[Question #4289] Any possible explanation for this?

29 months ago
Hey there. So I had protected intercourse with a girl about a month ago. 2 days after that, I started feeling a burning sensation below my lip (near my soul patch). This feeling was there on and off every day, and lasted for around 12 days. Then it stopped. Or at least I thought it did. But I felt it again on Day 16. And again on Day 20. It is primarily in one spot and moisturizing creams did not help. What could this be? I thought it could be HSV at first, but this seems awfully long for a prodrome syndrome right? I've never had cold sores in my life. So what are the odds this could be some kind of delayed primary HSV outbreak? Are there any other possible explanations for this? Thank you for the help!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
29 months ago
Welcome to the forum. Thanks for your question.

No STD is a likely explanation of these symptoms. You are correct that a herpes prodrome generally would not last so long. It also would not be likely to cause intermittent, on and off symptoms. Even more important, prodrome is primarily an issue for recurrent herpes, not initial infection -- so in the unlikely chance this is herpes, it's more likely from a longstanding infection than one acquired during the sexual event a month ago. Of course, half of all adults in the US have had HSV1, mostly oral, so you could well have previously undiagnosed oral herpes. But it seems unlikely to be the cause of the symptoms you have reported.

As for other STDs, both the symptom itself and the location near the mouth don't fit. Whatever is going on, I'm confident it's just a coincidence in timing, not because of the sexual exposure you have described. 

Sorry I can't give you more conclusive information, but I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD
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29 months ago
Thank you for the detailed reply sir. I just have a few more questions

1) I read somewhere that only 30% of people with HSV1 actually experience noticeable symptoms. Is this true? So most people infected with HSV1 are completely asymptomatic?

2) If this is indeed stemming from a longstanding infection, will this be classed as a primary/initial infection? Since I haven't had cold sores before? Or would this be classed as a recurrence? I'm just trying to get an idea of how unlikely it is to be HSV1. 

3) I suppose the only way to be sure of my HSV status is a blood test. Would it be effective at all if I take an igg test a month after exposure? Or is it really necessary to wait for 3 months? What index values should I look out for, to confirm it's a true positive?

Thanks again!

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
29 months ago
1) Correct, most people with HSV1 are entirely asymptomatic. 30% with symptoms is a pretty good guess, but it could be as low as 10%.

2) By definition, a primary infection is very recently acquired, within a couple of weeks. If your symptoms were due to herpes, it would have to be a recurrent episode. But herpes with only burning, tingling, etc is extremely rare. You can find it described on the web, especially on websites likely to attract worried or anxious persons. But in my 40 years of clinical practice and working in STDs, I have never seen a patient whose only herpes symptoms were this sort of thing. If it were herpes, within a couple days of onset of burning you would have developed visible blisters or sores.

3) When using the blood test to diagnose new herpes, it's always best to be tested twice -- the first time ASAP after onset of symptoms, then again 3-4 months later. The chance from negative to positive is the ONLY way to know that a positive result represents new infection. And if the initial test is positive, it would prove you were infected before the exposure.

I don't really recommend you be tested. Many people with HSV1 never develop positive blood tests, so a negative result would not prove you are not infected. And a positive result will not mean that herpes is the cause of these symptoms. But if you go ahead with testing anyway, don't worry about index value, at least not yet. If positive, then whether the index is low or high might be useful. But cross that bridge if or when you come to it. But I stress again that if you were my patient, or if I were advising someone personally close to me (or if somehow I were in your situation), I would not recommend testing and would not be tested myself in this situation.
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29 months ago
Thanks again for the prompt reply! Much appreciated sir. What you've said definitely puts my mind at ease. I just wanted to ask, if this is indeed herpes, can I expect symptoms related to burning/itching, etc to always be in the same spot (below my lip)? Or is it possible for HSV1 to reoccur in different spots around my mouth?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
29 months ago
Recurrent outbreaks (blisters, sores, etc) usually are in pretty much the same area each time. For example, if left upper lip, usually the same area every time, give or take an inch or so. However, this is unknown for itching, burning, etc in absence of outbreaks. But once again, I'll say that such symptoms are not likely to be herpes anyway.---
29 months ago
Thank you doctor. This has been extremely helpful. It must feel amazing to know that you've helped thousands of people worldwide. I'll take your advice and not worry about this. Have a great day!