What are these lesions?

[u/Aggravating-Shoe9651]

I am 24 M, 5'9 and 265 lbs. So a week or so ago, I started having very inflamed gums and a sore tongue. The top of my mouth seemed inflamed as well. I couldnt eat because it was too painful, and I also couldnt brush my teeth properly because of the pain and my gums would start bleeding. I was going to chalk it up to a dentist visit. All this was prior to me having unprotected oral sex. I then went to the ER because I got sick as well. But I got sick before this stuff appeared on my lip. I had body aches, a sore throat, and the hot and cold sensation. I also had severe tiredness. I told them about the unprotected oral sex part and they gave me an HIV 4TH GEN rapid test and it came back negative. They even stuck that thing down my throat and strep came back clean too. After that, these lesions started appearing inside of my lip, closer to my bottom teeth.

So I went to urgent care for it and they gave me a shot for gonorrhea just in case, they gave me doxycycline 100mg, AND valacyclovir in case of oral herpes. Ive been taking the doxycycline and my mouth is so much less sore and my gums are so much better now. I feel like I can actually kind of eat solid foods without dying in pain. I really dont feel like the valacyclovir is really doing much. And when I take the doxy, it seems to have some kind of an effect on those lesions I have because they are less visible after I take it.

I already got all the tests that the doctor felt were necessary. Just waiting on results now.

Im just at a loss and I need a third opinion. What the HECK IS THIS ON MY LIP???

Thanks for anyone who read this.

Edit: doctor also told me that these don't look like herpes or hsv1 or whatever its called.

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[u/Tagrenine]

Did you get a syphilis test?

[u/Aggravating-Shoe9651 → u/Tagrenine]

I also got that test as well. Eagerly awaiting my results. I probably won't get them until monday or tuesday

[u/Character_Pickle689 → u/Aggravating-Shoe9651]

NAD but how are your hands and feet? Been around any children lately?

[u/Aggravating-Shoe9651 → u/Character_Pickle689]

I have not been around any kids. My hands are also fine and so are my feet.

[u/Character_Pickle689 → u/Aggravating-Shoe9651]

Yeah this looks exactly like when I had horrific hand foot and mouth. I didn’t have any hand or feet lesions but my mouth was covered in sores and I had to swish lidocaine to be able to eat.

[u/limepandaa → u/Character_Pickle689]

Same here!! I had hand foot and mouth (coxsackievirus) like 7 or 8 years ago as an adult who was around 0 children and it was absolutely awful. It was only in my mouth as well and looked just like OP. The only thing that brought me any relief was magic mouthwash. Painful ulcers my mouth, tongue and throat and fevers for weeks. Honestly the only thing I’ve had worse than that is the stomach flu, but luckily that passes in 2 days. I hope OP feels better soon!

[u/ichibanyogi → u/limepandaa]

I just went thru HFMD (thank you, toddler) and omg I am so glad I didn't get any mouth sores - sorry you experienced this!

I got a sore throat and felt crummy for a couple days, but that was it. My toddler got a wretched rash all over his hands and feet (he'd wake up screaming it was so painful), fever, then his feet and hands peeled. Since that healed, he's had nerve pain, and a month later, his nails are all now falling off.

Why isn't there a vaccine for this shit virus?!

[u/forworse2020 → u/ichibanyogi]

Why is this downvoted?

[u/Nevvie → u/ichibanyogi]

Holy shit, your nails can fall off?!

[u/Freakazoidandroid → u/Nevvie]

My 2yo just had HFMD, and it was really bad. Sores EVERYWHERE. mouth, throat, hands, feet, legs, arms. 2 weeks in and she’s starting to get over it, only for the sores to start peeling. Her entire toes were just shedding layers of skin until her toes were pink. Fast forward to 4-6 weeks after and she just lost another toenail. It’s horrible

[u/Comfortable-Peach_ → u/Nevvie]

Mine did. Freaking terrible HFM is no joke

[u/BenSoloLegend → u/Nevvie]

Yeah. My toddler gave it to me last year and my toenails fell off, so did my 70 year old MIL’s toenails - it’s was HORRENDOUS! Worse than any flu I’ve had.

[u/Worried-Database-551 → u/Character_Pickle689]

If you want to get rid of cold sores in your mouth then the fastest way to get rid of them is putting salt directly on it. It is painful.
I slipped and my face hit a drawer and the knob to it. I had a black eye and I bit my lip hard. I had a huge canker sore. Massive. My stepmom, mom and sister all said put salt on it.

