[Question #12181] Oral HSV2 for someone who already has oral HSV1?
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9 months ago
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Male 52 with oral HSV1 cold sores since childhood. Get maybe 1 or 2 cold sore outbreaks a year, that follow a typical pattern and last 7-10 days.
The unusual frequency and back-to-back occurrences seem odd. Wondering if it's related to oral sex, and if this is potentially oral HSV2, or just an usual coincidence.
Previous type-specific HSV blood tests (years ago) were always positive for HSV1 (as expected), and always negative for HSV2 (and I have not had genital HSV2 symptoms ever).
Recently gave oral sex to a CSW who had no obvious signs of a genital outbreak.
- 5 days later, had typical cold sore outbreak lasting 7 days (right upper lip). (Had been eating a lot of almonds a few days before, and the arginine has been a trigger for cold sores for me.)
- 19 days after that outbreak, had milder one lasting only 3 days in generally same area (right upper lip). Behaved differently than usual (a large blister, that didn't scab like usual and just went away after a few days). No other triggers involved.
- 6 days after THAT, have another: prodrome symptoms for a few hours, then 2 very small, already scabbed over, circular lesions in a different area (on my lower middle lip). Looks like a cold sore, but not following the typical course and looks like will be gone after only 3-4 days.
The unusual frequency and back-to-back occurrences seem odd. Wondering if it's related to oral sex, and if this is potentially oral HSV2, or just an usual coincidence.
Previous type-specific HSV blood tests (years ago) were always positive for HSV1 (as expected), and always negative for HSV2 (and I have not had genital HSV2 symptoms ever).
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Terri Warren, RN, Nurse Practitioner
9 months ago
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It is likely just your HSV 1 behaving a bit differently, but it could be HSV 2, though unlikely. If you are really wondering, you could have the next cold sore swab tested OR you could do the IgG for HSV 2, but beware, there are lots of false positives on that IgG antibody test. If it is HSV 2, which I doubt, it will likely recur very infrequently, if ever. HSV 2 doesn't like the oral area at all.
Terri
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9 months ago
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Thank you for the reply.
Does the 3 back-to-back cold sore outbreaks in less than a month offer any clue about whether it's more likely to just be recurrent oral HSV1 (although much more frequent that usual), or new oral HSV2?
If I were to get an IgG test, when should I do so, considering the potential exposure was a little over a month ago?
Does the 3 back-to-back cold sore outbreaks in less than a month offer any clue about whether it's more likely to just be recurrent oral HSV1 (although much more frequent that usual), or new oral HSV2?
If I were to get an IgG test, when should I do so, considering the potential exposure was a little over a month ago?
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Terri Warren, RN, Nurse Practitioner
9 months ago
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I don't think the back to back cold sores offer clues but they are unusual, I know. If you were to do an IgG test, you should wait about 6 weeks for an initial test, and if positive, be prepared to do a herpes western blot for confirmation as there are so many false positives and poor commercially available confirmatory tests. At 6 weeks out, 70% of people who are going to be positive, will be positive for HSV 2.
Terri
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