The reason transmission via kissing in unlikely is because HSV 2 in the oral area is not active very often.
Her presentation is so inconsistent with the way HSV 2 reactivates orally, it just made me wonder.
The possibilities here are the following:
1. She simply has an unusual presentation of HSV 2 orally
2. The antibody test that was positive for HSV 2 was a false positive
3. The antibody test is accurate that she has HSV 2 but the oral lesions are not HSV 2.
If she were my patient, I would definitely have the lesions swab tested and if positive, typed, the next time it happens.
Terri