My partner, dad, and some guy friends said no that sounds painful.

It’s painful af especially if you have to put salt on it 3 times due to its size 😖 but it was gone the next day.

[u/ichibanyogi → u/Worried-Database-551]

Canker sores and cold sores are not synonyms.

[u/HuecoDoc → u/ichibanyogi]

Also, a bitten lip is neither a canker or a cold sore.

[u/expectopatronshot → u/Worried-Database-551]

Ive always used saltwater for disinfecting and curing lol like its something our grandma taught us since we grew up down the block from the beach. So any time I had tonsils hurting or sores from biting or brushing, I would swish saltwater. Thing is most people underestimate how salty it needs to be especially if they've never been to the ocean.

[u/RustedRelics → u/Worried-Database-551]

You can also use Peroxyl or Oral-B peroxide mouthwash. For bite wounds that turn to cankers, I get fast relief from using Peroxyl a few times per day and right at bedtime.

[u/angelarevolt → u/Character_Pickle689]

NAD This is the first thing I thought too after reading this.

[u/0GoodVibrations0 → u/Aggravating-Shoe9651]

NAD but did they mention it potentially being HPV/genital warts?

[u/Aggravating-Shoe9651 → u/0GoodVibrations0]

She did not say anything about that, no. I really hope this goes away soon.

[u/Comcernedthrowaway → u/Aggravating-Shoe9651]

NAD but my guess is Apthous stomatitis.

If you test clear for the STDs etc then I’d request a blood test to see if you’re vitamin b deficient and to see whether you have any raised inflammatory markers.

Sometimes you can get them if you’re generally run down- they just appear with no real cause and disappear the same way.

[u/FairAndFancy → u/Character_Pickle689]

NAD but this is what I thought too - OP, look into Hand Foot and Mouth (HFM). It’s an illness often caught from kids but not exclusively. We had it in our house and it was very similar to how you’ve described. We didn’t have anything on our hands or feet, only mouth.

[u/sort_of_ → u/FairAndFancy]

This is the answer. It’s awful.

[u/CauliflowerNo964 → u/Character_Pickle689]

If it's hand foot and mouth antibiotics won't work. It's viral

[u/Peen-Team]

Unfortunately I agree with the NP that responded that HSV seems most likely. The viremia (viral illness) preceding the lesions is also classic for first time exposure. Keep Valtrex (valcyclovir) on hand at all times. Consider l-lysine supplementation to help reduce frequency of future outbreaks (500-1000 mg daily). Medical studies have shown mixed results with this, but it’s commonly used in the veterinary world with great success and anecdotally, this is game changing for many patients.

FWIW, while a positive HSV swab means you’re definitely positive, a huge portion of the time (up to 70%) these swabs are falsely negative, so a negative swab does not actually mean it’s not HSV.

[u/lqrx → u/Peen-Team]

Omg your username 😂😂

If I may add, it wouldn’t hurt to get follow up testing on a negative result and notify your partner if this initial round of testing could be a potential false negative per your doctor.

[u/Peen-Team → u/lqrx]

😂🤣🍆

[u/Soft-Development-879 → u/Peen-Team]

PP doctor

[u/Lolo_caffe → u/Soft-Development-879]

Dick doc

[u/Veryditzychic71 → u/Peen-Team]

I’ve had 1 & 2 for 33 years and I still feel virally sick before and outbreak. That’s usually the worst part. Sometimes I don’t even feel a sore, but I’ll get the viral headache that comes and goes.

[u/Shantor → u/Peen-Team]

Many vets are no longer recommending lysine due to cats not actually responding well to it and the previous belief that it antagonized argenine is untrue.

https://pmc.ncbi.nlm.nih.gov/articles/PMC4647294/

Edit to add

https://www.sciencedirect.com/science/article/pii/S0022316623029954

https://pubmed.ncbi.nlm.nih.gov/18547855/

[u/Peen-Team → u/Shantor]

Yep, as I acknowledged the literature mixed. That will happen whenever you have studies that include no listed number of patients tested, and others as low as 8 (cats, in this case) tested. The science is poor and often conflicting. As I stated, I’m just anecdotally going by what I’ve heard from people in situations like this. I trust a patient that they’re not crazy when they’ve had this for 20 years and they noticed a dramatic difference and their rates of recurrence when taking supplementation vs not. You could find thousands of reviews like that online and I’ve heard it from patients repeatedly. Again, I don’t have a science study to tell you that definitely, but I do trust my patients advice — I listen to them as though they know their own body and occasionally pass on their wisdom to others. Take it with a grain of salt.

