[Question #552] Follow-up after HSV PCR testing

39 months ago
Hi, I'm a 37 M who posted before and talked to Dr. Handsfield. Without repeating everything, I had an encounter with a CSW during which we were deep french kissing for a while. I had no other risk behaviors. I know for a fact (based on her admission) that she never uses a condom for oral sex with anyone, so I was worried I caught oral HSV2 from kissing her (blood tests confirm I already have HSV1). Anyway, 4-5 days after the kissing encounter I developed a mild sore throat with tonsillitis (white coating on tonsils) and some soreness of lymph nodes. I also noticed 3 small vesicles filled with clear fluid on the inside of my mouth (on the cheek near the front of the mouth). These vesicles do not hurt at all. Dr. HHH said these were "mucoceles" and could not be herpes. The sore throat and tonsillitis went away after about 4 days, but the vesicles are still there. I had the vesicles swabbed by a doctor (on day 5 after encounter) and had an HSV PCR test done. The HSV PCR test was "inconclusive", and the nurse told me there was not enough quantity/quality of DNA to measure...
1) Does this mean I could have oral HSV2 and I am seroconverting?
2) Was the PCR test inconclusive because "mucoceles" aren't herpes and so there was nothing available to measure?
3) The mucoceles or herpes are still there (although a little smaller maybe), so should I go back in and get another HSV PCR swab?
I was expecting  a "negative" result since these are mucoceles, so I was pretty surprised/worried to get an inconclusive result...

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
39 months ago
I would not jump from inconclusive to seroconverting.  I'm not sure exactly what they meant by inconclusive - I think there are few things that could have been going on there and we get it from our lab every now and then.  How long have the vesicles been there?  Herpes vesicles rarely last very long in that state - they break pretty darn quickly.  Again,I'm not sure what was going on with your specific PCR test.  You know the likelihood that you would contract HSV 2 from someone's month by kissing so very low!  HSV 2 is not often oral at all, because HSV 2 strongly prefers genital tissue.  And when it lives orally, it very rarely recurs and very rarely sheds - maybe 3 days out of a year.  What is the likelihood that you would be the one to whom that would happen?  I have never, in 33 years of practice, seen anyone get HSV 2 from someone's mouth - never.

Terri
---
39 months ago
Hi Terri, Thanks so much for your help. The vesicles are just inside the mouth. There is one tiny vesicle with clear fluid on the inside of one cheek, and on the inside of the other cheek there are two tiny vesicles clustered together with clear fluid. They are completely painless. I have noticed these vesicles appear from time to time, typically in the same spots. Since I first noticed them (about 5 days after the encounter), about 6 days have passed. The vesicles appear to be intact and in the same state...maybe a tiny bit smaller. As far as I can tell, the vesicles have been there 6 days, but it could be longer, since I only noticed them once I looked in my mouth with a flashlight (due to sore throat). 
1) Dr. Handsfield felt these were mucoceles, because of their location and the fact they are totally painless. Is that what it sounds like?
2) What would cause an "inconclusive" result on the PCR swab?
3) If these are mucoceles, could the result be "inconclusive" because there is no herpes DNA to measure? Or would it normally be "negative" (meaning no HSV DNA)?
4) Should I get another PCR swab? Or is it so unlikely I have oral HSV2 that it's not indicated to have further testing?
I pray you're right...that I'm not the first case ever of oral HSV2 acquired from kissing. Last question...how does the fact I already have HSV1 (blood test) factor in here?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
39 months ago
Yes, that's what they sound like to me - I get them all the time, heaven only knows why!
I'm not 100% certain about this, but I know blood can cause problems with the PCR swab, contamination of various kinds can cause problems too.  When we've gotten this result, I've called the lab and not gotten very clear answers about your question. 
I think if there was no DNA to see, then the answer would not necessarily be inconclusive.  And inconclusive it not exactly the word that we get back - our says something else similar to that - I'll have to look it up..  Perhaps you should ask the lab directly what they mean by that.
I would say that you don't need another swab, no.  HSV vesicles (blisters) just don't last a long time like that in my experience - just not at all! 
If you have HSV 1 already and acquire HSV 2, you are less likely to have symptoms with your HSV 2 infection.  Not exactly what you want to hear, I know, but that the way it is. 

Terri
---
39 months ago

Hi Terri, I have had 3 swabs of the vesicles now -- 2 negative "cultures", one inconclusive. They were cultures (not PCR). "Inconclusive" was due to not enough fluid. However, since then I have been really stupid. I am not in a relationship but feel very guilty. I was recently with 4 more CSWs. Extensive french kissing and received lengthy unprotected oral sex from each one (NO vaginal sex). AGAIN, 4 days after first encounter with 1 of 4 CSWs, mild sore throat/tonsillitis with no other symptoms.

