[Question #7169] Oral Problems

7 months ago
After having sex with 6 people unprotected I some how got into a rabbit hole of google searching herpes. I discovered it was way more common than I once thought and eventually got the courage to get a blood test which turned out to be negative for both, although I do know they are not always accurate. Fast forward to now, I have been very careful with who I have been with due to worries. Since my blood test in march, I recently have given oral sex to one man twice. The second time, I got a sore throat right away that seemed to go away after about a day and I thought it was just trauma from oral sex. About 6 days later I notice I have a slight sore throat again, and I only really noticed because I was worried it could be COVID. I look at my throat and my tonsils are swollen with pus, it looked like strep throat. I instantly got worried and told the guy I was seeing, he said he has never had any STD, but I told him he should get blood tested for herpes. Time passed and he said he got the blood test and no call from his doctor so he assumed he was negative (I am not sure if he is telling me the truth regarding this all). Anyways, I went to urgent care, they did a rapid test for strep and it was negative but still prescribed me with azithromycin. About 1 - 2 weeks later everything seemed to have gone down and no pus, but I still notice some painless bumps in the back of my throat. I am not sure whether they have always been there or not. 
My questions are:
1. Could this be HSV2 in the throat presenting mildly? I will get a blood test in a few months but I would like to hear your opinion
2. I tried to get tested for throat STDs but planned parenthood isn't swabbing due to COVID, if i did have a throat STD like chlamydia or gonorrhea would the antibiotics I took have already taken care of it?
3. Do you have any suggestions on what else to test for or if anything at all? I tested for HIV with rna test at 21 days and 4th gen rapid at 27 both negative
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
7 months ago
Welcome. Thanks for your confidence in our forum.

I'll start with some general comments. Oral STDs are mostly pharyngeal, i.e. throat infection. Perhaps most pertinent to your concerns, the large majority of such infections cause no symptoms at all. Accordingly, sore throat and/or visible signs of pharyngitis like redness or white patches rarely are due to STDs. Regardless of your sexual history, your symptoms were far more likely due to a garden variety respirtory virus or non-strep bacterial infection, explaining the improvement with azithromycin treatment. (In view of the pandemic, you should have been tested for COVID-19. I'm curious if that was done.) Second, oral sex is quite low risk. Most STDs don't take hold very well in the throat; gonorrhea is the main exception. Some infections are vertually zero risk from oral sex, including HIV.

To your questions:

1. Herpes throat infection is not only rare, but when it happens causes much more severe symptoms than you report, usually accompanied by blisters or sores of the lips and the mouth itself. There is no reason at all to suspect HSV2 (or HSV1) as a cause. It seems likely your partner doesn't have HSV2, but even if he did, I would still reassure you that herpes is exceedingly unlikely.

2. If you happened to have either oral gonorrhea chlamydia or gonorrhea, the azithromycin would have cured it.

3. Gonorrhea and chlamydia are the only STDs for which oral testing is available or routinely performed. I don't recommend any other testing based on your symptoms and exposure history.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD
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7 months ago
Thank you so much for the quick reply! I just have a couple more questions if you don't mind.

I plan on getting a blood test in a few months, if it is positive would I be safe to assume it was from this encounter? Or could it previously just not have been picked up on the earlier test I took?
During oral sex, my front teeth hit my lip and it started bleeding, I think that's what created such big concerns for me. Because of this, does it put me at greater risk for HSV?
When someone gets HSV2 orally is it typically asymptomatic? Like do most people who get it orally never experience an outbreak of any kind?

Thank you again for all the help and information
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
7 months ago
Until now, I wasn't aware you have had an HSV blood test. (Re-reading your initial quesiton, I see it must have been last March. Sorry I missed it.) Negative for both HSV1 and 2? If you go ahead with another test and it's newly positive for HSV of eitiher type, it might implicate the oral sex event and the sore throat you experienced afterward. I don't think biting your lip during oral sex would have increased the risk of herpes. If it did, I would expect symptoms at the site of the bite, instead of (or in addition to) your throat. ---
7 months ago
Thank you! Sorry one last question. Whenever people acquire oral HSV2 do they typically not even have an initial first outbreak? Again thanks for all your help.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
7 months ago
Probably somewhere around half of all new genital HSV2 infections cause no symptoms; or only mild symptoms whose sigificance is not understood or misdiagnosed. However, it appears that oral infections usually cause typical symptoms like the ones I described above. I stress appears because there has been no research on it.

I'm sorry you haven't said more about when you had your last HSV blood test and the results for both HSV1 and HSV2. Normally threads are closed after two follow-up exchanges in addition to the first reply. However, in case you just forgot or didn't notice that suggestion, I'll leave this open for another day or two in case you would like my thoughts about those test results and when you should have a follow-up test, if you get tested at all.

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7 months ago
I got tested in March and the test came back negative for both! I took the tests months after my last exposure so I believe the results were as accurate as they could get. I just want to confirm that I should wait 12 weeks before getting tested correct? Again thank you so much for all that you do, it has been such a huge help to be able to read this forum. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
7 months ago
"I took the tests months after my last exposure":  If that negative result was 12 weeks or more after your last sexual exposure, then it's reliable. You don't have herpes and don't need any additional testing. If it was under 12 weeks, it's OK to have another test at that time. If you do that, I'm confident it will be negative.

That concludes this thread. I hope the discussion was helpful.
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