Rash around face

[Worry3214]

Hi there Terri,

I have hsv2. I’m on Valtrex. My boyfriend gave me oral on two separate occasions. The first time was around mid August and the second time was the beginning of September. I don’t think I was breaking out at the time. I don’t really know always, because I think I’m in my head a lot and always feel a little pinching (maybe because of hair growing back because of shaving though). I typically feel it in the upper labia (outside). Nothing crazy though.

About a month ago, my boyfriend began to develop some dry skin around his mouth. It’s now beginning to peel and it’s redder. It kinda looks like eczema with little bumps. Not itchy and it doesn’t hurt. No cold sores. He says he has never had this before and started like a month and a half ago. Does ohsv2 present in this way?

He also had developed a blood blister on his finger that’s been there for about a week but hasn’t gotten worse. Does herpes present in that way? If it was herpes, would it have progressed by now?

[Terri Warren]

No, HSV 2 oral infection is rare AND it would present just like a cold osre. Something else is going there, in my opinion. He could see a dermatologist about it.

Terri

[Worry3214]

Thank you for your response. Let’s say I had been breaking out, what are the chances that one would pass hsv2 from genitals to oral?

Also, as for the blood blister on the finger. That hasn’t progressed. There was another spot on his finger that progressed from a dark spot to a little bit of a bump, but I don’t think it has progressed from there in 2 weeks. I don’t think he had any cuts on his hand or finger when he touched me. Do you think there’s anything to worry about in that scenario?

Thank you for your time.

[Terri Warren]

We don’t have data on the question that are asking here as genital to oral infection is quite rare.

I think there is nothing to worry about in this scenario.

Terri

[Worry3214]

Prior to the first experience, I was on Valtrex for over 5 days. I was experiencing some irritation in the area due to bikini shaving. There was a bump in the area that did pop, but I felt like it might have been in the area because of shaving. I don’t think I’ve ever had a breakout before, or if I have it wasn’t significant so I don’t know what to look for. Retroactively thinking, I’m worried it was something. I might be getting in my head though.

He’s had the skin irritation since September 26th-ish and had peeling skin in the area for about a month in a half. No cold sore. You don’t think it’s correlated? I see online sometimes herpes presents itself in different ways for people so it’s just worrying me that is lasting so long.

Also, as for his finger, does herpes whitlow always go through the full cycle of bursting and becoming a sore? His finger had a bump as well as a blood blister, but they went away. If it was whitlow, would it have been more significant? Do you think I have anything to worry about in these situations?

Lastly, does Valtrex ever trigger a breakout? Whenever I start taking in for the first time in awhile, I tend to get extra irritation. And in this situation, I got that bump. Do you think it was an outbreak?

Thanks for your patience and for answering my questions.

[Terri Warren]

Nothing that you’ve written sounds herpetic to me. it does not present as a blood blister either. there is not biologic reason why valtrex would trigger an outbreak, exactly the opposite. I don’t think the bump was an outbreak but obviously I can’t be totally sure. If you ever want to know if something is an outbreak, you should have it swab tested.

Terri

[Worry3214]

Hey Terri, the rash went away. Thank you.

It’s been about almost 4 months from the last oral episode (first in mid August and second early/mid September – see context above). No symptoms for some months, but in the last month he’s experienced some swelling of the lymph node behind his right ear. It was kind of red at the surface, kind of like blood was surfacing to the top. It went away (decreased in size) and then came back. Then a couple days later he got a small cold sore-like spot in the left crease of his lip. I don’t know if he’s experienced a cold sore before. It isn’t noticeable unless your really looked or stretched out his lip/felt it. Do you you think this could be linked to the episodes in August and September, or would it be too far out…also given that oral HSV2 is rare? Is it more likely if it was linked to august or September it would’ve happened between 2-12 days? Is it more likely to be an HSV1 cold sore? I know swabbing is the best to know, but wondering what your perspective is on it.

Thanks for your help.

[Worry3214]

^ I noticed it dec 24 and it was completely gone by the 31st (maybe before).

[Terri Warren]

Has he had any herpes antibody testing done?
This doesn’t sound like classic HSV of either type. Is he worried about it? If yes, he might consider testing, but if you are staying together, not sure of the benefit.

Terri

[Worry3214]

I don’t think he has any antibody testing done, and I’m not sure if he even recognized he had a cold sore, if he did. I think I’m just hyper focused on it for him. So if he did get it during the two oral occurrences, it would have been more likely that symptoms would have shown up between 2-12 days? Do you often see it appearing for the first time after 4 or 5 months? Would it have been a more obvious presentation?

Thank you.

[Worry3214]

Would it be likely that another cold sore would pop up on the face that close in time to a previous one (the one mentioned earlier)? First was December 24 and there’s a red spot underneath his lip today 1/7. I’m confused because I feel like if it was hsv2 it wouldn’t reappear. Thanks.

[Terri Warren]

An outbreak at 4-5 months out would be a recurrence, not a primary outbreak.
I seriously doubt that HSV 2 would present orally two weeks apart.

Terri

[Worry3214]

Hi Terri, thank you.

To recap, the two oral sex occurances happened in mid August and early September. No cold sores or symptoms other than that rash that you said you believed was irrelated that started at the end of September and lasted well through October. After I told you about very small bump that popped up around 12/23 as well as that swollen neck lymph node (4 to 5 months after oral episodes), do you have a different opinion about the rash being connected? Do you think that was the primary outbreak? Or do you feel like the primary outbreak would be a more obvious presentation? Is it more possible that it could have just been a cold sore linked to having just had a cold? It resolved itself pretty quickly.

[Terri Warren]

I still think that HSV 2 is unlikely here, correct. A true primary would likely have more symptoms

Terri

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