1) Could this be an initial oral HSV2 episode (or a recurrence of the previous one)?

2) I've never had such mild, short-lived sore throats/tonsillitis with no other symptoms. What you said about HSV1 making HSV2 episodes have fewer symptoms scared me to death...it makes me think this "sore throat" is either a very mild first episode of oral HSV2 (due to HSV1 impact) or a recurrence of the oral HSV2 infection from the other encounter I mentioned. 

3) Should I get a "throat culture" for oral HSV2? Is that possible without blisters?

4) What is the approximate probability (numerically) that I have HSV2 now (keep in mind these CSWs never use condoms for oral with anyone)

5) Would you recommend a blood test to rule out HSV2? (or are these sore throats so soon after my encounters purely coincidence)?


Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
39 months ago
The usual herpes infection from receiving oral sex is HSV 1, not HSV 2.  HSV 2 strongly prefers the genital area and if it is oral, it is rarely shed from the oral area. 
Did you see anyone with the sore throat?  Was any testing done, like strep testing?
You can have your throat swabbed for HSV without symptoms, but I think recovery is unlikely and you may find it difficult to find someone who would do that. 
Honestly, I think your risk of acquiring HSV 2 in this situation is low, given the characteristics of the virus. 
Have you ever had a herpes antibody test?  Have most of your sexual contacts been receiving oral sex from CSWs?
Terri
---
39 months ago
Hi Terri, thanks for your help. I feel bad and know I need to stop. I've had several HSV IgG antibody tests (4 times, the most recent 1.5 years ago about 4 months after an encounter...ALL were positive for HSV1, negative for HSV2). Since the last antibody test 1.5 years ago, my only sexual relations have been several encounters with CSWs (all encounters within past 3 months)...I have NEVER had vaginal sex with a CSW. We often had mutual masturbation (using hands), and sometimes I received protected oral. Only with the recent 4 CSWs did I receive unprotected oral (all previous encounters were protected oral when I received it). However, I have deep french kissed several CSWs, approximately 7 within past 3 months. I happen to know all these CSWs perform unprotected oral frequently. None of them had a sore throat and none appeared to have blisters or herpes sores in/on their mouth. I also received a strep test during the first sore throat (when I first wrote you), and strep test was negative. I haven't had vaginal sex or performed cunnilingus since my last negative HSV2 blood test, so french kissing CSWs is my only risk factor for oral HSV2. I've had no genital symptoms. Are these 2 sore throats due to oral HSV2? I pray they are garden variety respiratory infections and not oral HSV2 (the timing of the sore throats is hopefully a coincidence). Do you recommend HSV blood testing? Or is it unnecessary (assuming no further encounters)?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
39 months ago
I can't tell you with 100% certainty that you don't have oral HSV 2 but I can reassure that this is extremely unlikely.  and no, I don't believe further testing is at all necessary in your situation.  Not at all. 
Best
Terri
---
39 months ago
Hi Terri, I will pay for a new question after this. I have good news and bad news. The bad news is, in addition to tonsillitis, there are multiple ulcers/blisters on the very back of my throat going down into the esophagus. The blisters appear kind of whitish in color I'd say. There are no blisters inside my mouth or on my lips, except in the very back of the throat. The good news is I got a rapid strep test, and it was positive for strep. To me, the blisters in my throat look like herpes, and they were so far back the doctor had a hard time seeing them, but he told me strep can also cause blisters in the throat. I got a herpes culture of my throat from 2 different places as well, and am awaiting the results of the cultures.
So, the first sore throat a couple of weeks ago was negative for strep (and no blisters in the back of throat)...this sore throat has blisters/ulcers in the back of the throat, and I tested positive for strep. Risks include french-kissing 7 CSWs...and unprotected oral 4 times recently (no genital symptoms).
1) Could I have both strep throat and an oral HSV2 infection at the same time? Would oral HSV2 only have blisters in the back of the throat?
2) Assuming throat cultures are negative for HSV2, can I safely assume I don't have oral HSV2?
3) Dr. Handsfield told me "kissing does not transmit STDs" in my first question, which made me feel better...was he trying to say it never happens or is exceedingly rare?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
39 months ago
Strep can definitely cause blisters and ulcers in the throat - that's what they do!
If your HSV culture is negative, then I think you should feel reassured that you don't have HSV 2 in your throat. 
Kissing can transmit HSV from someone who has oral herpes.  I think that's what Dr. Handsfield meant.  For most people, oral herpes is not necessarily considered an STD

Terri
---