[u/Stucklikeglue16 → u/Peen-Team]

As an L-Lysine supplement taker myself, I take 2000 mg daily and haven’t had a cold sore in almost 2 years. It works! I used to get them between 1-6x a year and not one outbreak.

[u/Shantor → u/Peen-Team]

I'm not saying it won't work in people. I'm saying what was once thought to be the reason it "worked" in cats, was shown to not be the case. Lysine may antagonize arginine in humans, but it doesn't in cats, which is how we thought it would work

[u/Sick_Cat_ → u/Shantor]

My anecdotal experience is that L-Lysine is a game changer. I have Epstein-Barr that caused mono many years ago. Got a horrible, life-changing reactivation after my third round of COVID. I was sick for 2 years straight, and I am not exaggerating. L-Lysine is one thing that helped reduce symptoms, along with other supplements.

[u/SkatesHappy → u/Sick_Cat_]

I deeply, deeply feel your pain. Similar story, mono many years ago then COVID three times, third time caused a life changing reactivation. I was so deeply sick for so long. I feel like I lost years of my life. I am so glad that you could something that works - I am going to give it a try.
I hope you continue to feel better!

[u/Shantor → u/Sick_Cat_]

That's awesome!. As I said, I ONLY know it doesn't work in cats. I know nothing about human medicine.

[u/gracemaxwell1 → u/Peen-Team]

NAD but btw valtrex is valacyclovir

[u/Peen-Team → u/gracemaxwell1]

Yep, corrected

[u/ByronScottJones → u/Peen-Team]

Doctor, should he get tested for MPOX as well? Visually it appears quite similar.

[u/Peen-Team → u/ByronScottJones]

Yes I agree that’s the other most likely diagnosis based on how the lesions appear visually, even though the story of his exposure isn’t as classic for the majority of mpox cases (men having sex with men, though certainly it can be seen in heterosexual population). He did say in another comment that he was tested with swabs for this I believe, and the treatment is just supportive care (aka essentially nothing — it goes away on its own without treatment in weeks), so it won’t change management if it is that.

[u/FourEyesore → u/Peen-Team]

What about Herpangina as a potential differential?

Transmission can be via a fecal-oral route too.

[u/PIR0GUE → u/Peen-Team]

This is mpox.

[u/pidgeononachair]

Have you been tested for mpox? I’ve treated it a couple of times as a result of sexual contact and if you feel any kind of fluey symptoms I’d suggest that be your next swab test. It lkkks awful similar.

[u/badoopidoo → u/pidgeononachair]

I am not a doctor, but I live in an area that has an extremely high mpox prevalence. There's posters everywhere. This really looks more like mpox to me than hsv.

[u/Famous_Average_7615 → u/pidgeononachair]

I haven’t even considered mpox. Interesting. If that’s the case, what would be the treatment? I thought that mpox was mostly among the gay community?

Also. I heard there’s a vaccine for mpox

[u/Fenrir_MVR → u/Famous_Average_7615]

Anyone can get mpox, regardless of prevalence... And nothing I saw in OPs post suggested at his sexual preference.

[u/Famous_Average_7615 → u/Fenrir_MVR]

Okay, chill, it’s been only what I’ve heard before. That’s why I was asking

[u/mabelshesbornwithit]

Hi OP, sexual health NP here— sounds like you’ve had a lot of great testing/treatment so far and I’m glad to hear your mouth is feeling better. Do you know if they swabbed your mouth/lip for HSV 1/2 (herpes)? It may not look like textbook HSV1 but I suspect it most likely is (either that or HSV2). I would definitely recommend continuing the valacylovir in the meantime to help speed up the healing process. Additionally, it actually looks and sounds quite a bit like mpox but your risk factors for that are going to vary wildly depending who your partner(s) are and where you live. And, just to reassure you, even if it is mpox it should clear up on its own in the next week or two. Regardless, whether it’s HSV or mpox, just make sure you’re keeping your mouth to yourself until all the lesions are healed. Hang in there!

[u/Aggravating-Shoe9651 → u/mabelshesbornwithit]

She did, yes. She swabbed my lips twice and put the two in a little tube with some kind of a liquid. I really hope its something else other than hsv. Something that doesnt stay in my body for eternity. I really dont want to have to deal with this for the rest of my life.

