Oral herpes is an infection caused by a virus known as the herpes simplex virus. This virus affects the lips, mouth, or gums, causing painful sores or blisters.
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:
Herpes Simplex Virus Type 1: Areas around the mouth, lips, and face.
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.
Swollen lymph nodes.
A high body temperature.
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:
Physical, emotional, or mental trauma.
A recurring illness.
Increased exposure to the sun.
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.
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.
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 deoxyribonucleic acid (DNA) test.
Tzanck test to check for HSV.
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.
The antiviral medicines that are administered to treat mouth sores include:
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.
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.
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.
The majority of oral herpes blisters appear on the lips or mouth. They can also appear elsewhere on the face, particularly around the chin and below the nose, as well as on the tongue. The sores initially resemble small bumps or pimples before developing into pus-filled blisters. These can be red, yellow, or white in color.
Oral herpes is most commonly transmitted by people who have an active outbreak or sore. Oral herpes can be contracted through intimate or personal contact like kissing or oral sex with an infected person.
Oral herpes affects 50 % to 80 % of adults in the United States. Based on the study reports by the National Institutes of Health, approximately 90 % of adults would have been exposed to the virus by the age of 50. A person infected with the herpes simplex virus will have it for the rest of his or her life.
A person can spread the virus even if they do not have any cold sore symptoms, though they are the most contagious when they do. This is much less likely if the contact occurred while a cold sore was present. Cold sores are contagious until they completely heal, which takes about two weeks.
Using antiviral medications such as Acyclovir, Famciclovir, and Valacyclovir orally (most effective). Topical antiviral ointments, such as Acyclovir and Penciclovir. To relieve symptoms, over-the-counter topical anesthetics or anti-inflammatory agents can be used.
The typical features of a recurring oral herpes simplex virus infection are as follows. The area where the infection will erupt may initially develop redness, swelling, heat, pain, or itching. Blisters that are painful and filled with fluid may appear on the lips or under the nose.
Herpes does not require sexual contact. Herpes can be transmitted in non-sexual ways, such as when a parent with cold sore kisses you on the lips. The majority of people who have oral herpes contracted it as children. During vaginal childbirth, a mother can pass genital herpes to her baby, but this is extremely rare.
Herpes symptoms can be confused with a variety of other conditions, including:
- Other sexually transmitted infections (STIs) that cause visible lesions, like syphilis or genital warts.
- Irritation due to shaving.
- Hair that has grown back into the skin.
- Vaginosis caused by bacteria.
- Infections caused by yeast.
- Bites from insects.
Herpes esophagitis symptoms include sores in the mouth and other parts of the body. Open sores in the mouth and painful or difficult swallowing are the most common symptoms. Swallowing can be painful if the throat or esophageal tissues are inflamed or ulcerated.
Peak plasma concentrations of Acyclovir may take up to two hours after oral administration. It may take up to three days for symptoms to subside; however, Acyclovir should be taken until the course is finished. Acyclovir works best when taken within 48 hours of the onset of symptoms.
Because the virus is found in and around the mouth, cold sores are also known as oral herpes.
Antiviral medication (Acyclovir and related drugs) may alleviate pain and discomfort and aid in the resolution of the outbreak. It could also help to reduce the number of outbreaks.
Last reviewed at:
17 May 2022 - 4 min read
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