Oral Herpes (HSV-1) (Herpes of the Mouth)

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Medical Author:

Charles Patrick Davis, MD, PhD

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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• Oral Herpes (HSV-1) Overview
• Oral Herpes (HSV-1) Causes
• Oral Herpes (HSV-1) Symptoms and Signs
• When to Seek Medical Care
• Oral Herpes (HSV-1) Diagnosis
• Oral Herpes (HSV-1) Treatment
• Self-Care at Home
• Medical Treatment
• Follow-up
• Oral Herpes (HSV-1) Prevention
• Oral Herpes (HSV-1) Risk Factors
• Oral Herpes (HSV-1) Prognosis
• Oral Herpes (HSV-1) Pictures
• Synonyms and Keywords
• Authors and Editors
• Viewer Comments: Oral Herpes - How Did You Manage

Oral Herpes (HSV-1) Overview

Oral herpes is an infection of the mouth and lips caused by a specific type of the herpes simplex virus (also termed HSV-1, type 1 herpes simplex virus, or oral herpes). The virus causes painful sores on the lips, gums, tongue, roof of the mouth, 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 herpes labialis or "cold sores." Another condition, "canker sore," is sometimes 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 suggest that in adolescents, up to 40% of genital herpes is caused by HSV-1 because of reported increased oral/genital contact (transmission by oral sex).

Oral herpes (HSV-1) infection (or exposure without noticeable infection) is common. About 65% of the U.S. population has detectable antibodies to HSV-1 by age 40. This article will focus on HSV-1, or oral herpes, not on HSV-2, also commonly known as genital herpes. HSV-2 is considered to be a sexually transmitted disease (STD). In addition, HSV-2 virus should not be confused with human papillomavirus (HPV), the cause of genital warts and some cervical and other cancer types.

• 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 is 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. People may not know that they have an infection. 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. 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.