Cold sores, or oral herpes, while not particularly nice to experience, are a common viral infection usually caused by the herpes simplex virus type 1 (HSV-1) and the less common herpes simplex virus type 2 (HSV-2) [1].
They are small, fluid-filled blisters that can appear on and around your lips and are often grouped together. Once the blisters break, scabs form and will last several days.
Cold sores usually heal in 2-3 weeks and won't leave a scar. However, cold sores are highly contagious even when you can't see the blisters [2].
What is herpes?
The herpes simplex virus (HSV) affects many people globally, with HSV-1 typically transmitted by oral-to-oral contact and causes infection in or around the mouth to cause oral herpes or cold sores, but it can also cause genital herpes. HSV-2 is mainly sexually transmitted and causes genital herpes [3].
Both types of the herpes simplex virus are more often asymptomatic, however, they can cause painful blisters or ulcers at the infection site, ranging from mild to severe. The infection is lifelong, and symptoms may flare up over many years.
Herpes is incredibly common with an estimated 3.7 billion people under the age of 50 having HSV-1 globally, while an estimated 491 million people aged between 15-49 have HSV-2 globally [4].
Difference between HSV-1 and HSV-2
As mentioned, there are 2 different kinds of herpes simplex viruses: HSV-1 and HSV-2. These viruses can live on many different body parts, but generally, HSV-1 cause oral herpes and HSV-2 causes genital herpes, with each strain preferring to live in its favourite area. However, either virus can infect either area.
For example, you can get HSV-1 on your genitals if you receive oral sex from someone with a cold sore on their lips. And you can get HSV-2 in your mouth if you give oral sex to someone with HSV-2 on their genitals.
If you have HSV-1 or HSV-2 on your vulva, vagina, cervix, anus, penis, scrotum, butt, or inner thighs, you would refer to this as genital herpes.
If you have it on your lips, mouth and throat, it would be known as oral herpes or cold sores.
Both herpes viruses can live in your body for years without causing any symptoms, making it difficult to know precisely how you may have been infected. This is why many people worldwide have herpes and don't even realise it.
How does oral herpes spread?
Oral herpes is easily spread from direct contact with someone with the herpes virus, and this could be as simple as kissing someone with an active infection. Both HSV-1 and HSV-2 can be spread to your mouth or genitals and can be spread by oral sex.
However, this is not the only way the herpes virus can be passed on, a parent can give their child a cold sore from a kiss, and a mother can pass genital herpes to a baby during vaginal childbirth if the infection is active, though this is rare.
You can also pass the herpes virus on if you touch a herpes sore or from the saliva of someone with a cold sore (for example, by sharing personal items like lip balm) and then touch your mouth, genitals, or eyes without washing your hands first.
While there's no cure for cold sores, there are treatments that can help manage severe or frequent outbreaks and can reduce the frequency, length and severity of future outbreaks.
What causes herpes on the tongue?
You can get herpes on the tongue, just like you can get it on your lips and inside your mouth. Both HSV-1 and HSV-2 can cause herpes on the tongue, however, it is more commonly caused by HSV-1.
Herpes on the tongue, or inside the mouth, starts as redness, then develops into a sore, then an ulcer and later, tends to crust over. It will usually be quite painful and may make it difficult to eat and drink.
Tongue herpes will usually go away on its own in around 7-10 days, but treatments, such as clinical treatments and pain-reducing medications, can help them go away faster.
A doctor can diagnose tongue herpes by looking at your tongue, doing a blood test, or swabbing the infected area.
What does herpes on the mouth look like?
Herpes on the mouth will begin with an initial redness and swelling, which may be painful or itchy. This will then turn into painful, fluid-filled blisters, which are highly contagious.
Next, they will leak fluid and become sores, which will crust over after around 4-6 days [5]. There are generally 5 stages of a cold sore and these pesky occurrences can last up to 2 weeks.
Are cold sores on the tongue considered herpes?
Cold sores on the tongue are considered herpes as the herpes simplex virus causes them, whether that be HSV-1 or HSV-2.
Herpes on tongue symptoms
While the most common cold sore symptom is a painful blister, people may also experience other oral herpes symptoms if they have a new herpes infection. These include:
- Fever
- Fatigue
- Body or muscle aches
- Headache
- Sore throat
- Swollen lymph nodes
- Nausea
Common triggers that can cause a herpes outbreak
While it's unclear what exactly can trigger a herpes outbreak, several factors may play a role, including:
- A weakened immune system, including recent fever, chest infection or flu-like symptoms
- Emotional stress
- Menstruation
- Physical injury
- Prolonged or intense exposure to sunlight
- Surgery [5]
Is re-infection or recurrence possible?
Recurrent outbreaks are most common in the first year after the initial infection and tend to lessen as the body begins building antibodies to the virus.
How to manage and treat oral herpes
Herpes sores are generally not seen to be dangerous and don't cause permanent damage to the skin. While treatment cannot cure the herpes infection, there are some things you can do to help prevent cold sores or manage symptoms.
For starters, it's important to avoid picking the scab or breaking blisters, as bacteria can cause secondary infections.
When it comes to treatment, antiviral treatment options can help reduce outbreaks while also lowering the risk of passing the virus on to other people.
Pilot's herpes treatment is a discreet way to manage herpes without having to leave the house! Simply complete our take-texted consult and an Aussie practitioner will create a treatment plan based on your specific need, which is delivered to your door in discreet packaging. You also have unlimited follow-ups and free cancellation anytime.
If you're in pain with an active breakout, chat with your pharmacist or doctor about the best pain relief options. If you have herpes on the tongue, you may also wish to gargle with warm salt water or mouthwash and avoid tobacco products, acidic, spicy or salty foods, and alcohol.
Conditions that can be mistaken for oral herpes
Some conditions can be mistaken for oral herpes. These include:
Canker sores
Canker sores are painful sores inside the mouth and are most commonly found on the mucous membranes of the mouth, such as the inner surfaces of the cheeks and lips, tongue and soft palate [6].
They will usually be oval or round, with a grey or white eroded surface surrounded by a red, inflamed area. They can appear singly or in groups and may be painful for 3 or 4 days, with complete healing taking up to 10-15 days. They can also recur multiple times a year.
It's unknown what causes canker sores, but it may be a virus, a form of an allergic reaction, or perhaps even an auto-immune condition, where the body has developed an immune response against itself.
Contact dermatitis
Contact dermatitis is a skin condition that can cause an itchy rash, cracked or dry skin, bumps, blisters and tenderness, and when it occurs around the mouth or genitals, it can be mistaken for herpes [7].
Contact dermatitis usually occurs after exposure to an irritant or allergen, with common causes being reactions to medication, cosmetics, detergents and jewellery. The rash will usually subside in 2-4 weeks, and while it isn't a serious condition, it can be itchy and uncomfortable.
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