[Question #591] Concern with symptoms after encounter

39 months ago
Hi, 38 yr old male, recently talked to Dr. HHH and Terri Warren. Concerned with symptoms. Recent encounters with 4 CSWs, extensive deep french kissing and received unprotected oral from each one (no other activities). Previous antibody tests indicate HSV1 positive, HSV2 negative. About 4-5 days after encounter with first CSW (or 3 days after encounter with second CSW) developed a sore throat w/tonsillitis and blisters on the back of the throat going down into esophagus. No blisters anywhere else. No genital symptoms. Saw doctor and tested positive for strep, was given antibiotic augmentin. I'm afraid I have contracted oral HSV2 from kissing CSWs, given the blisters in the back of my throat (please note all 4 CSWs regularly perform oral without condoms). 
1) I have never heard of strep throat causing blisters/ulcers in the back of the throat...to me they look just like herpes blisters. Could I have strep and oral HSV2 at same time?
2) Given the timing so soon after kissing CSWs and the sore throat combined with blisters in back of throat, I'm worried I have oral HSV2
3) I know oral HSV2 from french kissing is incredibly rare, but given these CSWs regularly perform oral without condoms, perhaps it is not so unlikely?
4) What is the numerical probability I have acquired oral HSV2 from these encounters?  Or is this just strep throat? I thought herpes esophagitis typically only occurred in people who are immunocompromised?
Edward W. Hook M.D.
Edward W. Hook M.D.
39 months ago

I'm sorry that you feel the need to return to our site.  Now that you have you will hear the same message that Dr. Handsfield and Ms. Warrant have tried to give you from me, making the three of us 100% in agreement that what you are describing in NO WAY suggests HSV-2 acquired by French kissing CSWs.  I have reviewed all that of your earlier interactions and agree with the earlier assessments completely.  Rather than once again telling you that what you describe does not suggest HSV and the reasons why, I will go straight to your questions:

1) I have never heard of strep throat causing blisters/ulcers in the back of the throat...to me they look just like herpes blisters. Could I have strep and oral HSV2 at same time?
I have seen strep cause blisters in the throat more times than I can count.  Nothing you have said suggests HSV-2 and you have multiple negative tests that confirm this

2) Given the timing so soon after kissing CSWs and the sore throat combined with blisters in back of throat, I'm worried I have oral HSV2
Why can you not accept that perhaps you caught strep throat through French kissing, not HSV.  This is orders of magnitude more likely.   If anything, the onset of your blisters is a bit early for HSV which typically occurs 5-10 days after exposure. Your worries are simply not justified.

3) I know oral HSV2 from french kissing is incredibly rare, but given these CSWs regularly perform oral without condoms, perhaps it is not so unlikely?
Not incredibly rare, neither f the three of us who have focused our careers on STIs including herpes for a cumulative duration of nearly a century has EVER seen or heard of such a case. 

4) What is the numerical probability I have acquired oral HSV2 from these encounters?  Or is this just strep throat? I thought herpes esophagitis typically only occurred in people who are immunocompromised?
There are no data to provide a numerical probability that what you are seeing is HSV, it has not been seen and therefore could not be studied.

I hope that my additional comments will be helpful to you.  You need to move forward from these unwarranted concerns.  eWH
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39 months ago
Hi Dr. Hook, thanks so much for your help. I promise this is the last time I'll be on here about this. I appreciate your patience. Your responses help me a lot. To be clear, with this particular sore throat (and blisters in back of throat), I have not yet had any negative cultures confirming absence of HSV2. After the first sore throat a few weeks ago (during which I talked to Dr. HHH and Terri Warren), I did have swabs done that were negative for HSV, but that was a separate event, and was prior to my most recent kissing encounters with 4 CSWs. I recently had swabs done of my throat to check for HSV2 this time, and I'm awaiting the results. Questions:
1) I have taken 2 days of antibiotics for strep, and the blisters/ulcers in my throat haven't changed any. Does this indicate higher likelihood of oral HSV2?
2) What in particular indicates this is not oral HSV2? Is it because oral HSV2 rarely causes blisters in just the back of the throat? (unless you are immunocompromised)
3) The CSWs did not have strep and were not sick. So perhaps this strep throat was just coincidentally caught around the same time?
4) Terri Warren said HSV1 (which I am confirmed to have) could cause reduced symptoms of an initial oral HSV2 episode...could that be the case here?
Edward W. Hook M.D.
Edward W. Hook M.D.
39 months ago
I am not sure if the fact that this is a different sore throat than the one you mentioned in the past three weeks makes things better or worse.  It seems to suggest that you may be fixated on something (HSV-2 pharyngitis acquired by French kissing) that none of three internationally recognized experts have NEVER heard of.  Your persistence does not change my opinion or advice.  Directly to your continuing questions

1) I have taken 2 days of antibiotics for strep, and the blisters/ulcers in my throat haven't changed any. Does this indicate higher likelihood of oral HSV2?
See what was said above about HSV-2 pharyngitis.  When people acquire oro-pharyngeal HSV (caused by HSV-1), the have oral lesions as well, not just throat symptoms.  The persisting blisters may still represent strep or a non-STI viral infection.

