[Question #8979] Oral Herpes/HPV Inquiry

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37 months ago
Hello Drs.,

I am a male and was a in a long-term, monogamist, relationship with a female until a few months ago. In recent weeks, I have gone out with a few different females and have kissed a few. I have also had sexual intercourse with four and performed oral sex on three ladies (I have also received oral sex). I always use latex condoms for penetrative sex. This past Monday, I noticed a small bump/raised area, round/oval shaped (perhaps ~3x5 mm), on the roof of my mouth (on the right of the mid-palatal suture). The bump is painless and is not red or particularly white (blends in overall with the rest of the color of the palate). It only hurts a little bit when a lot of pressure is applied to it (with finger; does not hurt when I swallow or eat). Close to the bump are a handful of small, reddish dots (I am not sure if these have been there for a while or also developed, at the same time as the raised area); could they potentially be from having eaten hot food? They are completely painless. 

I got STD blood and urine work done on Monday afternoon. The HSV-1 and 2 IGG test came back negative as were all the other results. The IGM test is still pending but I understand that both the IGG and IGM test for antibodies and it may take a while to develop them, in case of a recent infection. I also understand that the raised area could be a blocked salivary gland duct, potentially, though it seems that this usually appears under the tongue. The bump has remained overall the same size since it suddenly appeared on Monday as are the little reddish dots. What are the chances that the aforementioned symptoms could represent oral HPV or herpes (or even HSV-2)? Would it be safe to, at this point, to be kissing anyone, or should I do a PCR test or wait to do another IGG test first? I've read that initial oral herpes infections, for example, could appear on the roof of the mouth and be painless. 

Thank you very much. 
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Terri Warren, RN, Nurse Practitioner
37 months ago
The IgM test is very poor and the Mayo Clinic decided to discontinue its use in 2019 and the other large labs have agreed to discontinue it as well by the end of this year.  
This doesn't sound anything like HPV to me - and that is uncommonly orally though I have seen it.  
I would advise that you be seen and have a swab test done of the bump for HSV so you have a bit more information, though I'm not at all convinced it could be HSV  but you never know.  Are you able to get that done?  the sooner, the better.  And yes, PCR should be done. vs culture.  

Terri
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37 months ago
Hi Terri,

Thank you for the quick reply and this information. I have gotten it checked - when I got the blood and urine work done Monday afternoon, a PA checked it (she could not see the bump at all with a light in my mouth; I had to point out where it was). She was pretty confident that it was not HSV or HPV. I also had a dentist cleaning appointment this morning and, initially, the dentist also couldn't see it until I pointed out where it was. He also had high doubts it was HPV or HSV and thinks it may be a blocked salivary gland duct, but recommended I visit an oral surgeon if it does not resolve within two weeks. 

Another concern is the small reddish bumps near it (which are also painless). The PA couldn't see them, and my dentist mentioned they could be from having eaten something hot. I did start smoking cigarettes in the last few weeks also (1-2 a day); not sure if this would affect this area of the mouth. 

Earlier today, I got the PCR and should be getting the results in the next 2-3 days. 

This evening, by the way, I've felt that the raised area has decreased in size a little bit. 

What are the chances that, in the case this does end up being HSV,  that it is HSV-2 (based on the exposures I described in my first message and symptoms)? 

I was under the impression that symptomatic herpes most of the time involves some pain/tingling etc. Is that true or may there be situations similar to what I described? 

Thank you!   
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Terri Warren, RN, Nurse Practitioner
37 months ago
I'm glad that you were able to visit professionals to have this checked out in person, which is way better than my trying to guess over the internet.  
If this is HSV, it is unlikely to be HSV 2 as HSV 2 really doesn't like the oral area at all.  The vast majority of oral herpes is HSV 1, though I am not at all clear that what you describe here is HSV.
Most herpes lesions are tender, at least, that's correct.    
Let me know the results of your PCR swab, OK, when you get it?

Terri
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37 months ago
Hi Terri,

My results came back last week. One was a regular swab test and the second was for HSV specifically. The first test reported a superficial wound. More specifically, the note stated that for organism #1: moderate growth of respiratory flora and for organism #2: moderate growth of haemophilus parahaemolyticus. The doctor's office asked if I wanted an antibiotic but given the lack of pain and the fact that the bump has significantly reduced in size (I ended up having two bumps - the first one is gone and the second is very reduced in size now. The second one appeared a week after the first one and similarly, was painless and blended in with the rest of the roof of my mouth). 

The HSV pcr test (done simultaneously, with another swab of course) came back negative but the note stated that the lab was unable to amplify the DNA for the Solena HSV 1+2 Assay and to resubmit a lesion swab. Given the result of the first swab test and the fact that the doctor couldn't see anything, he confirmed it was most likely not HSV and that I don't need to do another pcr.  

Would appreciate any final thoughts on the above. The little red painless bumps are still on the roof of my mouth but I just can't remember whether they were there before the appearance of the two bumps. 

Thank you for your time and help! 
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Terri Warren, RN, Nurse Practitioner
37 months ago
I think this all sounds fine - like you don't have HSV.  I think you should move on from this and accept that you don't have HSV  orally.

Terri
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