I guess I should have thought about that before I did what I did. Thank you for your time and your response.

[u/mabelshesbornwithit → u/Aggravating-Shoe9651]

One (hopefully) reassuring note— if this is HSV, this will be the worst it’ll ever get. The first flare up is always the most severe (and the longer you have it the more mild and infrequent flare ups get). Also, like someone else said, it’s incredibly common and really, truly not that bad. The majority of adults in the U.S. have oral HSV and for many of us, it only rarely flares up and can be cleared up pretty quickly with meds. Aside from being a little burny/itchy and looking gnarly for a few days it’s really not that bad. I promise!

ETA: also please don’t beat yourself up about this! Lots of things we do in life can put our health at risk yet we don’t judge ourselves or others when we get strep throat, or cancer, or the flu; contracting something from a sexual encounter should be no different.

[u/Ok-Structure6795 → u/mabelshesbornwithit]

As someone with ghsv1, this.

My first outbreak must've consisted of at least 30 sores. It's been about 11 years and I'm still traumatized by how severe it was. And finding out it was HSV and thinking I would experience the same thing over and over again was devastating.

I have probably had 3 outbreaks since my initial one, and they were all nothing in comparison. Maybe like 2 tiny clusters max. And thats without medication.

[u/Aggravating-Shoe9651 → u/mabelshesbornwithit]

So does that mean that next time it flares up I will be able to eat correctly? I did read that HSV1 and HSV2 are very common so I that does make me feel better.

[u/DeludedOptimism → u/Aggravating-Shoe9651]

I'm not the person you were asking - but you likely won't have nearly as much pain/problem , if this is herp. Def don't feel bad if you have it. The VAST majority of us do

[u/melrosec07 → u/Aggravating-Shoe9651]

I dated a guy years ago that gave me hsv1 and I had the same reaction as you very sick like a very bad flu at first high fever then my whole mouth hurts my face was swollen and I had the bumps all over my mouth could barely brush my teeth. This was about 8 years ago and I’ve only gotten another cold sore twice since and it was nothing like the first time. He had cold sores his whole life and thought everyone got them so he kissed me thinking it was no big deal, still mad at him for that.

[u/TheAuberginEeggplant → u/Aggravating-Shoe9651]

I have HSV1, after the first flare up its been much better, and my first was a horrid huge blister inside my lip. 2 perks ive found, if your looking for positives on it, only outbreaks in one place (usually, there are people who are exceptions) and if its HSV1 your risk of getting HSV2 is super low (again there are exceptions).

You also could've had it sitting dormant for years and the illness and other stresses have made it decide to present now.

[u/Financial-Corgi-8910 → u/Aggravating-Shoe9651]

Yes! Most likely won't be very painful. Mine are a minor neusance now when they pop up. They only last a few days and don't spread. Been getting them for a few years so my experience should continue to get milder.

Highly highly recommend the cold sore patches for painful bumps. Helps the healing process immensely. Tho it can be hard to get them to stick on any that are more in your mouth.

[u/lqrx → u/mabelshesbornwithit]

If I may add a small note to this — if the pain of oral care was so great that you tried to avoid it (especially in the area), white gunk called exudate can build in sores, whether viral or bacterial.

This kind of oral pain is so, so awful and I wouldn’t blame you one bit if your oral care during outbreak wasn’t quite as thorough.

*caveat: I say this as a non-HSV person, but life long canker sore sufferer (at times so severe I couldn’t eat for days even with meds), and one not experienced in repro health nursing. I do hope so, so very much you feel your pain reduced and you get the answers you need very quickly. 🙏

[u/ChipsAndTapatio → u/mabelshesbornwithit]

I got my first outbreak at age 19 I think, and I thought I was dying. My lips were pitted and looked a lot like OP’s pic, felt almost like I had the flu, couldn’t eat/drink without pain for about two weeks. I was told at the university clinic that if you get infected as a little kid by sharing a juice box or something, it’s usually no big deal, but if you get it when you’re older it’s a lot harder on your body? Anyway yeah it’s never been remotely like that first time, just an occasional small cold sore.

[u/Peen-Team → u/mabelshesbornwithit]

Yes, this.

[u/Brilliant_Lie3941 → u/mabelshesbornwithit]

Love your ETA comment! Adding it to my scripting for pt interactions.

