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cold sore as an early sign of HIV infection?
Oct 28, 1996

Mr. Sowadsky-- About six months ago, I had sex with an old boyfriend, and although I do remember using condoms with him, I'm not sure because I was extremely intoxicated. At any rate, this summer I had an outbreak of cold sores on my nose after a sunburn. I didn't get concerned about the outbreak because I attributed it to the sunburn, but about three months later I had another outbreak of cold sores on my nose. Both outbreaks lasted about three days and then cleared up. In this last outbreak, I was extremely stressed out over school related activities, and my doctor told me this might be the cause. But as I read through the long list of HIV symptoms, I find that herpes simplex outbreaks are one of them. I've had cold sores in the past, but only during colds or flus. Should I be tested again for HIV? I was tested before the unfortunate night with my old boyfriend, and the test came back negative (yes, I did wait the appropriate 6 months between sexual encounters to make sure I was indeed safe from all previous sex acts), so the only person who could have infected me is my old boyfriend. What do you think? --Stressed out

Response from Mr. Sowadsky

Hi. Thank you for your question.

Cold sores are due to the Herpes Simplex viruses. A person can have the herpes viruses and NOT have HIV. They are two seperate infections.

Stress (both physical and emotional), can activate the herpes viruses, and lead to the characteristic lesions that the Herpes Simplex Viruses can cause. This is true in persons with or without HIV infection. If your body has been under stress (which can include sunburns, lack of sleep, drug/alcohol abuse, and emotional stress), this can certainly lead to a symptomatic outbreak of herpes infection. In all persons with herpes infection (whether it be oral herpes, genital herpes, or rectal herpes), the best advice we could give would be to reduce physical and emotional stress as much as possible. If you have recurrent outbreaks on a regular basis, check with your physician to see if you should start on medications. There are now several prescription medications for use against Herpes Simplex infections. In persons who get outbreaks often, a physician may prescribe a drug to reduce the occurences of symptomatic herpes outbreaks.

Having recurrent herpes outbreaks by itself doesn't necessarily indicate HIV infection, especially if you have been undergoing physical or emotional stress. However in persons who have HIV and herpes, they can have outbreaks occur more often. If you are concerned about having HIV from your encounter with your old boyfriend, then you may want to consider getting tested again for HIV. If you had sex while intoxicated (drunk), you may unknowingly have put yourself at risk for HIV. This is because when a person is drunk, they are more likely to have unprotected sex, and if they are using condoms, drunk persons are less likely to use condoms correctly. So you may want to get tested again (at 6 months post-exposure) to see if you were exposed to HIV.

Overall, since you mentioned that you were under a lot of stress, it would not be unusual for you to be having recurrent herpes outbreaks. This alone would not indicate HIV infection. But since you may have put yourself at risk while you were drunk, it may not be a bad idea to get tested again, to rule out HIV infection.

If you have any further questions, please feel free to call the Centers for Disease Control at 1.800.232.4636 (Nationwide). Rick Sowadsky MSPH CDS



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