Oral Herpes: Causes, Symptoms, Recurrence, Testing and Treatment

Oral Herpes - STDTestGuru
Oral Herpes – STDTestGuru

A highly contagious sexually transmitted disease (STD) caused by the herpes simplex virus (HSV) is called herpes. HSV can be transmitted from person to person via direct contact. Herpes can appear in different parts of the body, mostly it appears on the genitals or mouth. There are 2 types of HSV:

  • Herpes simplex virus type 1 (HSV-1)
  • Herpes simplex virus type 2 (HSV-2)

HSV-1 is spread through oral-to-oral contact, and it causes infection in or around the mouth, oral herpes. The infection can also develop in or around the genitals through oral-genital contact. HSV-2 is spread through genital-to-genital contact, and it causes blisters and sores in the genital or anal area. Mostly, oral & genital herpes infections are asymptomatic. Both HSV-1 and HSV-2 infections are considered to be lifelong. It is estimated that globally 3.7 billion people under age 50 (67%) have HSV-1 infection. And 491 million people aged 15-49 (13%) have HSV-2 infection globally. Herpes is contagious when symptoms are present. The infection can still be transmitted to others even when the symptoms are absent.

What is Oral herpes?

Oral herpes is an infection caused by HSV. Oral herpes is also known as herpes labialis. Most oral herpes is asymptomatic and people with HSV-1 infection are unaware they are infected. Symptoms may include painful blisters or open sores called ulcers in or around the mouth. Sores that occur lips are referred to as cold sores. It is estimated that 50% – 80% of adults have oral herpes in the US. More than half of Americans have oral herpes (herpes labialis), and 1 out of 6 Americans has genital herpes. This infection usually recurs 1 to 6 times per year. During a recurrence, the duration of symptoms is shorter and the symptoms are less severe.

Oral herpes causes

HSV-1 is the cause of almost 80% of cases of oral herpes. And there is no evidence that HSV-1 viruses mutate into HSV-2 viruses. Many people are infected by oral herpes in their childhood/as young adults by nonsexual contact with infected saliva. One can get oral herpes by engaging in intimate or personal contact like oral sex, kissing, and touching the infected person’s skin, or sharing infected objects such as razors, toothbrushes, lip balm, or silverware. Even parents may spread the infection to their children during regular daily activities. The HSV can also be passed between the mouth and the genitals during oral sex. In rare cases, pregnant women with HSV-1 infection can spread the infection to their infant during delivery to cause neonatal herpes.

Risk factors

A person is at risk of complications from the virus if they have a weakened immune system from conditions and treatments such as:

  • HIV or AIDS
  • Cancer chemotherapy
  • Atopic dermatitis
  • Anti-rejection drugs for organ transplants

Oral herpes symptoms

The incubation period is 2-12 days and the average is 4 days. Symptoms will last 2-3 weeks. Infected people may have a fever, tiredness, muscle aches, and irritability. Pain, itching, burning, or tingling occurs at the infection site before the sores appear. And then clusters of blisters erupt. The blisters break down and appear as tiny, shallow, gray ulcers on a red base. They become crusted or scabbed and appear drier and more yellow after few days.

Oral sores:

  • Sores may occur on the lips, gums, roof of the mouth, front of the tongue, inside of the cheeks, and in the throat
  • May extend down the chin and neck
  • Gums become red, mildly swollen, and may bleed
  • Neck lymph nodes often swell (painful)
  • Infected people in their teens/the 20s may experience a painful throat with shallow ulcers and a grayish coating on the tonsils

In a first-time outbreak, infected people also might experience:

  • Fever
  • Headache
  • Muscle aches
  • Sore throat
  • Painful gums
  • Swollen lymph nodes
Oral Herpes: Causes and Symptoms
Oral Herpes: Causes and Symptoms

Recurrence of oral herpes

When a person had an episode of herpes, the virus lies dormant in nerve cells in the skin and may come up as another cold sore at the same place as before. Outbreaks are common in the first year after the initial episode of herpes infection. Though the specific triggers that make oral herpes recur are unclear, some factors may play a role, which includes:

  • Viral infection/fever
  • Stress
  • Fatigue
  • Menstruation
  • Exposure to ultraviolet light or excessive heat and cold
  • Changes in the immune system
  • Injury to the skin
  • Surgery


A doctor will base a diagnosis on a physical examination. When a person requires a definitive diagnosis (when infection involves other organ systems) the doctor may conduct laboratory tests.

  • A sample from the sores
  • Antigen and antibody studies
  • Blood sampling for antibody studies
  • A culture analysis
  • A staining test called the Tzanck smear

Oral herpes treatment

Prescription-strength topical medications – Medications like or penciclovir (Denavir 1% cream) or topical acyclovir (Zovirax 5% cream) will reduce healing time and decrease pain associated with the lesion. The acyclovir cream can be used five times per day for 4 days, and penciclovir cream should be applied every two hours while awake for 4 days.

