Oral herpes or herpes simplex virus-1 (HSV-1) infection, as the name suggests, is a viral infection of the mouth and lips caused by the type 1 herpes simplex virus.

Many people with oral herpes do not have any symptoms and are not aware of the infection. But, in some cases, the virus may cause sores or blisters on the lips, tongues, inside of the cheeks, roof of the mouth, inside of the nose, neck, and chin. These lesions are often referred to as cold sores. In rare cases, the virus may also result in genital lesions. 

There is no cure for oral herpes, and the infected individual has the virus in their body throughout the lifetime. Fortunately, many treatment options are available to manage the symptoms and prevent their recurrence.

Let us understand more about this infection.

What is Oral Herpes (HSV -1)?

There are two types of herpes simplex virus, HSV-1 and HSV-2. The genetic make-up of both the viruses is different and may cause genital and oral lesions.

However, 80% of all lesions caused by HSV-1 are oral, and only 20% are genital. For the same reason, HSV-1 infection is also known as oral herpes. On the other hand, HSV-2 infection causes about 80% genital and 20% oral sores and is thus known as genital herpes.

Some studies show that HSV-1 is responsible for 40% of genital herpes due to oral sex. Besides, HSV-1 is a silent condition in most cases. About 70% of individuals suffering from it are not aware but have detectable antibodies to HSV-1 by age 40.

You can contract an HSV-1 infection by coming in contact with the infected mucus membrane, saliva, or moist skin. As the virus can be transferred easily, most people are infected before adulthood.

Once HSV-1 enters your body, it can pass through three stages.

  • Stage 1 (Primary infection): The virus enters mucus membrane or skin through small breaks or cracks and replicates. Symptoms such as blisters, fever, and oral sores may develop. Sometimes, the virus may not cause any symptoms, and people are not aware of the infection. It is known as an asymptomatic infection. This lack of symptoms is twice as likely as the symptomatic infection.
  • Stage 2 (Latency): In this stage, the virus moves from the site of infection to nerve tissue and stays there in the dormant stage unless activated by certain conditions.
  • Stage 3 (Recurrence): Factors such as physical or emotional stress, illness, fatigue, hormonal changes, depression, low immunity, and fever may activate the virus.
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Complications Due to HSV -1 

In some cases, the HSV-1 virus may cause some of the following complications:

  • Herpes whitlow (the virus spreads to the fingertips. Kids who suck their thumb may transfer the virus from the mouth to the thumbs)
  • Eye problems such as infections, scarring, and loss of vision
  • Atopic dermatitis
  • Pharyngitis
  • Encephalitis
  • Keratoconjunctivitis
  • Hepatitis

Causes

HSV-1 is a DNA virus and is responsible for oral herpes that causes sores in and around the mouth. The incubation period, the time between infection and appearance of the symptoms, is about three to six days and transmission of the virus is more likely if lesions are present. 

Skin contact is the commonest way of transmitting the infection, and you can easily get infected by simple touching. Some ways of getting infected are:

  • Sharing lip balm or toothbrushes or glasses
  • Eating from the same utensils
  • Kissing
  • Direct exposure to saliva or droplets formed in the breath

Symptoms

As discussed before, symptoms depend on the stage of the disease. 

Some symptoms include:

Early symptoms

  • Sore lips
  • Tingling
  • Burning sensation
  • Pain
  • Itching

Late symptoms

  • Pimple-like lesions
  • Sores
  • Bumps
  • Blisters
  • Fever blisters
  • Swollen, bleeding, and red-colored gums
  • Swollen and painful lymph nodes
  • Pain in the throat
  • Grayish coating on the tonsils
  • Shallow ulcers

Oral sores may cause intense pain and may make it difficult for you to eat or drink. The sores can occur on gums, lips, throat, tongue, the roof of the mouth, and inside of the cheeks. Sometimes, it may also extend down the neck and chin.