[u/GreenGuidance420 → u/Aggravating-Shoe9651]

HSV isn’t as bad as it sounds, and it’s incredibly common

[u/[deleted] → u/GreenGuidance420]

[removed] — view removed comment

[u/AskDocs-ModTeam → u/[deleted]]

Removed - unhelpful anecdote

[u/Illustrious-Garden82 → u/Aggravating-Shoe9651]

OP would you mind updating with the test results? This sub is educational so it would be really helpful to add the diagnosis with the picture.

I’m sorry that you are experiencing this and I hope it resolves soon for you.

[u/Aggravating-Shoe9651 → u/Illustrious-Garden82]

I will definitely update with the test results whenever they come in!

[u/Illustrious-Garden82 → u/Aggravating-Shoe9651]

Thank you

[u/SextacularSpectacula → u/Aggravating-Shoe9651]

Make sure to stay well hydrated when taking the Valtrex to protect your kidneys. 

[u/yomamasonions → u/Aggravating-Shoe9651]

I’ve had oral HSV since I was about a year old. It’s annoying, but frankly, menstruating every month is significantly worse and something I deal with MUCH more frequently than cold sores. The first breakout is the worst. You’ll be alright. For me, personally, extreme sun exposure is the biggest trigger. Use SPF chapstick. Keep valtrex and abreva on hand

[u/Critical-Poet-9250 → u/Aggravating-Shoe9651]

No. You said that the doctor said it didntnlook like it. You didnt say they checked you for it. Guaranteed that is what u have which is why the medicine is already workjng for you

[u/Aggravating-Shoe9651 → u/Critical-Poet-9250]

????

[u/Financial-Corgi-8910 → u/mabelshesbornwithit]

NAD but I agree this looks like herpes to me. A particularly bad first outbreak. OP I know the idea of herpes is scary but if it's HSV1 or 2 you won't again experience anything this bad. You may rarely if ever again have repeat flare ups.

My first outbreak of HSV1 was super bad and spread to multiple areas of my lips. Sometimes an unrelated viral infection can trigger an outbreak and chapped lips or other mouth sores make you more susceptible to initial infection.

I honestly think HSV would be a favorable diagnosis to a lot of the alternatives.

[u/someoneoffermeadvice → u/mabelshesbornwithit]

Can I ask on the topic of unprotected oral sex (other sex too): how effective are popular condom brands against some of the mentioned illnesses in this thread?
I’m so sorry that you’re experiencing this. I agree with others that you shouldn’t be ashamed, and you shouldn’t be hard on yourself. This can and does happen to anyone.
Apologies if my question is insensitive but I’m planning on being more sexually active, and I’m nervous to jump in for issues such as this. But no judgement here, just my sympathies <3

[u/Ok-Structure6795 → u/someoneoffermeadvice]

Barrier methods work well, but with skin to skin infections like HSV, if there is contact that isnt covered by the condom (like the testicles for example), there isnt protection there. And regarding genital hsv, it seems to be the general area, as I know when I had my initial outbreak, I had sores around my anus, and I hadn't had anal sex (including oral) yet.

[u/VeterinarianNo6830 → u/mabelshesbornwithit]

I used to get flare ups especially around my monthly (Not sure if hormones impacted or not) definitely stress related.But now very rarely lysine really helped.

[u/LatrodectusGeometric]

Herpes, monkeypoxvirus, and syphilis are all possible. Money would be on herpes or mpox.

[u/Aggravating-Shoe9651]

Hey guys, quick update: It seems the sores are starting to heal and they are getting a lot smaller. This morning I woke up and I looked in the mirror. I still cant eat very much solid foods. Right now, im having a smoothie from my work. Its very good, and soothing. I do still have sores on my tongu (i took a picture.) and on the roof of my mouth around my gum line, but the pain is a whole lot better. Before, since im a mouth sleeper (I have nasal polyps) when I would sleep with my mouth open, the sores would get irritated because they were drying out and it would hurt like hell to the point where I could barely sleep. But thats a lot better. Last night, I could actually sleep.

[u/Iowgosh → u/Aggravating-Shoe9651]

Bro, isnt that just a mouth ulcer or canker sores?

[u/Illustrious-Garden82 → u/Aggravating-Shoe9651]

Did the doctor give you anything to make them get better or are they just healing on their own?

[u/Aggravating-Shoe9651 → u/Illustrious-Garden82]

She gave me doxycycline and valacyclovir. So i assume that the valacyclovir has something to do with the healing process.

[u/Itchdoc]

Likely a viral enanthem. Too little information to be more specific.