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Had unprotected intercourse. Blood test normal. Suffering from oral sores and sore upper lips. What's wrong?

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Practicing since : 2009
Answered : 4362 Questions

I am a Caucasian guy 30 yrs old and have a question regarding oral sores.

I have had persistent mouth sores for the past few months (2-3 months). The first time I had them I noticed that the two veins on the bottom of tongue had little reddish nodules on them (maybe 5-6 each vein). They then turned into white sores/ulcers within a few days of appearing and took 1-2 weeks to heal each of them. My tongue felt swollen and I noticed the sides of my tongue had red indentations and the tongue was not smooth as normal. I assumed it was due to tongue resting on teeth because swollen. I had an increased feeling of fatigue and at times had headache and neck/body soreness. My neck glands also felt sore but were not obviously swollen as would be normal when I have had a flu. Since the initial outbreak I have had reoccurence of mouth sores on the side or under my tongue or on the membrane beneath the tongue. They are white, don't have a really prominent reddish border and can vary in size from small to massive. One recently healed below the tongue, on the bottom of mouth, took 2 weeks to heal and has left a rough patch where it was due to depth of the sore. I have recently had a sore upper lip at the outer lip line and someone said it was sign of a cold sore. I have never had a cold sore before in my life, so I was of the belief I did not have any HSV. I have never been tested for HSV1 or HSV2. Can someone please advise what may be causing these reoccurent mouth sores on the bottom of my tongue and mouth?

Past history:
I had unprotected intercourse on holiday with a girl I met in a club in Indonesia in Oct 2011. Between 1-2 weeks after that I became sick with extremely swollen neck lymph nodes, loss of hearing, night sweats, vertigo and a patchy rash on back of throat. Was given oral Corticosteroids and antibiotics and advised that it may be pharyngytis/mono neucleosis. Did not feel better after 3 days, went to hospital and was given more antibiotics/corticosteroids and a blood test taken and including HIV, HEP A, HEP B, HEP C. Blood test results showed negative to HEP and HIV antibodies. Advised white cell activity idicated a virus, advised most likely cause is usually infuenza. Returned back home and fell ill again, was heavily fatigued and unable to work for 2 weeks. Was out of breath walking around house and was in bed for 16 or more hours each day, not always asleep, just couldn't get up to do anything. My physician took another blood test in December including HIV, HEP, Chlamydia and Gonorrhea. Results were negative again, he advised there was indication of a virus and again that it was most likely influenza.
Posted Fri, 13 Jul 2012 in Sexual Problems
Answered by Dr. Rakesh Madhyastha 2 hours later

Thanks for the query

I believe that you have been extensively worked up for all sexually transmissible diseases so the oral sore might not be std related.
Recurrent oral sores needs to be worked up. The path of the investigation should be to rule out auto immune diseases. Example XXXXXXX profile, acla, etc. Biopsy of the lymohnodes if they are swollen and tender is almost always a gold standard for diagnosis of the problem.
I would like you to approach a good immunologist or an internist for the same.
For now
1. Avoid spicy food
2. Gargle your mouth with betadine mouth gargle at night
3. Follow good oral hygiene

I hope I have answered your query, if you have no further queries please accept my answer

I wish you good health

Above answer was peer-reviewed by
Follow-up: Had unprotected intercourse. Blood test normal. Suffering from oral sores and sore upper lips. What's wrong? 1 hour later
Thank you Doctor Madhyastha,

I have been tested for the STD's listed above but no others'. I know I have not been tested for HSV1, HSV2 or Syphilis as they are not on my blood results. I am not sure if there are others' that should have been considered before all STDs' can be ruled out as primary or secondary cause. Is there any other consideration I need to be aware of before disregarding an STD? I have read that some may not be detectable early in the infectious cycle. My last blood test was done 2-3 months post possible exposure. I have attached some photos' of my tongue. The two nerve branches are risen, inflamed and have small lumps along them, the bottom of my tongue is very sore.

I understand that this may lead to the same recommendation, however, I would not like to rule out any possible STD infection if there is any possibility that one may still be the cause as I am sexually active.

Answered by Dr. Rakesh Madhyastha 29 minutes later

Thank you so much for replying with the photos. It was of good help.
I could see few lesions under your tongue and on it and I also noticed some small lesions on your upper lip. Hsv is good possibility in this case. Please get the tests done. It is treated with oral and local anti viral agents for 2 weeks.
I would also like to add here that hsv tends to recurr several times during the first year of infection just like in your case inspite of treatment. But again I would like to add here that autoimmune issues are also
good differentials. I would like to revise my earlier recommendation of seeing an immunologist. Please find yourself a good internist or even a dermatologist for this matter.

I hope I was of help, if you have further queries I would be happy to answer

Above answer was peer-reviewed by
Follow-up: Had unprotected intercourse. Blood test normal. Suffering from oral sores and sore upper lips. What's wrong? 7 minutes later
Hi Dr Madhyastha,

Thank you for your time on this. I will go and see my doctor to arrange the tests as suggested and obtain a referal to an internist/dermatologist for further direction. Thank you for the advice for both the auto immune tests and clarification on possible STD infection.
Answered by Dr. Rakesh Madhyastha 4 minutes later

Happy to help

Dermatologists are trained to take care of both issues so it would be wiser to approach them first

I wish you good health
Above answer was peer-reviewed by
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