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Oral Herpes – Symptoms, Pictures, Causes, Treatment

Written by Dr.Mary

What exactly is Oral Herpes?

This is a viral infection of the lips and mouth which is caused by the herpes simplex virus – termed HSV. This virus develops sores which are painful and develop on gums, tongue, lips, mouth roof, cheeks inside as well as often on the neck and face. It can also cause muscle aches as well as fever. This infection is also referred to as “cold sores”. A different condition, known as “canker sores” is also thought to be caused by HSV, but this is actually untrue. Canker sores develop only in the mouth, on the roof of the mouth, on the tongue but not on any skin surface. Although they do reoccur, they are not infectious and usually are self-limiting and have no difficulties. Canker sores are caused by matters which aggravate the oral mucosa.


With oral herpes, there are 2 types caused by 2 similar viruses. One type is herpes simplex virus type 1 or HSV-1 and the other is herpes simplex virus-2 or HSV-2. Both types of herpes are very contagious.

Herpes doesn’t always develop symptoms – it does not always cause any outward, visible signs. When an individual does have symptoms, the blisters or sores can last for several weeks and then go away. They can return which is known as an “outbreak” or “recurrence” up to 6 times a year of more or they may not reoccur for years, if ever.

Kissing or touching and any sexual contact with the area that is infected spreads oral herpes. This virus is more communicable when an outbreak is occurring, but it is likely although less so, for the virus to spread when there is no sign of an outbreak. An oral herpes eruption or return is most infectious until the sores have entirely healed and not even the scabs are able to be seen.

Oral Herpes Symptoms

Oral herpes has an incubation period of 2 to 12 days. The incubation period is the time between contact with the virus and the appearance of symptoms. The average incubation period is around 4 days.

Signs and symptoms of this virus can last 2 to 3 weeks. Some of the symptoms include:

  • Fever
  • Muscle aches
  • Tiredness
  • Pain
  • Irritability
  • Tingling
  • Burning
  • Itching

Many individuals have symptoms of itching, burning, and tingling proceeding the outbreak of blisters or sores. Then groups of sores or blisters develop. The blisters or sores break down quickly and appear as shallow, tiny, gray sores on a red base. Several days afterward, they crust or scab over as well as appearing much drier and more yellow.

The most concentrated pain from these sores occurs at the onset and can make drinking or eating hard. The blisters or sores can develop on the gums, lips, and the front of the tongue, throat, and the inside of the cheeks as well as the roof of the mouth. They may also extend down the chin or the neck. The gums can be red colored, mildly swollen, and can bleed. The lymph nodes in the neck can swell and are painful. Individuals in their teens or twenties may also develop an aching throat with superficial ulcers as well as a coating which is gray on the tonsils.

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Any individuals with this virus should see their physician if they develop any of the following:

  • Difficulty eating or drinking
  • Dehydration
  • Drowsiness
  • Decrease in urination
  • Irritability
  • Dry mouth

If a child with cold sores is less than 6 weeks old, the baby’s physician needs to be notified if oral blisters or sores appear. Disease complications or severe infection may occur more frequently in infants. With babies, HSV-1 can go to the brain and create damage.

Individuals with weakened immunity systems should also notify their primary care physician if sores or blisters appear. If a person’s immune system is weak, they are much more likely to have disease complications or severe infection. Women who are pregnant need to also consult immediately if HSV infection is noticed especially if she is close to term.

Oral Herpes Treatment

A physician will make a tentative diagnosis on data provided by the patient and on the physician exam. The typical appearance of the herpes sores usually leaves very little doubt of the diagnosis. Often additional testing is not usually necessary.

If an authoritative diagnosis is needed, the physician can conduct the lab tests listed below:

  • Tissue sample from the sore
  • Viral culture analysis
  • A staining test called the Tzanck smear
  • Antigen and antibody studies

For self-care at home do the following:

  • Use acetaminophen or ibuprofen for fever and muscle aches
  • Consume plenty of fluids
  • Avoid bodily contact with lesions as well as lesion secretions

Treatment can also include:

  • Topical anesthetic such as lidocaine (xylocaine, Nervocaine, Dilocaine, Zilactin-L) can be approved for pain relieve of oral blisters and lesions.
  • Oral or IV drugs exist for HSV but only for individuals with weakened immune systems, infants younger than 6 weeks or those with severe disease.
  • A few individuals can require hospital admission especially those with severe local infections, those with infections which have spread to other organ system, those with weakened immune systems, those who need IV hydration

Mild cases of herpes simplex require no treatment. Severe infections can need management with an antiviral agent. Oral antiviral drugs include:

  • Zovirax (acyclovir)
  • Famvir (famciclovir)
  • Valtrex (valacyclovir)
  • Topical Denavir (penciclovir) creams can shorten attacks of recurrent HSV-if it is applied early, normally before lesions develop.

These medications may stop viral reproduction in the skin but do not eradicate HSV from the body or stop later outbreaks. These medications are use more frequently with HSV-2 infections. Most scientist and researchers suggest consulting an infectious disease expert when individuals with HSV infections need hospitalization.

Oral Herpes Pictures

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