A cold sore usually passes through several stages:

  • Itching and tingling: Many patients feel burning, itching, or tingling around the lips before hard, small, and painful spots appear.
  • Blisters: Blisters erupt from the painful sores on your lips. Sometimes they may also be present around the cheeks, nose, or inside the mouth.
  • Crusting and oozing: The blisters can burst, resulting in a yellowish or white fluid that forms a crust.
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All in all, the appearance of the symptoms depends on the stage and whether it is the first outbreak or recurrence. During the initial outbreak, you may not have symptoms for up to 20 days after exposure to the virus. The sores can take two to three weeks to heal. Recurrences usually appear at the same spot and tend to be less severe.

During the initial outbreak, you may also get the following symptoms:

  • Painful gums
  • Headache
  • Swollen lymph nodes
  • Fever
  • Sore throat
  • Muscle aches

Transmission

Sores caused by HSV-1 are most infectious when they ooze as the virus can easily spread through contact with body fluids. However, you can also spread the virus in the absence of blisters. 

An infected individual has a virus dormant in the nerve cells. Recurrence can be triggered by:

  • Hormonal changes such as associated with menstruation
  • Fatigue
  • Immune system disorder
  • Viral infection or fever
  • Stress
  • Exposure to sunlight and wind
  • Injury to the skin

Risk factors

Almost everyone is at risk of oral herpes. But having some conditions may increase the risk of HSV-1 infection, such as:

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

Precautions

If you are at a high risk of complications or have got cold sores more than nine times a year, your doctor may advise an antiviral medicine to take regularly. 

If sunlight is a triggering factor, applying sunblock to the affected area can help. You can also talk to your doctor about the need for an oral antiviral drug if you plan to go to a place with intense sunlight exposure.

To prevent the spread of sores to other part or other people, you may try the following:

  • Avoid sharing personal items such as lip balm, utensils, towels, and toothbrushes, especially when blisters are present
  • Avoid skin contact, oral sex, and kissing when blisters are present
  • Wash your hands thoroughly with soap and water
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Treatment

There are various treatment options.

Home Remedies

  • Acetaminophen or anti-inflammatory drugs such as ibuprofen for muscle aches and fever
  • Avoid contact with secretion or lesions
  • Have plenty of fluids to prevent dehydration

For mild infections, these self-care tips may be adequate. However, medicines have side-effects and may not be taken by all. So, it is better to consult your doctor before taking acetaminophen or anti-inflammatory drugs.

Other options that may help soothe your symptoms are:

  • Cornstarch
  • Aloe vera gel
  • Mint or tea leaves

When To Consult A Doctor

But you should consider treatment and consult your doctor if you have the following:

  • Sores that do not heal even after two weeks
  • A weak immune system
  • Frequent recurrence
  • Severe symptoms
  • Irritation in the eyes

Medications

The current approach involves managing the symptoms and limiting the number of outbreaks. In many cases, the sores and other symptoms may subside without treatment. But your physician will determine if you need medicine. If required, you may be prescribed one of the following medications:

  • Famciclovir
  • Acyclovir
  • Valacyclovir

These medicines lower the risk of you transmitting the infection to others. They also reduce the frequency and intensity of symptoms and outbreaks. The mentioned medicines are available as creams or pills. For severe infections, they can also be administered by injection.

Initiating treatment with 24 hours significantly lowers the duration of the outbreak.

Medicines are recommended for:

  • Infants younger than six weeks
  • People with severe disease
  • People whose infection has spread to other organs
  • Dehydrated people
  • Those with a weak immune system

Final Thoughts

Oral herpes is a prevalent condition and is caused by the HSV-1 virus. In most cases, people with HSV-1 infection do not have symptoms. When present, the most common symptoms are sores or blisters in and around your mouth. It is thus also known as oral herpes.

While there is no cure for this infection, managing it in the initial stage lowers the risk of transmitting the condition to others and also reduces the frequency of recurrence. So, if you feel you may have oral herpes, consult your doctor as early as possible.

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