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Oral Herpes (HSV-1)

Oral Herpes (HSV-1) Overview

Oral herpes is an infection of the mouth and lips caused by the herpes simplex virus (also termed HSV). The virus causes painful sores on lips, gums, tongue, roof of the mouth, and inside the cheeks and sometimes on the face and neck. It also can cause symptoms such as fever and muscle aches. People commonly refer to the infection as "cold sores." Another condition, "canker sore," is often thought to be caused by HSV, but this is not true. Canker sores occur only inside the mouth, on the tongue and on the soft palate (roof of mouth), not on skin surfaces. Although they reoccur, they are not contagious, usually are self-limiting, and have almost no complications. Canker sores are caused by substances that irritate the oral mucosa.

There are two types of HSV, termed HSV-1 and HSV-2. These two viruses have distinctly different DNA, and both cause oral and genital lesions. However, HSV-1 causes about 80% of all oral lesions and only about 20% of genital lesions while HSV-2 causes the reverse (80% genital and 20% oral). Studies also suggests that in adolescents, up to 40% of genital herpes is caused by HSV-1 because of reported increased oral/genital contact.

Oral herpes (HSV-1) infection (or exposure without noticeable infection) is common. About 65% of the U.S. population have detectable antibodies to HSV-1 by age 40. This article will focus on HSV-1, commonly termed oral herpes, not on HSV-2, commonly known as genital herpes.

  • HSV-1 affects only humans. Mouth sores most commonly occur in children 1-2 years of age, but they can affect people at any age and any time of the year (also termed herpes gingivostomatitis).


  • People contract HSV-1 by touching infected saliva, mucous membranes, or skin. Because the virus is highly contagious, a majority of the population are infected by at least one herpes subtype of HSV-1 before adulthood.


  • After HSV-1 infects a person, it has a rather unique ability to proceed through three stages.


    • Stage 1 - Primary infection: The virus enters the skin or mucous membrane, usually through small cracks or breaks, and then reproduces. During this stage, oral sores and other symptoms, such as fever, may develop.


      • The virus may not cause any sores and symptoms. You may not know that you have it. This is called asymptomatic infection.


      • Asymptomatic infection occurs twice as often as the disease with symptoms.

    • Stage 2 - Latency: From the infected site, the virus moves to a mass of nerve tissue in the spine called the dorsal root ganglion. There the virus reproduces again, usually without any symptoms, and becomes inactive, until reactivated by certain body conditions (see Stage 3).


    • Stage 3 - Recurrence: When people encounter certain stresses, emotional or physical, the virus may reactivate and cause new sores and symptoms. Investigators have suggested the following factors may contribute to recurrence: stress, ultraviolet light (including sunshine), fever, fatigue, hormonal changes (for example, menstruation), immune depression, and trauma to a site or a nerve region where previous HSV infection occurred.


Next: Oral Herpes (HSV-1) Causes »

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Oral Herpes

Stress Overview

Everyone is familiar with stress. We experience it in varying forms and degrees every day. In small doses, stress can actually be beneficial to us. It is only when the stress becomes too great, affecting our physical or mental functioning, that it becomes a problem.

  • In small doses, stressors can help give us increased energy and alertness, even helping to keep us focused on the problem at hand. This type of stress is good. People may refer to the experience of this type of stress as feeling "pumped" or "wired."
  • As the level of pressure gets too great, stress eventually surpasses our ability to cope with it in a positive way. Often, people describe themselves as being stressed out, burned out, or at wits end. At this point, it is important to find positive and productive ways to deal with the stress and, more importantly, to address the person or situation that is causing the stress.
  • Everyone reacts to stress diffe...

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