Oral Herpes: Symptoms & Treatments

What is Oral Herpes (HSV Mouth Infection)?

Many people associate herpes simplex virus or herpes with sexually transmitted diseases. However, not all herpes infections are contracted via sex. 

Oral herpes – herpes simplex 1 or HSV-1 – affects the mouth. It causes cold sores and fever blisters to develop in and around the mouth. Both herpes simplex 1 and herpes simplex 2 can infect the mouth and genitals, but simplex 1 is most often linked to oral infections.

Virus type 1 HSV lesions usually last about 7 to 10 days. They begin as fluid-filled blisters that rupture after a day or two. 

The fluid within the sores contains the herpes simplex virus type, which is how it transmits from one person to another. Anyone who comes into contact with the highly contagious fluid from another person’s sores is at risk of contracting the virus.

Most people are infected in childhood, often through contact with a parent or another close person in their lives. 

Herpes is often transmitted via kissing and other types of touching. Sharing objects such as lip balm or silverware contaminated with the infected fluid can also cause it.

Once infected, a person has herpes for life. However, this doesn’t mean the infection is always active. It is common for the virus to lay dormant in the body and not show any symptoms. 

Some people will experience only one outbreak in their life, while others have outbreaks more often. The most common causes of outbreaks include stress, sun exposure, or other illnesses. 

Outbreaks tend to occur more frequently during the first year after infection. Over time, the body develops antibodies that help prevent severe and/or frequent outbreaks.

What Does Oral Herpes Look Like?

Most people experience itching or tingling before they see any visible signs of a herpes outbreak. Gradually, a fluid-filled blister appears in or around the mouth. Sometimes it bleeds. 

Blisters might be singular or develop in a cluster or group. After a day or two, the blister pops and scabs over. 

Oral herpes outbreaks resemble pimples or canker sores, which makes it challenging to determine if you’re infected with herpes or affected by another skin abnormality. 

Sometimes, especially early on, they might experience flu-like symptoms like fever or swollen glands. 

How Common is Herpes Simplex Virus (HSV) of the Mouth?

Oral herpes is very common. 

According to the National Institutes of Health (NIH), about 90 percent of adults have been exposed to the virus by the time they’re 50.1 But this doesn’t mean they have it. 

Some people are exposed but never contract the virus, while others “catch” it immediately after exposure.

Statistics show that as of 2016, an estimated 3.7 billion people under the age of 50, or 67% of the global population, had an oral or genital HSV-1 infection. 

The highest prevalence of the infection was in Africa (88%) and the lowest was in the Americas (45%).2

What Causes Oral Herpes?

Herpes is a virus. It’s caused by someone coming into contact with the infected liquid present in herpes sores. Someone with an active outbreak puts other people around them at risk of contracting herpes. 

Most of the time, the virus is spread through close contact. This can include sex or kissing, but it also might spread when sharing objects (like make-up or food and beverages) with an infected person. 

The virus is highly contagious and most adults have been exposed to it at least once in their lives.

What are the Symptoms of Oral Herpes?

The symptoms of herpes vary a bit based on how long someone has had the infection. Newer infections tend to be more intense than those present in someone for a longer period. 

Initially, symptoms of a herpes outbreak might include headache, swollen lymph nodes, and flu-like symptoms. However, some people contract herpes and experience no symptoms other than sores.

Subsequent infections can include milder flu-like symptoms, but this often isn’t the case. The primary symptoms of a herpes recurrence are sores in the mouth or around the edges of the mouth. 

In general, symptoms include:

  • Itching or tingling around the mouth at the site where a sore eventually develops
  • Redness
  • Pain
  • Fluid-filled blisters that leak and develop into crusted over sores

Not everyone experiences sores after their initial outbreak. The severity and duration of symptoms all depend on how your body responds to the virus. 

How is Oral Herpes Diagnosed?

Oral herpes presents similarly to other infections and allergic reactions. The only way to know for sure that you have herpes is to undergo a virus culture (PCR) test, blood test, or biopsy. 

You or your doctor might assume you have a herpes infection based on an incidence of exposure and/or location of the sores, but this isn’t definitive like a test. 

For example, if you know your spouse has herpes simplex 1 and you develop symptoms, you’ve likely been infected.

