[Question #1644] oral lesions following mononucleosis

44 months ago

I am asking a question relating to oral lesions.

 

I’m a 29 year old male, non drug-user, heterosexual, sexually active. I have had cold sores (HSV-1) since I was a child. I get them on average 1 to 3 times a year, on my lips.

 

This May, I became very sick. I experienced night sweats, no appetite, fever, weakness, and pharyngitis. Concerned by my symptoms, I got tested for HIV and Mono. HIV test was neg. and Monospot test pos. The acute symptoms lasted 1 month, followed by 4 months of lingering malaise. However, 1 month after onset of my illness, I began having ulcers on my gums. I have gotten them 1 or 2 at a time, every 2 to 3 weeks, for 5 months. They were always located on the hard gingiva, at the border between my teeth and where the gum flesh begins. 2 notable exceptions were two ulcers I had on the hard palate of my mouth. All were small,  crater-like lesions, which did not bleed, but quite painful to touch and made it painful to eat. They lasted on average 5 days. They concerned me, and I decided to do a 2nd HIV test (4th gen) + hep and syphilis tests which were done more than 3 months after any sexual activity, and which were all negative and thus conclusively ruled those out. Nevertheless the sores continued until October. However, now in December I got a cold sore on my lip, which was unremarkable except for the fact that it was followed the next week by a 2nd cold sore, and the week after that by a third! I have never in my life experienced 3 cold sores in a row. Considering the difficult year I’ve had regarding my health, I am now concerned again about what this means.

 

My questions are :

1)    Were these oral lesions likely herpes, or something else entirely?

2)    Should I get further testing done? Should I have any concerns?

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
44 months ago
I think the lesions sound more like canker sores, which are not caused by herpes.  We don't really know what causes canker sores, but they are not an STD. Sometimes they are a reaction to foods but sometimes, they just come and can be so painful and annoying and we don't know why they come.  I don't think you need any testing of these lesions.
If you are getting more cold sores than usual, you could try daily treatment for a while to see if you can get the virus to settle down a bit.
And no, I don't think you need more testing really - it sounds like your immune system has been a bit down this year and the herpes virus loves to come out when the immune system starts dropping balls periodically and is tries to juggle all the needs for immune response.  If you mean do I think you have HIV infection I certainly do not.

Terri
---
44 months ago
Terri,

Thank you for your response, it is appreciated. You may be interested to know that about a month ago I visited an ENT specialist regarding the sores, and while I did not have any active at the time, as per my description he also suspected they were canker sores. I accepted his diagnosis without question, but what started giving me doubts again was that not much more than one month after my oral lesions stopped appearing (fingers crossed it stays that way) the back-to-back cold sores began, making me wonder if there was a connection there. In other words, making me wonder if the oral lesions I have been having were in fact herpes and which now for some reason are appearing on my lip instead of in my mouth.

The second point I wanted to make, and feel free to educate me further on this, is that when I did my own research regarding these lesions, I read many  resources which stated that canker sores tend to be on the "soft" areas of the inside of the mouth, meaning the inside of the cheeks or the area under the tongue, and intraoral herpes tend to appear on the "hard" gingiva and on the hard palate. Can you provide any insight on this?

As for HIV testing, I believe my  2 negative results, and I do not fear that this is the cause, though I certainly did at first before I tested.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
43 months ago
I have also read the information that you have, about the location of canker sores vs. cold sores.  And I do know people who have had intraoral herpes lesions, but not many at all.  The only way you can know if any lesion in the mouth is herpes or not is to have it swab tested, preferably using PCR instead of culture, as it is far more sensitive.

Terri
---