Orofacial HSV-2

[roose]

Sorry, I know I’m packing a lot of information here, but thanks in advance for reading.

As far back as 2006 I had what I thought might have been cold sores in my mouth and on my tongue, but never on the outside of my lip. I dismissed them as canker sores at the time, but when I took l-arginine supplements or ate a lot of almonds (high in arginine), they seemed to appear much more frequently. On my tongue, they felt like multiple tiny blisters on the side, and were painful. I would also get lesions elsewhere on the inside of my mouth. When I stopped taking the supplements or eating almonds, the sores would hardly appear. I read that arginine makes herpes activate for many people but I still dismissed the sores as canker sores and didn’t go to the doctor.

Fast forward to 2009, and I came down with the worst flu of my life. Two days prior, I vomited without any other symptoms, and the next day developed a bubbly blister on my bottom lip. The sore was where the pink part meets the red outter part. Very quickly the sore “burst” into a very painful open sore that I again dismissed as a canker sore. The next day I came down with full-blown flu symptoms, and another sore appeared right above the one on my bottom lip. Then my mouth and throat ERUPTED in painful sores. Again I suspected herpes but when I sent a picture to my doctor he said he couldn’t tell if they were canker sores or herpetic. When I should’ve gotten a swab test I didn’t. Terrible mistake. To be honest, they did look a lot like canker sores, but I’ve never (before or since), had my mouth erupt in sores like that. Seems atypical of canker sores.

An important note: my wife gets frequent cold sores on the OUTSIDE of her mouth near the lip. It’s a very typical presentation of cold sores.

About a month or so after the flu subsided and the mouth sores went away, I developed a very noticeable tingling/itching sensation on the right side of my upper lip, right nostril and tip of nose, also on the right side. Immediately I thought I contracted cold sores from my wife, because she described the prodrome symptoms as itching/tingling. Soon after she would develop sores. Only once however, did I develop anything that resembled a sore. It was more like a raised round area at the right corner of my upper lip, exactly where I felt tingling, itching and pain. When I experienced this, I did assume that I had contracted my wife’s cold sores, but didn’t think it was a big enough deal to get swabbed.

In January of this year, I tested positive for HSV-2 via type-specific blood test from my doctor. Of course I was shocked, and began researching everything I could find on the internet. I have what I believe is an oral HSV-2 infection with a high recurrence of prodrome symptoms in the areas I described above. A month ago I started 500 mg of Valtrex daily, and almost immediately felt the tingle start to subside. The Valtrex has virtually alleviated all of the tingling/itching/burning in those areas. If there is anything that would be responsible for these constant prodromes, is the fact that I’m at the in the sun multiple times a week.

So, since I haven’t produced a swabable lesion, I was considering taking another blood test to rule out HSV-1. I should note that to this day, I cannot think of any genital symptoms that would indicate a genital infection, barring the natural hypersensitivity to things that are probably unrelated. In other words, nothing I’ve had matches any pictures or descriptions I’ve found so far.

My test results showed an antibody index of 7.46 for HSV-2. The disclaimer stated that “Approximately 0.3% of HSV may be deficient in the glycoprotein detected in this assay and would give a false negative test result.” This seems to indicate a low failure rate. My doctor said the test was done via HSV DNA Quant, and the lab said they use the latest testing technology. The doctor and lab are part of a university with a world-renowned medical school.

1. Does it sound like I contracted herpes in 2006 and had a major outbreak + lip tingling later on, or was the outbreak in 2009 indicative of a new infection/primary outbreak, followed by recurrent prodrome around my lip?

2. Do you think I need to take another blood test to rule out a false negative result for HSV-1?

3. If I have both oral and genital HSV-2, what are the chances I’d only have symptoms orally?

4. If I only have tingling/prodrome on my lip, could I still test positive via swab culture?

Thanks so much for your time!

[Terri Warren]

1. Have you had sex with someone other than your wife that might have had HSV 2 in 2006? Has your wife been tested for HSV 2?
2. As it turns out there are many false negatives on the screening test for HSV 1. The western blot is by far a better test for HSV 1. I would recommend that to rule out HSV 1 in your situation with oral symptoms.
3. That would actually be very unlikely, though you have not had any lesions orally, correct? Remember that HSV 2 can show up anywhere in the boxer shorts area, including buttocks, thigh, abdomen, anus and penis.
4. It’s possible if your mouth is infected that you could recover virus using a PCR swab when symptomatic, yes.

The antibody test that you report does not look for HSV DNA, it looks for antibody to HSV, very different things. Did you have a swab test that looks for HSV DNA?

Terri

[Terri Warren]

1. Have you had sex with someone other than your wife that might have had HSV 2 in 2006? Has your wife been tested for HSV 2?
2. As it turns out there are many false negatives on the screening test for HSV 1. The western blot is by far a better test for HSV 1. I would recommend that to rule out HSV 1 in your situation with oral symptoms.
3. That would actually be very unlikely, though you have not had any lesions orally, correct? Remember that HSV 2 can show up anywhere in the boxer shorts area, including buttocks, thigh, abdomen, anus and penis.
4. It’s possible if your mouth is infected that you could recover virus using a PCR swab when symptomatic, yes.

