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Oral Herpes - Symptoms, Diagnosis and Treatment

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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.

Written by

Dr. Geethika. B

Medically reviewed by

Dr. Achanta Krishna Swaroop

Published At May 17, 2022
Reviewed AtJanuary 18, 2024


Oral herpes, caused by the herpes simplex virus (HSV), is a widespread viral infection that affects a significant portion of the global population. While antiviral medications can manage symptoms, finding a cure for herpes remains at the forefront of scientific research. Herpes simplex virus 1 (HSV-1) causes approximately 60 % of cases of herpetic whitlow (finger herpes infection), 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. Herpes simplex virus type 1 affects regions around the mouth, lips, and face. Herpes simplex virus type 2 targets the genital area.

What Causes Oral Herpes and How Does It Spread From One Person to Another?

Oral herpes is caused by the herpes simplex virus (HSV) and is primarily transmitted through close personal contact, particularly during activities that involve the exchange of bodily fluids.

  • Transmission can occur through direct contact with an infected individual's saliva, sores, or lesions. This commonly occurs through kissing, sharing utensils, or close personal contact.

  • Even without apparent symptoms, individuals carrying the HSV infection can shed the virus and potentially transmit it to others through saliva or other bodily fluids.

  • Newborns can contract oral herpes during delivery if the mother is experiencing an active genital herpes infection.

  • Oral herpes also spreads from one person to another when they engage in sexual activities like kissing or oral sex with an infected individual.

What Are the Symptoms of Oral Herpes?

The herpes simplex virus exhibits an incubation period for oral herpes infections, typically ranging from two to twelve days after contact with the virus. On average, symptoms manifest around day four. The illness's duration varies among individuals, lasting approximately two to three weeks.

Initial Infection:

  • The primary oral herpes infection is characterized by its severity, with symptoms resembling the flu.

  • Symptoms include swollen lymph nodes, headaches, and irritation.

  • However, some patients may not exhibit any symptoms during the initial infection.

Recurrent Infections:

  • Recurrent infections are generally milder compared to the primary infection.

  • Blisters during recurrent infections typically erupt on the edges of the lips.

  • Not all patients experience recurrent infections.

Common Signs and Symptoms:

Oral sores cause intense pain, particularly at the onset, making activities like eating and drinking challenging.

  • Before the appearance of sores, patients may experience pain, itching, burning, or tingling at the infection site.

  • Clusters of fluid-filled blisters follow, breaking down rapidly and being highly contagious.

  • Blisters may manifest as shallow, tiny, gray ulcers on a red base.

  • After a few days, the blisters leak fluid, forming scabbed or crusted sores that appear dry and yellow.

  • Sores may occur on the lips, front of the tongue, gums, buccal mucosa, palate, and throat.

  • In some cases, sores may extend down the chin and neck.

  • When blisters occur on the gums, they may become mildly swollen, red, and may bleed.

  • The lymph nodes in the neck often become painful and inflamed.

  • Among adolescents, the herpes virus may cause throat pain along with shallow ulcers. Additionally, a grayish coating on the tonsils may be observed.

While oral herpes is often associated with lesions on the lips and mouth, it can also affect the throat. HSV-1 is more commonly associated with throat herpes. Throat herpes is a manifestation of the infection in the oral cavity. It presents its own set of challenges and symptoms. Difficulty swallowing, swollen lymph nodes, and sore throat are common indicators of throat herpes.

Herpes esophagitis is a condition characterized by inflammation of the esophagus. It is a relatively rare manifestation of herpes infection, usually occurring in people with weakened immune systems, like those managing HIV, organ transplant recipients, or those undergoing chemotherapy.

How Is Oral Herpes 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.

Exams and tests:

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.

When to Seek Medical Care?

Medical care for oral herpes should be sought immediately in the following cases:

  • Experiencing difficulty eating or drinking due to painful sores.

  • Experiencing signs of dehydration like decreased urination, drowsiness, irritability, or dry mouth.

  • Uncertainty about the nature of the sores.

  • Infants under eight weeks as they are more susceptible to complications.

  • People with compromised immune systems or expectant mothers.

  • In instances of throat herpes, especially if breathing or swallowing difficulties emerge.

  • If severe symptoms, complications, or recurrent outbreaks occur.

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 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.

How Far Away Is a Cure for Herpes?

The prospect of finding a cure for herpes has been a longstanding goal in medical research. Scientists have made strides in understanding the virus and developing antiviral medications that can reduce symptoms and the frequency of outbreaks. However, a definitive cure for herpes that eradicates the virus from the body remains elusive. Scientists are optimistic that the application of gene therapy might offer a pathway toward a potential cure for herpes in the future. Scientists are striving to develop a herpes vaccine for public availability by 2030.

What Are the Self Care Tips for 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 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.

Frequently Asked Questions


How Does Oral Herpes Look Initially?

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.


How Does One Get Oral Herpes?

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.


What Is the Prevalence of Oral Herpes?

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.


When Does Oral Herpes Become Contagious?

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.


What Is the Best Way to Get Rid of Oral Herpes?

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.


How Does Oral Herpes Feel?

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.


How Does the Non-sexual Transmission of Oral Herpes Take Place?

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.


What Is Similar to Oral Herpes?

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.
- Pimples.
- Infections caused by yeast.
- Hemorrhoids.
- Bites from insects.


What Does Oral Herpes in the Throat Look Like?

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.


How Long Does It Take for Acyclovir to Work for Oral Herpes?

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.


What Is the Distinction Between a Cold Sore and Oral Herpes?

Because the virus is found in and around the mouth, cold sores are also known as oral herpes.


How to Heal Oral Herpes Sores More Quickly?

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.
Dr. Achanta Krishna Swaroop
Dr. Achanta Krishna Swaroop



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