Oral prescription-strength medications – Current FDA-approved oral antiviral drugs used in the treatment of HSV in adults are acyclovir, valacyclovir (Valtrex), and famciclovir (Famvir). These medications will help to reduce the duration of the outbreak.
Acyclovir, valacyclovir, and famciclovir are considered to be safe and effective during pregnancy. But topical treatment would be preferred. Pregnant women and nursing mothers should contact their physician prior to using any medication. Common side effects of these medications include headache, nausea, or diarrhea. The doses may differ depending on the individual situation as determined by the prescriber.

Treatment for the first outbreak of oral herpes infection:

  • Acyclovir (400 mg) is to be taken orally three times a day for 10 days or until the lesions have crusted.
  • Valacyclovir (2000 mg) is to be taken orally every 12 hours for 1 day.
  • Famciclovir (250 mg) is to be taken orally three times a day for 7-10 days.

Treatment doses for recurrent oral herpes:

  • Acyclovir (400 mg) is to be taken orally three times a day for 5 days. And this may also be given as 800 mg twice a day for 5 days or 800 mg three times a day for 2 days.
  • Valacyclovir (2000 mg) is to be taken orally every 12 hours for 1 day.
  • Famciclovir (1500) is to be taken mg orally once.

Who requires hospital admission?

  • People with severe local infection
  • For people whose infection spreads to other organ systems
  • A person with weakened immune systems
  • Dehydrated individuals
  • Infants younger than 6 weeks

Oral herpes home remedy

Home remedies for oral herpes infection may include applying a cool wet compress to the lesion to reduce the pain and keep the lesion from drying and cracking. Using compresses frequently will cause more drying, so a moisturizing balm should be applied. Lemon balm and L-lysine are popularly used as home remedies for this infection. These home remedies for oral herpes are well tolerated for those who wish to try them at their own risk.

Apart from this, there are some natural treatment options. Lemon balm, citrus bioflavonoids, L-lysine supplements, lactobacillus acidophilus, vitamin C, vitamin E oil, and vitamin B12 have also been considered in the potential treatment of HSV. However, there is no clinical evidence to support these treatments.

Possible complications

Autoinoculation – touching a cold sore (on the lip) can cause herpes of the finger, herpetic whitlow. Usually, this occurs at the time of primary infection when viral shedding is high. And a more serious complication is an infection of the eye or ocular herpes (herpetic keratitis). When this condition is left untreated, ocular herpes may lead to serious damage or even blindness.

Hardly, herpes may affect the brain and causes encephalitis. This condition requires hospitalization and intravenous antiviral medications. HSV-1 is the common cause of fatal viral encephalitis worldwide. Among immunocompromised people or people who are receiving chemotherapy, severe outbreaks of herpes may occur. Colds sores may also spread to the lower face or they may invade organs. The antiviral drug is used to prevent or lessen such attacks.

For some people, herpes can be associated with erythema nodosum. This is an inflammatory skin reaction characterized by red and painful skin lumps that usually appear on the front side of the legs. And the condition can be caused by inflammatory and infectious diseases, including herpes virus infections.

Is herpes curable?

Presently, there is no cure or vaccine for the herpes simplex virus (HSV). Avoiding sunburn and stress and other risk factors can help prevent additional outbreaks. Usually, sores will heal within 2 weeks even without treatment. There are cold sore treatments available to help decrease the healing time, reduce pain, and in some cases, suppress the recurrence of the virus. Cold sores recur during the first year after infection and usually resolve on their own within 1-2 weeks. These sores may never appear again or may appear only when something triggers them. Most of the time, people with sores lead normal lives and they aren’t terribly affected unless they happen to recur very often.

Oral Herpes Statistics
Oral Herpes Statistics


  • Must avoid physical contact with someone else’s cold sores.
  • Avoid sharing cups, towels, silverware, makeup, or lip balm.
  • Using condoms or dental dams during oral, anal, and vaginal sex.
  • Avoid having sex until sores are totally gone.
  • Don’t wet contact lenses with spit.
  • Should wash bedding and towels in boiling hot water after each use.
  • Use a sunblock that contains zinc oxide on lips (to prevent a possible recurrence).

Facts about oral herpes

  • In 2016, 3.7 billion people under the age of 50, or 67% of the population, had HSV-1 infection (oral or genital).
  • According to WHO, the prevalence of the infection was highest in Africa at 88% and lowest in the Americas at 45%.
  • About 50 to 80% of US adults have oral herpes.
  • It is estimated that one in two American adults have oral herpes and it is often caused by the herpes simplex virus (HSV-1).
  • Most people are first exposed to HSV-1 before the age of 5, according to the New York State Department of Health.

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