Oral Herpes – Treatment, Causes, Recurrence on Lips, Tongue, Throat

Key Facts

• Oral herpes is a common infection caused mainly by the herpes simplex virus type 1 (HSV-1)
• It is commonly referred to as cold sores or fever blisters
• Oral herpes is highly contagious and can be spread through close personal contact such as kissing or sharing personal items
• There is no cure for herpes; once the virus is in the body, it remains there for life
• The symptoms can be managed with antiviral medications and other treatments
• Not everyone with the virus shows symptoms; some individuals might never know they have it
• Stress, fatigue, and illness can trigger an outbreak

What is Oral Herpes?

Oral herpes is a viral infection caused primarily by the herpes simplex virus type 1 (HSV-1), and less commonly by herpes simplex virus type 2 (HSV-2). It is characterized by the development of small, painful blisters or sores around the lips, mouth, or gums. These sores are often referred to as cold sores or fever blisters.
The virus is highly contagious and can be transmitted through close personal contact such as kissing or sharing personal items like utensils, towels, or lip balm with someone who has the infection. Once a person is infected with the virus, it remains in the body for life. Oral herpes can have periods of activity where symptoms are present, followed by periods where the virus is dormant and no symptoms are visible.
Not everyone who is infected with the virus will develop symptoms. However, even without visible sores, an infected person can still transmit the virus to others. There is no cure for oral herpes, but antiviral medications can help to reduce the severity and frequency of symptoms, and can also reduce the risk of transmitting the virus to others.

Causes of Oral Herpes

Oral herpes is primarily caused by HSV-1. It is spread through direct contact with the virus, usually through:

• Kissing someone with a cold sore
• Sharing eating utensils, lip balm, or razors with someone who has the virus
• Oral contact with the genitals of someone with genital herpes

Infection can occur even when there are no visible blisters.

Prevention of Oral Herpes

Preventing oral herpes involves minimizing contact with individuals who have visible cold sores and taking steps to reduce the risk of spreading the virus:

• Avoid close contact with individuals who have active blisters
• Do not share personal items like utensils, towels, or lip balm
• Wash hands frequently, especially if in contact with someone with a cold sore
• Use sunscreen on lips as sunburn can trigger an outbreak
• Use a condom or dental dam during oral sex if you or your partner has a history of herpes infections

Oral Herpes Symptoms

The initial infection may cause no symptoms or an outbreak of mouth sores. Symptoms of an oral herpes outbreak include:

• Small, fluid-filled blisters on or around the lips or inside the mouth
• Pain around the mouth
• Sore throat
• Fever and muscle aches
• Swollen lymph nodes

Diagnosing Oral Herpes

Diagnosing oral herpes primarily involves identifying characteristic symptoms and obtaining a medical history, but laboratory tests can also be used for confirmation. Here are the steps usually involved in diagnosing oral herpes:

Clinical Examination: The diagnosis often begins with the healthcare provider examining the lips, mouth, and surrounding areas for signs of an oral herpes outbreak. Typical signs include clusters of small blisters, which can rupture to form painful sores.

Medical History: The healthcare provider will ask about the patient’s medical history, including any prior episodes of cold sores or blisters, family history of oral herpes, recent stress or illness, and potential exposure to the herpes simplex virus.

Viral Culture: In some cases, especially if the diagnosis is unclear or if it is the first episode, a healthcare provider might take a swab of the fluid from a blister and send it to a lab where it will be cultured to see if the herpes virus grows. This method is most effective in the early stage of an outbreak when blisters are present.

Polymerase Chain Reaction (PCR): This is a highly sensitive test that can detect the DNA of the herpes virus in a sample from the sore. PCR can be used to identify which type of herpes virus is causing the infection.

Blood Test: Blood tests can be used to detect antibodies to the herpes virus. This is often used to diagnose a past infection but can be less effective in diagnosing a current oral herpes outbreak.

Tzanck Smear: This less commonly used test involves staining cells from the blister to look for changes that are characteristic of herpes infection. This test is less specific than viral culture or PCR.

Patient’s History of Recurrence: If a patient has a history of recurrent cold sores, this can also aid in the diagnosis.

After the diagnosis, the healthcare provider will discuss the results with the patient and talk about possible treatment options. Because oral herpes is a viral infection, it cannot be cured, but there are medications and other treatments available to help alleviate the symptoms and reduce the frequency of outbreaks. It’s also important to take steps to prevent the spread of the virus to others, especially during an active outbreak.

Recurrence of Oral Herpes

The recurrence of oral herpes is a common phenomenon because the herpes simplex virus (HSV) remains in the body for life once it has been contracted. After the initial infection, the virus becomes dormant in nerve cells and can reactivate at various times, leading to recurrent outbreaks of cold sores or blisters around the mouth and lips. These recurrent outbreaks are often referred to as “flare-ups.”

