[Question #2137] Oral Herpes Breakout after PEP . HIV/ PEP / ORAL HERPES

47 months ago

Dear Doctor Hunter / Doctor Hook


I understand that I have asked many questions before regarding my case. I also understand how repetitive questions beat the whole educative point of the forum . However I now have an unmistakable breakout of cold sores on my upper lip and these questions have neither been asked before by me and I also believe will be beneficial for the readers of the forum. Your opinion will also give me great peace of mind.

My exposure was 20 seconds of insertive oral sex with a lesion on my penis and 20 seconds of deep kissing. I took PEP for 28 days . I now understand this was a big mistake.

Among the many tests iv taken – one of them was an HSV1 and 2 IGG, IGM  test at 9 days post exposure . Only HSV1 IGG antibodies were present. NO IGM was present. Iv also had cold sores in the past before .

TODAY At 7.5 weeks post exposure and 3.5 weeks post pep – I have developed an UNMISTAKABLE breakout of HSV1 cold sores. Obviously my anxiety is skyrocketing as I have no access to an HIV physician here.


My questions are


1.     I know that since iv had the HSV 1 Virus in my body even before this exposure – it could be a recurrence caused by extreme stress. But could it also be because of a fresh infection from the exposure caused due to the kiss ? Would the symptoms show up 8 weeks later ? Usually the sypmtoms show up in 20 days I read but - Could it have been delayed by the PEP ? Symptoms showed up at 52 days post exposure

2.     If it was caused by the exposure – this means that she had a sore on her mouth and therefore it could have touched the lesion on my penis. In this case – perhaps my PEP helped me ?

3.     I know you mentioned that I don’t need any further testing for HIV with my exposure . Would your opinion change in the light of this new development ? Last test was HIV negative with duo test at 49 days post pep

4.     Would a test 4 weeks post PEP still continue to be 95-98% valid if someone gave . I know the confirmatory test according to guidelines is 3 months. My wife and I had planned to take the test at 4 weeks post pep and move on with our lives. Im not sure if we need to change it because of this exposure.


I really hope that you will answer our questions (my wife and mine ) . You have been our guide over the last two months. We don’t have access to HIV physcians and while we understand that this is not medical advise directly – Your answers give us great peace. One after the other – we have been plagued with symptoms – many of these have been psychosomatic in the past but the last two are not. The ulcer under the tongue took 9 days to heal but within one day of healing iv got an out break of HSV 1 .

This is a very difficult time for us. Please guide us with your knowledge 

47 months ago
List of tests taken

HIV DUO - Negative -  48 post exposure - 20 days post pep
VDRL - NEGATIVE - 6 weeks post exposure
CHLYMADIA AND GONNORHEA - 9 days post exposure
HSV 1 and 2 IGG and IGM - No Igm found . hsv1 igg found ( 9 days post exposure ) 

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
47 months ago
Good morning, I answer the herpes question on this forum. 

I believe strongly that your cold sores are simply a recurrence of the cold sore virus that you already had.  There is just no reason to believe that this is a new infection that is showing up 8 weeks later.  Once you have HSV 1, you are highly, highly unlikely to acquire it again. And this applies both to the genital and oral areas of your body (I know you have a concern about the oral sex).  I don't believe that the PEP had any impact you having or not having an outbreak of your cold sore virus.  This does not change, in any way, our recommendations about your further HIV testing - you don't need it.

Nothing about you having a cold sore recurrence has us concerned in the least.

Since you have dealt with Drs. Handsfield and Hook, I want you to know that they agree with this post. 

I know you've been dealing with great worries over the last few weeks, and I hope I can be just another clinician to add reassurance for your concerns.

Terri Warren

47 months ago
Dear Nurse Warren / Dr Hunter 

Thank you for your mail . 

I know that iv asked a lot of questions. Iv been in a state of extreme anxiety. Iv told my family the truth and it has affected my family. My job and business is in ruins as iv not been able to work over the last two months. The words of this forum have helped me get back to atleast trying to put my life together. 

1 . My worry with the oral herpes was that IF i got it from my sexual experience, it means that she had sores on her mouth . This means my risk of HIV goes up. 

Iv started visiting a therapist for my anxiety. Iv also decided to do one final HIV test at 8 weeks post exposure and then close the topic. 

2. I know the test at 8 weeks post PEP is not conclusive but will my risk be like one in million or what would it be ?

I am so anxious . I dont know how to move on . What advise do you give to people when they are stuck in a place where I'm Stuck . Every moment is full of fear . 

47 months ago
My worry with the oral herpes was that IF i got it from my sexual experience, it means that she had sores on her mouth , and given the fact that i had a small lesion 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
47 months ago
You are really reaching here for the worst possible situation, and I get it - there is a lot at stake here.  You've had HSV 1 for a long while, I assume, having had recurrent cold sores, and that makes it extremely unlikely that you would get it again.  Also, you got nothing right away, correct?  It's been almost 2 months since the encounter - this certainly doesn't  suggest any new infection from this encounter.

I think one in a million is about right.

Even though your family is suffering from your disclosure, I think this is a huge good step - with your anxiety, it had to be worrisome to them about what was going on with you.  

You are not at all able to step back from this situation yet and look at it objectively - you can only live inside of your panic at this point.  With good therapy, I'm hoping you can make progress on seeing this more realistically. 

I would encourage you to stop testing so often - allow yourself one more herpes antibody test, if you absolutely must, at 12 weeks - and only IgG.  Continued testing will just keep your anxiety going - I know that is counterintuitive, but it's true.  I think the trick to getting this anxiety under control is to take very specific steps - stop testing, stop posting, stop searching for information on the internet.  You can reward yourself for good behavior in these areas with one final HIV test and one final herpes IgG test.  Continue with therapy and seek out only cognitive behavior therapist who specialize in help with these kinds of issues. 

With that spirit in mind, I'm going to allow one more comment/question on our forum and then we need to stop as even this is feeding into your anxiety.  All three of us are in agreement on this issue about continued posting.  When you have reached the 12 week mark, we will be happy to hear form you one final time that your tests are all negative. 

Terri Warren
47 months ago
Thank you for your reply

Actually I already have Hsv1 igg antibodies in my blood so im not sure which test you mean at week 12.

What iv decided is one final HIV test tomorrow at week 8 post exposure and then stop . My wife is also comfortable with this. I see from your reply that the week 12 test for HIV would not be necessary in my case.  I want to move on after tomorrow from this incident . 

Am i correct to understand that i can move on without the week 12 hiv test  ? 

Thank you for allowing me the last clarification . I will work on therapy from here onwards
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
47 months ago
I was referring to a test for HSV 2 if that worries you?  I have zero worries about HSV 2 in your situation personally.
I don't feel an HIV test at 12 weeks is necessary - no - I just didn't want you to test beyond that, if you felt compelled to test again.
I'm so pleased that you and your wife have decided together to have a final HIV test at 8 weeks.  I think that's huge progress on your part. 

You're welcome - we all wish you only good things in the future.