What could cause persistent high fever and mouth ulcers?

Hello doctor,

I have been experiencing a persistent high fever (~39 degrees Celsius) that lasted for approximately five days. The fever did not respond significantly to regular Paracetamol and Ibuprofen during that time. As of now, the fever has subsided, but my temperature remains around 37.3 degrees Celsius with the use of Paracetamol. Alongside the fever, I initially developed multiple mouth ulcers, which have increased in number daily. Current symptoms include:

The ulcers are now widespread:

1. On the sides and underside of my tongue.

2. On my gums.

3. On the soft tissue beneath the teeth.

4. My gums feel bruised, swollen, and sensitive, especially between the teeth.

5. I have no skin rash, no lip blisters, and no cold sores.

6. Eating and drinking have become very difficult and painful due to the extent and location of the ulcers.

Specific concern: There is one particular ulcer on the tip of my tongue that stands out:

1. It is present both on the top and underside of the tongue at the same spot.

2. The pain at this location is significantly more intense than at the other ulcer sites.

3. This ulcer is my primary concern.

Blood tests suggested a viral infection with a possible mild bacterial component, which is why I was prescribed a penicillin-based antibiotic. Given my recent direct oral contact with a partner who has genital herpes (HSV-2), I am particularly concerned about whether this could represent a primary oral herpes infection. I have since been prescribed Acyclovir (antiviral medication). I am also using chamomile tea rinses to help ease the pain of the ulcers as an alternative symptomatic treatment. The doctors I have seen did not conduct a detailed examination of my mouth, but they indicated that, based on their brief assessment, nothing appeared particularly unusual to them.

Current treatment:

1. Chlorhexidine plus Lidocaine spray for oral hygiene and pain relief.

2. Alternating Paracetamol and Ibuprofen for fever and pain management.

3. Penicillin-based antibiotic.

4. Acyclovir (antiviral).

5. Chamomile tea rinses to soothe oral discomfort.

My questions:

1. Based on the progression and presentation, do these symptoms appear more consistent with:

1. A typical viral infection (e.g., coxsackievirus, Epstein-Barr, etc.)?

2. A secondary bacterial infection?

3. A primary oral herpes infection, considering my specific exposure?

2. Does the distinct ulcer on the tip of my tongue require separate evaluation or more urgent attention, given its severity and unique appearance?

Please help.

Thank you.

Hello doctor,

Thank you for your reply.

I do not have the resources to purchase a higher-tier subscription at this time, such as the 50-hour option or hotline. Due to the pain of my ulcers, it is nearly impossible to speak right now, so I would appreciate receiving textual information for now.

To answer your question: The ulcers started last week, and have continued growing in numbers to today, now I have around 10 plus, the main tongue one. They essentially started forming right after performing oral sex on my partner, where we were both unaware of her herpes condition. It seems that today, from the morning to now (the evening here), the number has stayed the same.

Thank you for the recommendation regarding the Benzydamine and Chlorhexidine mouthwash. I have been using a Chlorhexidine plus Lidocaine spray, but I was not sure if it helped or not.

How long do these lesions usually last? Now it is day five. I read online that they usually last seven to 10 days in the first outbreak, as I have never had herpes before. Lastly, regarding the detailed medical history, I am providing a blood test done recently. One day after noticing the lesions, the blood tests say all four tested items are negative (CMV, EBV, Syphilis, and HIV).

Please help.

Thank you.