[Question #623] Followup and final post

41 months ago
Hi, 38y/o male. Confirmed previously as oral HSV1. Previous exposure mid-Feb (french kissing/protected oral with CSW), followed by 3 days of sore throat/tonsillitis starting 5 days after encounter (spoke to HHH after this encounter). Separate encounters ending on March 8 with 4 CSWs (extended french kissing and unprotected oral with each CSW), second sore throat confirmed as strep soon after these encounters (spoke to TW and Dr. Hook after these encounters). 3 throat swabs recently came back negative for herpes for second sore throat, although doctors may not have been able to accurately swab the blisters in back of throat. No genital symptoms. Questions:
1) TW said she couldn't say for sure I didn't have oral HSV2, and that oral HSV1 can make oral HSV2 symptoms less severe, so is it possible the FIRST sore throat 5 days after kissing was a less severe form of oral HSV2?? (I NEVER had a throat swab for the first sore throat, only swabbing of "mucoceles" inside mouth, which obviously were negative)
2) Have you ever seen pharyngitis by itself in the absence of herpes lesions as a manifestation of oral HSV? Could this be the "less severe" form of oral HSV2 which TW mentioned? (during the first sore throat)
3) Is it higher risk considering these CSWs never use condoms for oral sex (hence they could acquire oral HSV2)?
4) Is it safe to date/kiss people? Should I get tested for HSV2 at 6 weeks and again at 3 months?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
41 months ago
So sorry to see you back -- not personally of course, but because of the evidence that we aren't helping. Obviously you have been unable to understand, believe, and/or process the repeated, detailed, science-based advice and reassurance you had had in your three previous threads. From your most recent thread with Dr. Hook:  "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...." and "I promise this is the last time I'll be on here about this."

I'll just add a general comment, similar to what Dr. Hook said last time:  You keep focusing on individual symptoms, tests, and the exposure, without paying attention to the fact that our opinion you don't have HSV2 is based on the combination of them all. Could such an exposure result in oral HSV2, even though it's so rare that neither I, Dr. Hook, nor Terri have ever seen such a case? Sure. Could someone with active herpetic vesicles have a falsely negative PCR test for the virus? Sure. Could that happen 3 times, not just once? OK, maybe I can buy that as well. Could someone have sore throat due to HSV2 despite not having the other things that go along with herpetic pharyngitis (ulcers, marked lymph gland inflammation, fever)? Hard to imagine, but this too might happen rarely. 

But what are the odds that all those factors, every one of them, would break the wrong way in a single person? It is simply impossible. Accordingly, the answers to today's question -- which for the most part are duplicates already answered, just with different wording -- really don't matter. Therefore, I'm not going to address them in detail, just will say that the answers to 1-3 all are no; and the answers to 4 are yes (safe to kiss and date) and no (you should not be tested again).

I have no confidence that hearing the same answers yet again is going to help you further. It is obvious that every reply simply generates additional "what if" or "did you really mean" sorts of questions. You are going to continue to worry, and hearing the same information now or in the future isn't going to change anything. This is clearly a mental health issue:  it is seriously abnormal to be so unable to accept or process this sort of infection, or to separate your likely anxieties over a sexual decision you regret from herpes or other disease consequences from that event. Accordingly, the only thing I can recommend is professional counseling. I truly suggest it from compassion, not critiicism.

However, we will not answer any more questions on this forum. If you post another new thread, it will be deleted without reply, and without refund of the posting fee.

Best wishes to you--  HHH, MD


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41 months ago
Hi Dr. Handsfield, I agree about counseling. Nevertheless, your answers (as well as those of TW and Dr. Hook) are ultimately helpful to me, even though it doesn't seem so. My anxiety has decreased since reading through all your answers. I am also contacting a therapist to talk about this stuff. I just wanted to followup given my most recent negative cultures from 3 throat swabs of the second sore throat. Also, to let you know the 3 recent throat swabs were ONLY "HSV cultures", and NOT PCR. One of 3 cultures was a "DFA culture", the other two just regular cultures. I've never had a PCR culture. I'm assuming the fact these were not PCR cultures doesn't change your opinion about all things breaking the wrong way being impossible. I understand and agree that further paid questions will be deleted. I wasn't sure if another new thread means I'm not allowed to write this question within the existing post, or can't pay for any new questions. If I'm not allowed to write anything further within this paid post, I understand. I appreciate your help.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
41 months ago
Culture is fine; it misses a few more infections than PCR does, but still would pick up almost all active HSV infections. I don't know how to interpret "PCR culture" (the terms used together) or "DFA culture". (DFA = direct fluorescent antibody and is yet a different test. It misses more infections than culture or PCR.) In any case, these results further confirm you don't have herpes. PLEASE stop testing any more, any type of test. It's time to let this go and move on with your life. The worst you had was a common cold or garden variety viral pharyngitis, plus mucoceles or something similar.

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41 months ago
Hi Dr.  Handsfield, sorry for the confusion. I had 1 DFA test and 2 regular cultures from 3 throat swabs of the SECOND sore throat (no PCR ever taken). All were negative for herpes. I had these swabs done because there were fluid filled blisters in the back of my throat going down into the esophagus, in addition to the confirmed strep test. I'd never heard of strep causing fluid filled blisters in the back of a person's throat, so it concerned me. 

To be clear, there were no throat swabs done on the FIRST sore throat, the one that appeared 5 days after kissing the first CSW, which consisted of sore throat and tonsillitis for 3 days (confirmed by doctor), along with mucoceles. The first sore throat was definitely not a cold...I had zero nasal symptoms. So it must have been a virus, although I've never had a virus that caused ONLY a sore throat and was so short lived. That said, I hear everything you're saying. Although I've never had a sore throat like it, I'm going to assume the first sore throat was a very coincidentally timed and strangely presenting version of a sore throat. I'm going to assume I don't have oral HSV2, and I won't get any more tests. And I won't be posting any more questions about this issue. I really do appreciate all your help (along with TW and Dr. Hook). Thanks again.


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
41 months ago
This doesn't change my opinion that you definitely did not catch oral herpes and something else explains all your symptoms. In additon to mucoceles and standard viral pharyngitis, there are viral infections other than herpes that cause both oral blisters or ulcers and pharyngitis -- especially enteroviruses. Google enterovirus and "hand foot and mouth disease" for more information. It's a benign infection that clears up on its own, with no long term health consequences. I'm only guessing, of course. But what I'm not guessing about is that you do not have herpes.

Thanks for your thanks.  Best wishes.

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