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Oral Herpes: Symptoms and Causes

Dr. Sujala S Aradhya

Dr. Sujala S Aradhya

  Basaveshwar nagar, Bengaluru     Jul 13, 2019

   6 min     



Oral herpes is an infection caused by the herpes simplex virus. Herpes simplex virus causes painful sores in the mouth, tongue, lips, inner cheeks and roof of the mouth. In addition to that, the infected person may also have fever and muscle pains. This virus affects only humans and is contracted through skin contact, touching infected saliva and mucous membranes.

More About Herpes Simplex Virus Infection

The herpes simplex virus(HSV) is known only to affect humans. It spreads when one comes in contact with infected skin, mucous membrane or saliva. 

Once infected, the HSV undergoes three stages of development:

  • Primary infection: This stage involves the virus entering the body via the skin, mucous membrane or saliva, after which it undergoes reproduction leading to the virus multiplying in the body. This is when the infected person shows symptoms like fever and cold. It isn’t necessary that you show symptoms, once infected. In some cases, your body may not react to the virus at all. In such a situation, you are considered to have asymptomatic infection. 

  • Latency: The multiplied virus now goes toward the dorsal root ganglion, which is a mass of nervous tissue in your spine. Here, it undergoes further reproduction, after which it becomes inactive. 

  • Recurrence: the virus does not remain inactive for long. Should you undergo any mental or physical stress, then the virus reactivates bringing about sores and accompanying symptoms. 

Children between the age 1 and 2 often have mouth sores from the virus. This doesn't mean people of other ages are not prone to get infected. The highly contagious nature of the virus makes it easy for people to contract the virus. In fact, a huge number of people have been infected by at least one subtype of the herpes virus before they reach adulthood.

What causes Oral Herpes?

Oral herpes is caused by the Herpes simplex virus, which is a DNA virus. DNA viruses are a type of virus that have DNA in them which allows them to replicate in the host body. In this case, humans are the host. 

The virus causes sores in and around the mouth. There are two subtypes of herpes that may cause these sores.

  • Herpes simplex virus, type 1 or herpes-1: This virus is responsible for about 80% of oral herpes. This form of the virus mainly affected the parts of the body above the waist.

  • Herpes simplex virus, type 2 or herpes-2: Causes the rest, which mainly includes genital herpes. 

Either way, the virus is capable of infecting any part of the skin throughout the body. So, the virus responsible for cold sores could cause genital herpes and vice versa. HSV 1 can cause 

However, both types of HSV are capable of infecting the skin at any location on the body. Thus, the virus that usually causes oral herpes (HSV-1) can cause genital herpes as well as herpes on the hands and eye. The virus that causes genital herpes (HSV-2) can also cause oral herpes, although it almost exclusively infects the genital area. HSV-1 may cause genital herpes either through oral sex or if the person transfers the diseases form part of the body to others.

These infections have a tendency to recur, most of the time in the same region as before. A patient might find the same ore appearing over and over again over a year, or occasionally. It is always best to go and consult your doctor. They will recommend a blood test to check if you are infected.

What are the symptoms of Oral Herpes?

The incubation period in oral herpes is 2-12 days, which means the symptoms begin showing between 2-12 days after you have been infected. In most cases, the average incubation period is four days. Once the symptoms show, they last for 2-3 weeks. 

Symptoms include:

  • The occurrence of fever, fatigue and soreness in the muscles

  • Pain, burning and irritation at the site of infection, before the appearance of the sores

  • Cluster of blisters that erupt. The infected site now has crusty, scabby ulcers.

  •  Intensely painful oral sores that cause difficulty eating and drinking. The sores occur on the lips, inner cheek, tip of the tongue, gums, mouth roof and throat. They may also be seen on the chin and neck.

  • Mild swelling, redness and bleeding of gums

  • Lymph nodes in the neck my swell up, causing pain.

  • In teens, Ulcers on the tonsil cause throat pain.

How is Oral Herpes diagnosed?

The doctor will do a physical examination, and based on this; he will work towards diagnosing the sores. The sores have an appearance that is characteristic of herpes infection. For the confirmation, and if your infection involves other organ systems, the doctor may conduct laboratory tests. The doctor takes the sample of the infected area to identify the virus. The virus is then analysed using antigen and antibody studies as well as a staining test called Tzanck smear.

All these tests help the doctor to confirm their diagnosis. The tissue sample is only taken when the doctor is not sure what the rash is. The antibody test is not necessarily useful due to the common occurrence of the infection. Patients could have antibodies from previous occurrences of the infection.

How is Oral Herpes Treated?

Based on the symptoms and your immunity levels, medication and pain relievers are prescribed. It is very important to drink plenty of fluids to prevent dehydration. You can also take acetaminophen or ibuprofen; these help with the fever and muscle pain.

To treat the pain on the sores, use lidocaine or similar topical anaesthetics.

In the case of infants, if sores appear and the urine becomes visibly less, it is best to consult your doctor. If the infant is younger than six weeks, then it will be admitted in the hospital. The same goes for adults, and the sores can become very painful, making eating and drinking difficult, which causes dehydration. So, consult a professional immediately for proper treatment.

How can you prevent Oral Herpes?

The best way to prevent herpes infection is to avoid contact with sites of transmission, such as saliva, skin, or mucous membranes, especially if they have sores. Avoid physical contact with other people who have sores. 

Avoid sharing items such as lipsticks, lip balms as these things cannot be washed or sanitised. Also, keep the washing and sanitising yourself, should you notice an outbreak in one part of the body. This way, the infection won't spread to other parts of the body. 

Also wash your hands, once you apply any cream or ointments in the infected area.

Future infection and cold sores can be prevented by;

  • Not spending too much time under the sun, and also using generous amounts of sunblock on the lips and face

  • Get proper relaxation and avoid too much mental and physical stress

  • Keep your mouth protected, and avoid any trauma

  • Consume antiviral medications as prescribed by your healthcare professional

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