentally used a shot glass right after someone. The person drank from the glass, put it down, and then I drank from it maybe 30 seconds – 1.5 minutes later instead of a clean glass. Didn’t see the person the rest of the night so I don’t know if they had a cold sore or not.

Saturday around dinner time I had a tickle in my throat. By 2am Sunday I was awake coughing up green/brown mucus with a very sore throat and heavy post nasal.

I went to urgent care 12 hours later (Sunday 2pm) and swab tested negative for strep. No culture though. Also respiratory PCR panel with nasal swab negative for common viruses. Provider said my nostrils were very inflamed and my throat was very red. Gave me azithromycin. Seemed to help but who knows. I went to another urgent care that Thursday and got another strep swab and a herpes throat culture. I thought I saw lesions but the urgent care didn’t and so swabbed my throat and tonsils. Would have been my primary outbreak, 4 days after onset. Culture came back negative.

I have tested for hsv-1 & 2 twice in my life. Latest was one year ago. Negative both times for both types.

What are the chances that was a primary herpes outbreak? I’m going to Igg test this Friday since it’s been 6 weeks.

Don’t normally associate herpes with cough/bronchitis, but I have seen some studies where college students presented with upper respiratory symptoms diagnosed bronchitis and cultured herpes positive. A few for kids with primary outbreaks and a cough too.

How common is hsv-1 with pharyngitis and a cough/nasal involvement? The negative respiratory panel and strep test seems to leave herpes on the table.

The illness lasted Sunday – Friday. Sunday was three days from possible exposure.

[Terri Warren]

Your symptoms and your encounter do not fit with this being a primary HSV 1 infection. They do fit well with some other type of respiratory infection,however. The thing is, the chance of getting herpes from a shot glass in itself are incredibly low. Was there alcohol in the shot glass? If yes even lower!

Terri

[throwaway1111]

Thanks for the reply. I had an Igg at 6 weeks come back negative.

I also got a split lip a few days ago and a small ulcer-like sore on the inside part of the split. A little bit on my lip. The white part of the sore came off when I brushed it. I’m wondering if that’s typical of herpes?

The ulcer right on the split threw me off because my canker sores are usually inside my mouth by some margin. This was in the split lip itself. No blister that I ever saw. Just a white sore.

No chances to get it swabbed but will if it comes back.

[throwaway1111]

One follow up. I swabbed the lesion myself for PCR testing just recently. When I broke it open it bleed a bit and some blood got on the PCR swab.

Will that impact the accuracy of the test?

[Terri Warren]

Blood will not impact the reliability of the PCR swab, no. hard to know what this lip thing might be from your description

Terri

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