The antibody test that you report does not look for HSV DNA, it looks for antibody to HSV, very different things. Did you have a swab test that looks for HSV DNA?

Terri

[roose]

Hi Terri, thanks for your responses. Answers below.

1. Have you had sex with someone other than your wife that might have had HSV 2 in 2006? Has your wife been tested for HSV 2?

I didn’t meet my wife until a few years later, so was still dating other women at the time. Given my sexual history, it would not surprise me if I contracted oral HSV-2. My wife has not been tested for HSV-2 although she will do that soon.

2. As it turns out there are many false negatives on the screening test for HSV 1. The western blot is by far a better test for HSV 1. I would recommend that to rule out HSV 1 in your situation with oral symptoms.

How about taking another antibody test through my doctor? Wouldn’t that reduce the likeliness of missing HSV-1 antibodies significantly? Also, how long should I wait after I stop taking Valtrex before retesting? I’ve been taking 500 mg daily for one month.

3. That would actually be very unlikely, though you have not had any lesions orally, correct? Remember that HSV 2 can show up anywhere in the boxer shorts area, including buttocks, thigh, abdomen, anus and penis.

I have had what could very well be oral lesions. The canker sore-like lesions I experienced occasionally since 2006, the lesion “explosion” in 2009 and the cut/bump + itching/burning in the right corner of my lip about 6 months ago. After months of research, I have not had any symptoms that resemble anything I’ve read or seen online, and nothing close to what I’ve experienced orally. I have had some intermittent itching on my penis shaft, but that seems to be tied to a harsh body wash, sweat or some irritant. There have been NO lesions, bumps or even redness in that area. This has been happening almost daily for a few months now. I will have it swabbed though at my next doctor visit to make sure.

4. It’s possible if your mouth is infected that you could recover virus using a PCR swab when symptomatic, yes.

I’ll get my lip swabbed then.

The antibody test that you report does not look for HSV DNA, it looks for antibody to HSV, very different things. Did you have a swab test that looks for HSV DNA?

I didn’t have anything swabbed at the time I was diagnosed. Only a blood/antibody test.

Some additional questions if you don’t mind:

1. What are the chances of getting hsv from a single unprotected encounter, if the female is not experiencing an outbreak?

2. Is it possible to have primary outbreak outside of initially-infected area? For example, if HSV was initially contracted through the penis, could a primary outbreak happen on the buttocks or thighs?

3. Is there any way to tell by the index value how recent the infection is? For example, would a 7+ index value be that high if the initial infection was within 2 months of testing, or would it be lower/higher?

Thanks again!

[Terri Warren]

I didn’t meet my wife until a few years later, so was still dating other women at the time. Given my sexual history, it would not surprise me if I contracted oral HSV-2. My wife has not been tested for HSV-2 although she will do that soon.

There is no way to know if your infection is only oral or only genital or both without a swab test demonstrating virus present from either location.

I have had what could very well be oral lesions. The canker sore-like lesions I experienced occasionally since 2006, the lesion “explosion” in 2009 and the cut/bump + itching/burning in the right corner of my lip about 6 months ago. After months of research, I have not had any symptoms that resemble anything I’ve read or seen online, and nothing close to what I’ve experienced orally. I have had some intermittent itching on my penis shaft, but that seems to be tied to a harsh body wash, sweat or some irritant. There have been NO lesions, bumps or even redness in that area. This has been happening almost daily for a few months now. I will have it swabbed though at my next doctor visit to make sure.

It would be excellent if you had a swab at home to gather if you have anything that might be a lesion. Then you can return it to your doctor’s office to be sent to the lab. We do this with patients all the time so anything could be caught early. This would apply to either oral or genital lesions.

Then I’m not sure what your doctor meant by the test looking for HSV DNA.

The chances of acquiring HSV 2 without an outbreak from a female at a single encounter are statistically really really small – well less than one in 1000, I would guess.

In my experience, the first outbreak, if there is a first recognized outbreak, would be genital and recurrences in other areas in the boxer shorts region.

The strength of your index value only indicates that you’ve had herpes for a while – certainly more than one month but other than that, we can’t know when you contracted it.

Terri

[roose]

Thanks Terri. My final question is:

How long should I wait (off of Valtrex) till I’m ready to take the IGG test again? I was on daily 500mg suppressive therapy for exactly one month then stopped 6 days ago. I want to be sure the Valtrex won’t interfere with the antibody test.

[Terri Warren]

I think you’ve had plenty of time to make antibody in this situation already. It would be OK to test now if I’m reading this all correctly. You aren’t worried about new infection, right?

Terri

[roose]

No, just wanna make sure the first test didn’t miss HSV-1 antibodies.

[Terri Warren]

OK

Terri

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