Here are some factors that can contribute to the recurrence of oral herpes:

• Stress and Fatigue: High levels of stress and fatigue can weaken the immune system, making it easier for the virus to reactivate
• Immune Suppression: Any condition that suppresses the immune system, including certain illnesses or medications, can increase the likelihood of a herpes outbreak
• Sun Exposure: Excessive exposure to sunlight and UV radiation can trigger a recurrence
• Hormonal Changes: Hormonal changes during menstrual cycles or pregnancy can cause the virus to reactivate in some women
• Physical Trauma: Injury to the lips or inside of the mouth can trigger an outbreak
• Fever and Illness: Fevers or infections can sometimes cause a recurrence of oral herpes, which is why the sores are sometimes called “fever blisters.”
• Diet and Nutrition: A diet lacking in essential nutrients, especially lysine, or high in arginine-rich foods like nuts and chocolate, can trigger the virus
• Temperature Extremes: Extreme cold or hot temperatures can sometimes trigger the herpes virus

The severity and frequency of recurrent outbreaks can vary widely among individuals. Some people have frequent outbreaks, while others have them rarely or not at all.

To manage recurrent oral herpes, it’s important to:

• Recognize and avoid triggers, such as excessive sun exposure or stress
• Maintain a healthy lifestyle to support the immune system
• Use antiviral medications or creams as prescribed by a healthcare provider
• Practice good oral hygiene

Seeing a healthcare provider for personalized advice and treatment options is also recommended for managing recurrent oral herpes effectively.

Oral Herpes Treatment Options

While there’s no cure for oral herpes, treatments can relieve symptoms and reduce the duration of an outbreak:

• Antiviral Medications: Prescription antiviral medications such as acyclovir, famciclovir, and valacyclovir can be used to reduce the severity and duration of outbreaks. These medications may also be taken on a long-term basis as suppressive therapy to reduce the frequency of outbreaks in individuals with recurrent oral herpes.
• Topical Ointments and Creams: There are over-the-counter and prescription creams and ointments that can be applied directly to the sores to alleviate pain and discomfort.
• Pain Relievers: Over-the-counter pain relievers such as ibuprofen or acetaminophen can be used to relieve pain during an outbreak.
• Cold Compresses: Applying a cold compress to the affected area may help to reduce pain and swelling.
• Lip Balms and Creams: Lip balms and creams that contain a drying agent such as zinc oxide can be applied to the blisters to help dry them out and relieve discomfort.

How does herpes simplex spread?

Herpes simplex virus, including both HSV-1 and HSV-2, spreads through direct contact with an infected area or bodily fluid from a person with the virus.

• HSV-1 primarily spreads through oral contact. This can include kissing, sharing utensils, drinks, lip balm, or anything that comes into contact with the mouth. It can also spread to the genital area through oral-genital contact.
• HSV-2 is usually transmitted through sexual contact, including vaginal, anal, and oral sex.

The virus can spread even if the infected person does not have visible sores or symptoms, through a process known as asymptomatic shedding.

How long do sores from herpes simplex last?

Sores from herpes simplex usually heal within 2 to 4 weeks. The first outbreak is often the most severe and can last longer. Subsequent outbreaks are usually milder and may heal more quickly.

When should I call the doctor?

You should call a doctor:

If you suspect that you have been exposed to the herpes virus or have symptoms like blisters and sores.

If you experience severe symptoms such as difficulty in urinating, extensive sores, or infection spreading to other areas.

If you have a weakened immune system due to a medical condition or medication, as herpes can be more severe in such cases.

If you are pregnant and have or suspect you have herpes, as there’s a risk of transmitting the virus to the baby.

What questions should I ask my doctor?

When consulting your doctor about herpes simplex, you might ask:

• What tests can confirm if I have herpes?
• What can I do to alleviate symptoms?
• How can I prevent the spread of the virus to others?
• Are there any medications that can help manage the condition?
• How can I manage stress or other triggers that might cause outbreaks?

Is a cold sore the same as oral herpes?

Yes, cold sores are a common manifestation of oral herpes, which is typically caused by HSV-1. Cold sores are fluid-filled blisters that appear around the mouth and can cause pain, burning, or itching. They are highly contagious, especially when the blisters are open and weeping. Cold sores can recur periodically, and their outbreaks can be triggered by factors such as stress, illness, or sun exposure.

Bottom Line

Oral herpes is a common and chronic condition. Though it cannot be cured, it can be managed effectively with medications and lifestyle adaptations. It’s essential to follow preventive measures to reduce the risk of infection or re-infection and to seek medical advice if you suspect you have oral herpes, especially if outbreaks are frequent or severe.

This article is complete and was published on June 23, 2023, and last updated on August 25, 2023.