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oral herpes

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Cold sore

Oral herpes

Alternative Names
cold sores, fever blisters, herpes simplex , HSV-1

Oral herpes is a common condition that shows up as blisters inside the mouth or on the lips. The cause is a virus called Herpes Simplex Virus Type I (also called HSV-1). Oral herpes is contagious. Herpes can spread to other parts of the body, such as the eyes, fingers, or genital area (external sex organs). Note: Genital herpes is usually caused by Herpes Simplex Type 2 (HSV-2) but it is possible to have genital outbreaks with either strain of virus.

What is going on in the body?
Oral herpes occurs in two stages, primary infection and recurrence of infection. At some time during childhood, most people come down with the primary infection, which may or may not have symptoms. Some children get sores or blisters inside the mouth with few symptoms. Fussiness, fever, sore throat, and generalised cold-like symptoms are possible. This primary infection takes about 2 weeks to clear up. It is possible to spread the virus from person to person while the disease is active.

After this primary infection, a recurrence can happen at any time. The virus remains in the body but is not active. Recurrent infection usually causes blisters (most people call them cold sores or fever blisters). The sores break out on the lips, gums, tongue, or on the inside of the cheeks. There is often some swelling and mild soreness or pain when the sores appear. Some people feel a warning just before the outbreak of blisters. They describe it as a tingling feeling of the area. These blisters start out very small but may form larger sores, which take about 2 weeks to scab over and heal.

These outbreaks may come along with being tired or run-down, during periods of emotional stress, after exposure to sunlight, while having colds or flu, shortly after a dental appointment, or when not feeling well in general. However, many outbreaks seem to occur with no clear reason. Some people have more outbreaks than others.

What are the signs and symptoms of the disease?
  • The first outbreak may not have any symptoms.
  • Usually tiny blisters grow into larger sores in the mouth, on the tongue or the lips.
  • Swelling and redness usually happen before and during an outbreak.
  • Fever is sometimes present.
  • A person may generally not feel well.
  • A person may feel tired.
  • It may be hard for the person to eat because of the sore throat.

What are the causes and risks of the disease?
  • This disease can be spread from person to person much like a cold or flu.
  • Sores can be spread to other parts of the body such as fingers or eyes. This is a serious event that should be seen at once by a doctor.
  • Sometimes sores can also spread to the genital area.
  • Sores can become infected with bacteria if not kept clean.
  • People with cancer or other debilitating diseases may be more at risk.
  • People with HIV or other autoimmune disorders may be more at risk
  • People undergoing x-ray therapy or chemotherapy may be more at risk.
What can be done to prevent the disease?
  • This is a contagious disease, at least during part of its course.
  • Limit exposure to anyone with cold sores, much the same as for a cold or flu. Touching, kissing, or using the same dishes and silverware can spread the disease between people.
  • Use sun block or sunscreen on lips when outside.
  • Keep the mouth clean to prevent secondary bacterial infection.
  • Try not to touch the sores; they can sometimes spread to other parts of the body.
How is the disease diagnosed?
If a strange blister or sore appears in or around the mouth, see a healthcare professional. A simple examination will give a diagnosis. There are laboratory tests for this virus but they are seldom needed.

What are the long-term effects of the disease?
Most people can get these blisters at any time during their lifetime. There are no vaccines for prevention.

What are the risks to others?
  • If a person gets outbreaks of these blisters fairly often, he or she should see a doctor.
  • If a person's throat is sore or headache occurs, a doctor should be consulted.
  • If a person notices sores near the eyes or on the fingers, he or she should see a doctor.
What are the treatments for the disease?
  • In most cases, these sores are self-limiting. They will usually crust over and go away in about 2 weeks. If they last longer a doctor should be consulted.
  • Antiviral drugs, such as acyclovir,valacyclovir, and famciclovir, are available by prescription but usually are not needed The treatment of choice is penciclovir. It is in a cream form, and it is applied every 2 hours upon the sensation of the "tingle" often felt right before the onset of a cold sore. This therapy should be followed for a period of 4 days.
  • Keep the area clean by using a diluted (one and a half percent) hydrogen peroxide mouth rinse. A diluted salt-water rinse (1/2-teaspoon salt in 8 oz. warm water) may also be soothing.
  • Lip balm may be soothing for sores on the lips.
  • Keep lips covered with sunblock especially during the healing period.
  • Application if ice for a couple of hours at the "tingle" stage may abort the blister.
What happens after treatment for the disease?
These sores usually clear up and go away in about 2 weeks. If they last longer than this or if they come back often, a doctor should be consulted.

Author: Marvin Goldfogel, DDS
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Potential conflict of interest information for reviewers available on request

This website and article is not a substitute for independent professional advice. Nothing contained in this website is intended to be used as medical advice and it is not intended to be used to diagnose, treat, cure or prevent any disease, nor should it be used for therapeutic purposes or as a substitute for your own health professional's advice.  All Health and any associated parties do not accept any liability for any injury, loss or damage incurred by use of or reliance on the information.


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