Oral Herpes - Cause, Symptoms and Treatment

More commonly known as cold sores, oral herpes is an infection of the mouth and lips caused by the Herpes Simplex Virus or HSV. The infection appears as small, fluid-filled blisters and is transmitted through skin-to-skin contact. From the first time that a person gets oral herpes, the virus stays in the body for the rest of his/her life. This means that while there is no complete cure for oral herpes, there are enough medications to relieve any pain or discomfort from the sores and prevent them from spreading.

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What causes oral herpes?

The Herpes Simplex Virus is responsible for causing oral herpes but HSV may in turn be of two different types – HSV-1 and HSV-2. While these two viruses have distinctly different DNA, both can cause oral and genital lesions. However, HSV-1 causes the majority, about 80% of all oral lesions and only about 20% of genital lesions and the reverse is true of HSV-2 which causes 80% genital and 20% oral sores. According to some studies, in adolescents, up to 40% of genital herpes is caused by HSV-1 because of reportedly increased oral/genital contact.

How is oral herpes transmitted?

The Herpes Simplex Virus of both types enter the body through abrasions, small cuts or breaks in the skin or mucous membranes. Most of the people get infected after direct skin-to-skin contact with someone carrying the virus who may or may not display noticeable lesions. While children are exposed to the viruses simply by touching an infected person, adolescents and adults can be exposed by both skin contact as well intimate body contact like when kissing or having sex.

Symptoms of oral herpes

Signs of oral herpes vary greatly and sometimes the infection can be present without noticeable symptoms.
 

1. As the name suggests, oral herpes is most commonly recognized by sores on the lips, gums, throat, the front of the tongue, the inside of the cheeks, and the roof of the mouth. Sometimes they also extend down the chin and neck.
    
2. Yet another symptom is an intense pain at the onset of the sores which may make eating and drinking difficult. In fact pain or a burning, itching, tingling sensation may occur at the infection site even before the sores appear.
    
3. The sores occur as cluster of blisters filled with fluid. Once they erupt, the blisters break down rapidly and  appear as tiny, shallow, gray ulcers on a red base. A few days later, they become crusted or scabbed and appear drier and more yellow. Blisters will usually appear one to three weeks after getting the virus and last for 10 to 14 days.
    
4. Oral herpes may cause gums to become mildly swollen, inflamed and they may even bleed.
    
5. Lymph nodes in the neck could become swollen and painful.
    
6. Teenagers and young adults may develop a painful throat with shallow ulcers and a grayish coating on the tonsils.
    
7. Apart from swollen gums and blisters around the mouth, children especially those under five are also likely to run a temperature and have headaches.

Even after the primary infection clears up, the herpes simplex virus continues to be present in a dormant form in the body and can cause recurrent infections. This usually appears blisters on the lips which usually start with a tingling sensation, redness and swelling around the lip. This is followed by small, fluid-filled blisters, which break open and develop a yellow scab. The scab usually falls off around seven days later.

In most cases oral herpes occurs in three stages in a human.

1. In stage one, also known as the primary stage, the virus enters the body through small cuts, cracks or abrasions on the skin or mucous membrane and reproduces. In many cases, the infection may remain asymptomatic that is the person may not develop sores or blisters and not even know that he/she has contracted oral herpes. Among those that symptoms occur, there may be blisters, fever and headache.
    
2. Stage two is known as latency and in this the virus moves from the infected site to a mass of nerve tissue in the spine called the dorsal root ganglion. There the virus reproduces again, usually without any symptoms, and remains dormant until reactivated by certain body conditions.
    
3. The third stage is that of recurrence when the virus may be reactivated and cause new sores and symptoms. Among the factors may contribute to recurrence are stress, exposure to ultraviolet light (including sunshine), fever, fatigue, hormonal changes, immune depression, and trauma to a site or a nerve region where previous HSV infection occurred.

How is oral herpes diagnosed?

In the majority of cases, oral herpes is easily diagnosed by a doctor based on the patient’s history and clinical examination. The Infection is confirmed by any one of the following diagnostic tests:
 

1. A tissue of fluid sample from the sores to identify the nature of the virus and hence infection.
    
2. A virus culture analysis.
    
3. Tzanck smear, a staining test, which shows non-specific nucleus cell changes due to HSV.
    
4. Antigen and antibodies to confirm whether the oral herpes is caused byHSV-1 or HSV-2.

Treatment of Oral Herpes

As yet there is no complete cure for oral herpes which will destroy the HSV entirely from a human body. Cold sores usually
clear up within a week or so. Treatment usually consists of measures that provide relief from pain and discomfort due to the sores and prevent the infection from spreading.

1. The patient can take over-the-counter painkillers like paracetamol or ibuprofen in order to ease any pain or irritation.
    
2. Over-the-counter anti-viral cold sore creams can lessen the severity of outbreak if applied at the first signs like tingling or burning sensation around the lips. Once the sores develop, the creams can provide relief from the skin discomfort.
    
3. Occasionally, if the infection is particularly severe or frequent, a doctor may prescribe anti-viral tablets.
    
4. One should drink enough fluids to stop dehydration; this is particularly important in young children. In case of foods, one should stick to cool and soft foods which will not irritate the skin. For the same reason it is best to avoid salty, acidic or spicy foods.

Effective treatment of oral herpes also includes following certain habits and making some lifestyle changes.

1. The patient should try not to touch the sores and if he/she does, should wash hands to prevent spreading the infection not only to others but even to other parts of their own body like the eyes.
    
2. It is best not to have sexual contact or even intimate contact like kissing until the infected person’s cold sores have healed completely.
    
3. Also the patient should avoid sharing any item of personal use which may have come in contact with the virus like lipstick, lip gloss, razor, towel, and cutlery.

While nothing can completely cleanse the HSV from a patient’s system, with certain medications and precautions, he/she can effectively manage the infection and prevent it from spreading to others.