What Treatments are Available for HSV Mouth Infection? 

Although there is no cure for an HSV infection, there are treatments that minimize the discomfort associated with a recurrence. 

Treatments include:

  • Anesthetic creams like lidocaine and prilocaine
  • Antiviral topical medicines like zinc oxide and glycerin
  • Oral antiviral medications, including acyclovir, famciclovir, and valacyclovir
  • Heat application sticks that warm the affected area to 122 degrees F (50 degrees C) within seconds, blocking the replication of the virus and the formation of a sore3

Doctors and general dentists recommend treatment options based on a patient’s:

  • Age
  • Overall health
  • Medical history
  • Expected outcome
  • Personal preference
  • Tolerance for a specific therapy or medication 

Is Oral Herpes Permanent? 

Yes. Once a person contracts the herpes virus, they will always have it. 

However, this doesn’t mean they’ll have active recurrences throughout their lives. There are things you can do to reduce the risk of recurrence. For example:

  • Avoid stress
  • Mitigate fevers
  • Avoid prolonged exposure to sunlight

If unavoidable circumstances such as menstruation, surgery, or physical injuries trigger an outbreak, the treatments listed above can reduce your risk of an outbreak and/or lessen the severity of an outbreak.

Can Oral Herpes Go Away on Its Own? 

The signs and symptoms of a herpes outbreak go away on their own, but the virus remains in your body once you have it. 

Some treatments are available to help you lessen the severity of an outbreak and/or reduce the risk of you transmitting the virus to other people.

Potential Complications of Oral Herpes

For most people, herpes is more of an inconvenience than it is a serious medical condition. Mild scarring might be a concern following a particularly severe outbreak.

There are two instances in which herpes poses a more severe risk, but neither of these instances involves oral herpes. For example:

  • Neonatal herpes is a risk for infants born to mothers with genital herpes. It can lead to neurological disability and is potentially fatal.
  • Herpes simplex encephalitis occurs when herpes infects a person’s central nervous system (CNS). It’s treatable, but can be fatal if not treated properly. 

Many people have herpes but are asymptomatic, meaning they don’t even know they have it. 

Can Oral Herpes Come Back?

Oral herpes sores can come back. The virus remains in your body forever once you’ve contracted it. 

However, it can remain dormant for a certain period and then reactivate. When this occurs, a person is likely to develop mild symptoms, including sores. 

Some people refer to this as herpes “coming back,” even though it’s better described as a flare-up or recurrence.

Tips for Preventing Oral Herpes

Oral herpes is very contagious and it’s nearly impossible to prevent exposure. Exposure is very common for most people by the time they reach adulthood. 

To prevent herpes sores recurrence, you can keep the area around your mouth clean and dry and take antiviral medications at the first sign of a flare-up. 

Many people feel a tingling or burning sensation before a sore develops, which is when they can begin taking an antiviral medication. 

Over-the-counter topical medications are also available to lessen the severity and duration of symptoms.

Resources

(1) “Oral Herpes.” Www.hopkinsmedicine.org, www.hopkinsmedicine.org/health/conditions-and-diseases/herpes-hsv1-and-hsv2/oral-herpes.

(2) World Health Organization. “Herpes Simplex Virus.” Who.int, World Health Organization: WHO, 31 Jan. 2017, www.who.int/news-room/fact-sheets/detail/herpes-simplex-virus

(3) Opstelten, Wim, et al. “Treatment and Prevention of Herpes Labialis.” Canadian Family Physician Medecin de Famille Canadien, vol. 54, no. 12, 2008, pp. 1683–7, www.ncbi.nlm.nih.gov/pmc/articles/PMC2602638/.

(4) “Herpes Simplex Virus (HSV) Mouth Infection.” Cedars-Sinai, www.cedars-sinai.org/health-library/diseases-and-conditions/h/herpes-simplex-virus-hsv-mouth-infection.html.

(5) “Herpes Simplex Virus (HSV) Mouth Infection - Health Encyclopedia - University of Rochester Medical Center.” Www.urmc.rochester.edu, www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=85&ContentID=P00888

(6) “Cold Sore - Symptoms and Causes.” Mayo Clinic, 2018, www.mayoclinic.org/diseases-conditions/cold-sore/symptoms-causes/syc-20371017.

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