Oral Herpes Simplex (Cold sores)

Medically reviewed by The Dermatologists and written by Dr. Alexander Börve

Herpes is a common skin disease that can be categorized into two categories: HSV-1 and HSV-2. Both types of herpes may present with symptoms of blisters or sores in the affected region. Some individuals, for instance, are unaware that they have the disease because their symptoms are so minor. Others, however, may have many outbreaks per year. HSV-1 and HSV-2 are most commonly associated with outbreaks around mouth and genital area, respectively – although either type may be found in either location. Herpes simplex can also infect fingers and the eyes.

Oral herpes, also known as labial herpes, is usually caused by HSV-1, which is found in saliva and is transmitted mainly through mouth-to-mouth contact. Transmission of the virus can also occur through direct contact with the sores or secretions and sharing utensils or lip products. Through oral sex, HSV-1 can be transmitted to genital areas and cause genital herpes, but it is rare that HSV-2 infects the mouth.

Once infected with oral herpes, you have some immunity against genital herpes, even though the different virus types prevent them from having complete immunity against each other.

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Symptoms

Herpes blisters (also known as fever blisters or cold sores) appear as one or more blisters in a group around the affected region. The sores are typically inflamed and painful, and over the course of the outbreak, they may leak clear fluid and leave a scab. There is a lot of variability in terms of the duration, appearance, and repeating herpes outbreaks. The most typical additional symptom during the initial outbreak may include fever or fatigue.

Oral herpes is most commonly seen as cold sores on the lips or the skin around the mouth, with clusters of small fluid-filled blisters that often hurts. You can also get the same sores inside the mouth. The skin around the blisters and the mucous membranes inside the mouth tend to blush or swollen with a HSV-1 infection. It often hurts and is already swollen one or two days before the blisters formed. Oral herpes usually do not give any scars. Young children who get herpes for the first time can get strep throat-like symptoms, sometimes without blisters on the lips.

However, the herpes virus does not disappear from the body after an outbreak. From the skin the virus moves to nerve cells next to the spinal cord where it lies dormant. It can be activated again and give cold sores again, especially when you are sick with the flu or pneumonia, expose your skin to strong sunlight, stressed or menstruating. When oral herpes recurs, the first symptom is often an uncomfortable tingling or throbbing sensation in the skin around the mouth.

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What can I do?

If you have herpes breaking out with blisters, do not kiss others. You should also wash your hands often to avoid passing on the virus through hand contact with others. You should not share lip product, utensils or food with others. Because the herpes virus can cause a painful eye infection, you should try to avoid touching your eyes with your fingers when you have a herpes outbreak.

Should I seek medical care?

It is rare that wounds become infected by bacteria, where they become even more swollen and lasting. In this cases, you may need to use antibiotics.

If you have had eczema, you can be extra sensitive to cold sores. Widespread eczema can impair your immunity against herpes viruses. If you have used drugs that impair defense against infection, you may need medicine that prevents the herpes virus itself from spreading. There are both ointments or tablets that you take in the early stage of the infection.

If you already have a severely immunocompromised because of a serious illness, you can also get a widespread and severe herpes infection. Other very rare complications include inflammation of the meninges, or brain. If you become very ill from a herpes infection, you should be treated in hospital.

If you are pregnant, there is a small risk that the virus may transmit to the newborn during childbirth. You should contact their doctor if you are pregnant and get a herpes outbreak for the first time or if you get an outbreak during the last trimester of pregnancy.

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Treatment

At this time there is no known cure for either type of herpes, although there are treatments that suppress symptoms. Antiviral creams containing aciclovir (e.g. Zovirax) may relieve superficial symptoms. In some cases, when symptoms are severe, treatment with prescription antiviral medicine in tablet form may be required. It is not curative, but suppresses the symptoms. In these cases, treatment should start as early as possible after the first signs of disease.

Source:

U.S. National Library of Medicine. Herpes Simplex. Available at: https://www.nlm.nih.gov/medlineplus/herpessimplex.html

World Health Organization. Herpes simplex virus. Available at: http://www.who.int/mediacentre/factsheets/fs400/en/