Oral Herpes - Symptoms, Diagnosis and Treatment

What Is Herpes Simplex Virus?

Herpes simplex virus 1 (HSV-1) causes approximately 60 % of cases of herpetic whitlow, whereas herpes simplex virus 2 (HSV-2) causes the remaining 40 % of cases. The herpes simplex virus is extremely contagious in nature, and the two variants affect different areas, namely:

1. Herpes Simplex Virus Type 1: Areas around the mouth, lips, and face.

2. Herpes Simplex Virus Type 2: Genitals.

In rare cases, the virus spreads to the fingertips through an open wound and causes pain, swelling, erythema, and blisters known as herpetic whitlow. The symptoms of an infection after exposure to the HSV virus may include:

• Lesions (vesicles, blisters, sores) on the tongue, mouth, chin, cheeks, or nostrils.

• Swelling of the lips.

• Pain and difficulty in swallowing.

• A sore throat.

• Swollen lymph nodes.

• A high body temperature.

• Headaches.

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• Dehydration.

• Nausea.

Does the Virus Show Recurrence?

Once the initial outbreak regresses, the virus stays dormant in the body for years. The herpes virus in this incubation period resides in a latent state in the dorsal root of spinal nerves. When it gets reactivated under certain conditions, the clinical lesions are then manifested. The following factors can trigger the recurrence of the herpes infection:

• A fever.

• Physical, emotional, or mental trauma.

• Immunocompromised conditions.

• A recurring illness.

• Excessive stress.

• Hormonal imbalances.

• Increased exposure to the sun.

• Surgery.

Recurrence of herpetic whitlow has been noted in 30 % to 50 % of the cases (due to latent sensory ganglion infection). Recurrent herpetic whitlow is treated by suppressive therapy with an antiviral agent. Since the body develops antibodies when it is infected the first time, the recurrent outbreaks are usually less severe and heal faster.

How Does Oral Herpes Spread From One Person to Another?

• Oral herpes spreads from people with an active outbreak of the infection or from those with a painful herpetic sore. It spreads from one person to another when they engage in sexual activities like kissing or oral sex with an infected individual.

• When a person comes in contact with virus-infected surfaces like razors, towels, dishes, and other shared items.

How Can Oral Herpes Be Diagnosed?

Oral herpes can be diagnosed by a healthcare provider by observing the oral changes. At times, a sample of the sore is taken and sent to a laboratory for closer examination.

Tests may include:

Main tests -

• Serum antibody test for HSV.

• Swab test for HSV.

• Lumbar puncture for HSV infections of the brain and spinal cord.

Other tests -

• Viral culture.

• Viral deoxyribonucleic acid (DNA) test.

• Tzanck test to check for HSV.

What Are the Symptoms of Oral Herpes?

The herpes simplex virus shows an incubation period. In the case of an oral herpes infection, there is an incubation period which is between the time of contact with the virus and the appearance of symptoms. It is usually two to twelve days, with an average of day four. The duration of the illness varies from person to person, and the signs and symptoms usually last for two to three weeks. The initial or primary infection of oral herpes is usually severe. It may cause symptoms resembling the flu, like swollen lymph nodes, headache, and irritation. However, few patients do not show symptoms at all. The recurrent infections are milder in comparison to the primary infection, and the blisters usually erupt on the edges of the lips. However, recurrent infections are not seen in all the patients.

The most common signs and symptoms of an oral herpes simplex virus infection are discussed below.

The oral sores may cause the most intense pain at the onset and make daily activities like eating and drinking difficult. Symptoms like pain, itching, burning, or tingling may precede the appearance of sores at the injection site. This is followed by the eruption of clusters of fluid-filled blisters, which break down rapidly and are highly contagious. These blisters may appear as shallow, tiny, gray ulcers on a red base. After a few days, these blisters will leak fluid and form sores that are scabbed or crusted and appear more dry and yellow. These sores may occur on the lips, the front of the tongue, the gums, the buccal mucosa, the palate, and the throat and may also extend down the chin and neck as well. When the blisters occur on the gums, the gums may become mildly swollen, red, and may bleed. The lymph nodes of the neck often become painful and inflamed. Among adolescents, the herpes virus may cause pain in the throat along with shallow ulcers and a grayish coating on the tonsils.

How Is Oral Herpes Treated?

The antiviral medicines that are administered to treat mouth sores include:

• Acyclovir.

• Valacyclovir.

• Famciclovir.

Antiviral skin creams like Acyclovir are also prescribed to shorten the outbreak by a few hours to a day. These medications work more efficiently if taken when the initial symptoms are seen, even before the development of blisters.

What Are the Steps That Can Be Followed to Help a Patient With Oral Herpes?

• The pain can be eased by applying ice, or a warm washed cloth to the sores.

• The blisters must be washed gently with antiseptic soap and water. This destroys the germs and helps prevent the spread of the virus to other areas of the body. Patients are advised to keep the infected areas clean at all times.

• Patients are advised to avoid hot beverages, and spicy, salty, and citrus foods.

• Patients are recommended to gargle with lukewarm salt water or apply an ice pack for relieving pain and irritation on the blisters or cold sores.

• Over-the-counter pain relievers such as Acetaminophen (Tylenol) or Ibuprofen can be taken orally or applied topically in the form of ointments.

Conclusion:

The symptoms are self-limiting in one to two weeks. However, antiviral medicines are prescribed to help reduce the pain and resolve the symptoms earlier. A weakened immune system further worsens the prognosis of the disease. Hence it is best if the symptoms are identified at an early stage to have appropriate treatment taken for the same.