2) What in particular indicates this is not oral HSV2? Is it because oral HSV2 rarely causes blisters in just the back of the throat? (unless you are immunocompromised)
Please see above and review all of the explanations offered to you by the three of us.  You keep asking the same questions but the answers do not change and therefore need not be repeated.

3) The CSWs did not have strep and were not sick. So perhaps this strep throat was just coincidentally caught around the same time?
Many people carry strep asymptomatically.  In fact that is part of the way if it often transmitted- by asymptomatic persons.

4) Terri Warren said HSV1 (which I am confirmed to have) could cause reduced symptoms of an initial oral HSV2 episode...could that be the case here?
With GENITAL infections, person with HSV-1 tend to have milder initial symptoms if they go on to acquire HSV-2 and vis versa.  That does not change that there are no good data to support your apparent belief that you have HSV-2 of the throat.

EWH



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39 months ago
Hi Dr. Hook. Maybe I'm fixated on oral HSV2. It's been scary. After kissing a CSW in mid-February, I had a sore throat 5 days later. Once again, after french kissing 4 CSWs earlier this week, I developed ANOTHER sore throat 5 days later. Both were confirmed by doctors as pharyngitis, and the second was positive for strep (first sore throat was negative for strep). The TIMING of these sore throats is frightening. Plus having blisters in back of my throat 5 days after kissing a CSW (for most recent sore throat) is scary. Any specific responses are helpful and truly appreciated.
1) What did you mean a second sore throat in the last month after separate encounters could make things "better or worse"?
2) You said, "HSV (caused by HSV1) they have oral lesions." Is this equally true for oral HSV2? How likely is it to have HSV2 ulcers ONLY in the back of your throat, combined with sore throat? (I did not ask that of HHH or Terri Warren, so it's new)
3) How likely is it to have strep and oral HSV2 outbreak at the same time? (This question was not answered by HHH or Terri Warren, so it's also new)
4) It seems the blisters in my throat have been reduced to reddish, clear "bumps", so maybe antibiotic is helping?
5) Could you say specifically why this doesn't seem like oral HSV2? (despite 2 confirmed sore throats in a month 5 days after kissing each time)
Thanks again and specific responses help a lot. I won't be back, assuming my swabs are negative for oral HSV2 (praying for the best).
Edward W. Hook M.D.
Edward W. Hook M.D.
39 months ago

Obviously all that I, Dr. Handsfield and Terri have said has gone unheard.  As this is the third and therefore final reply as part of this exchange as per Forum guidelines, I will go directly to your questions.  The thread will be closed later tonight:

1) What did you mean a second sore throat in the last month after separate encounters could make things "better or worse"?
The fact that with two sore throats in three weeks you have worried and assumed they represent HSV-2 pharyngitis, something that NONE of us has EVER SEEN following kissing of any sort is worrisome because it indicates that you have not heard anything that we have tried to tell you earlier.  Having one sore throat and being anxious about it given your exposures is understandable, but that with a second sore throat, and despite the clear explanations that you had already received is worrisome as it indicates you are having trouble moving along despite clear advice from respected scientists.   

2) You said, "HSV (caused by HSV1) they have oral lesions." Is this equally true for oral HSV2? How likely is it to have HSV2 ulcers ONLY in the back of your throat, combined with sore throat? (I did not ask that of HHH or Terri Warren, so it's new)
As already mentioned, HSV of the mouth (i.e. oral) is so rare that it has not been systematically studied.  It is logical however to assume that if HSV-1 pharyngitis only occurs in combination with oral lesions, the same would be the case for HSV-2, particularly since HSV (1 or 2) shedding appears to occur on the mouth and lips, not the pharynx.

3) How likely is it to have strep and oral HSV2 outbreak at the same time? (This question was not answered by HHH or Terri Warren, so it's also new)
Physicians are trained to look for unifying diagnoses, not to give patients multiple diagnoses when one provides ample explanation.  In your case, all of your current symptoms could be explained by a strep throat so there is no need to wonder if you have a heretofore undescribed form of HSV-2.  In fact, it is illogical to have such concerns.

4) It seems the blisters in my throat have been reduced to reddish, clear "bumps", so maybe antibiotic is helping?
sounds like it.

5) Could you say specifically why this doesn't seem like oral HSV2? (despite 2 confirmed sore throats in a month 5 days after kissing each time)
No, I will not repeat the pages of explanations you have already received.

I hope you can move forward.  it seems to me that you may not be cut out for kissing CSWs if you are going to attribute every sore throat you have to a disease that is not recognized by medical scientists (such as HSV-2 pharyngitis in the absence of oral lesions).  If you continue to worry, my advice is to print all of the explanations you have received and review them with a mental health professional to address your unwarranted and persistent concerns.  I say this out of concern for you, nothing more.  This thread is now over.  EWH 
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