Oral and Genital HSV-1

[miranda85]

I was diagnosed with HSV-1 two days ago. My symptoms started last week after my boyfriend gave me oral with a cold sore. I had no idea that a cold sore could cause genital herpes! Currently, I have genital and mouth sores. The lymph nodes in my neck are swollen and painful. One of my tonsils also has sores. I am taking Valtrex 1000mg 3x a day. The medicine makes me feel awful and I don’t have any energy. I am aching all over, off and on. Has anyone else had oral and genital sores at the same time? I’m confused as to why my mouth has sores since I have had cold sores in the past. I would have thought that my mouth wouldn’t have been affected. Also, my doctor only gave me a prescription to last 7 days but I am concerned that I will have another OB and it will be just as horrible as this one has been. Should I wait to see if I have another OB or go ahead and ask for another prescription? The genital sores are only painful when I use the bathroom. It’s the mouth sores that are killing me! Any advice?!?

[optimist]

Did the doctor swab your oral and genital sores and those swabs came back positive for HSV1?

[miranda85]

No, he just looked and said that it is definitely herpes and put me on Valtrex. My boyfriend had a cold sore so the doctor assumes that it is HSV-1.

[optimist]

I see. Is this a case where you and your boyfriend have only engaged in oral sex and never intercourse?

 

One thing to be aware of it that most people who have HSV (and this applies to oral HSV1, oral HSV2, genital HSV1 and genital HSV2) do not know they have it yet are capable of transmitting it, even in the absence of symptoms. So I'm trying to understand why the doctor is assuming your oral and genital infections are both caused by HSV1. If you have never had intercourse before and have only engaged in oral sex, and he knows your boyfriend has oral herpes, this may be why he's assuming both of your infections are due to HSV1. Oral HSV2 is uncommon and also the least contagious of the various type/location combinations, so he is likely excluding that as a possibility.

[miranda85]

I’m also wondering why he assumed that all of it is due to HSV1. I told the nurse and the doctor that we are sexually active but that the symptoms started three days after having oral sex and intercourse. At the end of last year, I was tested for all STDs and everything came back negative. I’m starting to wonder if it is possible that it is both HSV1 and HSV2 because I don’t understand how it could be oral HSV1 when I have had cold sores in the past but never sores all over the inside of my mouth and throat.

[optimist]

It could be the doctor feels type differentiation is an insignificant aspect, and maybe it is, depending on your situation and how you two feel about it, but if he specifically diagnosed you with genital HSV1 without testing you, I don't see how he could make that assumption based on what you told him. If you feel a need to be typed and it's too late to be swabbed, an IgG blood test will reach greatest accuracy 12 months following infection, though possibly longer if you're taking antivirals. I'd also recommend looking back at the STI tests from last year to see if they included HSV testing. Most doctors don't include HSV testing in STI panels, even when patients ask to be tested for "everything."

[miranda85]

Thanks for the information! I really appreciate it! I’m not sure if I should go to a different doctor and get tested. I doubt the treatment for it would be any different, but I am kind of curious as to which type I actually have. The testing I had done last year included testing for herpes. I have heard so many people say that their first outbreak wasn’t bad but mine has been horrible. I can barely eat anything because my mouth and throat hurt so terribly. It really makes me wonder if this could be from HSV2. I’ve had cold sores over the years which means that I already had HSV1 and I don’t see how these mouth and throat sores could be from HSV1. Wouldn’t I have had these awful sores before now if it is from HSV1? I’m so confused!

[optimist]

You're correct that the treatment would not be different at all.

 

HSV1 and HSV2 present identically, and it's actually more common for people to have noticeable first outbreaks with HSV1, but I get what you're saying that you already had cold sores which makes you wonder if this could be a new type causing problems. If you do have oral HSV2, the good news is that it rarely recurs and sheds virus about 25x less than oral HSV1. I know that doesn't make what's currently going on less painful.

 

Anther possibility is that you currently have an unrelated throat infection and your weakened immune system is causing you to express symptoms of a genital infection. But again, I get what you're saying that you were previously tested for HSV. When you were tested before, did you come back positive for HSV1?

[miranda85]

No, everything was negative but since I have had cold sores in the past, I just assumed that I have had HSV1 for a while! The back of my throat and my tonsil has sores that look just like herpes. I think I’m going to make an appointment with another doctor for a second opinion. I would really like to know for certain which type I have.

[Lifegoesonn]

I'm confused you said u was tested for everything including herpes and everything came back negative, but you said u always got cold sores for years so hsv 1 would come back positive you know ?

[optimist]

@Lifegoesonn The IgG tests misses 30% of HSV1 infections. It's possible that was the case here if there was a history of cold sores.

[Jack101]

Or she had cheilitis which is often mistaken as a cold sore.