Oral herpes is an infection of the mouth and lips caused by herpes simplex virus (or HSV ). The virus involves the occurrence of localized painful sores on the lips, gums, tongue, palate, inside the cheeks and sometimes on the face and neck. It can also trigger symptoms such as fever and muscle pain.
Usually people confuse infection with canker sores. Canker sores are located just inside the mouth, on the tongue and palate, not on skin and on other surfaces. Although they often manifests, they are not contagious, usually good delimited and not followed by other complications. The appearance of canker sores is caused by various substances that can irritate the oral mucosa.
There are two types of herpes (HSV) HSV-1 and HSV-2. These two viruses have different and distinct DNA and both causes oral(sores) and genital lesions. However, HSV-1 is responsible for 80% of all oral lesions and only 20% of genital lesions; the situation is reversed for HSV-2 (80% genitals and 20% oral lesions).
Studies suggest that in case of teenagers more than 40% of cases of genital herpes is triggered by HSV-1 because of increased ratio of oral and genital contact. Chances contacting HSV-1 are quite high. Approximately 65% of the population have detectable antibodies of HSV-1 at the age of 40 years.
HSV-1 occurs only in humans.
Mouth sores occur most often by children aged 1-2 years, but can affect people of any age and at any time of the year (it is also called herpetic gingivostomatitis).
HSV-1 can be transmitted by touching infected saliva, through contact with infected mucous membranes or skin. Because the virus is very contagious, most people are infected with at least one subtype of herpes HSV-1 even before adulthood.
Once the virus is contacted by an individual, presents a unique way of evolution, in three stages:
1. Primary infection – the virus enters the skin or mucous through small cracks and then reproduces itself. At this stage, there are oral lesions and other symptoms such as fever.
– In some cases, the virus does not cause any damage and cause no symptoms, so that the person is not aware of its existence. This is called asymptomatic infection.
– Asymptomatic infection is found twice as often than symptomatic infection .
2. Latency – from the infected areas, the virus retreats to the nerve cells, to the dorsal root ganglia of the spine. There the virus reproduces itself again, usually without any symptoms and becomes dormant until it is reactivated in certain conditions.
3. Recurrence – When people are faced with stressful situations, emotionally or physically, the virus reactivates and causes new signs and symptoms.
Experts suggest that the following factors may contribute to virus recurrence:
– Stress,
– Ultraviolet rays (including the sun)
– Fever,
– Fatigue,
– Hormonal changes (eg, menstruation)
– Immune system suppression
– Nerve damage in a region which has been previously infectied with HSV.
Causes:
Herpes simplex virus is a DNA virus that causes injury including around the mouth. Specifically two subtypes of herpes can cause these injuries:
– Herpes simplex virus type 1, herpes 1 or HSV-1 – responsible for about 80% of the cases of oral herpes infections
– Herpes simplex virus type 2 herpes 2 or HSV-2 – which causes about 20% of the same types of oral infections.
These viruses enter the body through small cracks or cuts in the skin or mucosa through contact with an infected person (whether lesions are visible or not). The main mode of contagion is simply reaching an infected person. Teens and adults can catch HSV through kissing or sexual contact, especially in the case of herpes simplex virus-2.
The genital and oral lesions recur over time, because viruses exist in the body, but remain dormant in nerve cells. One of the ways herpes simplex virus multiplies in human cells is taking over the cell nucleus and changes its structure. The modified core provides information and helps diagnosing the HSV infections after microscopic examination. The eruption of vesicles occurs after maturation of HSV particles that break the human cell membrane.
Signs and symptoms
The incubation period – HSV-1 the period between the contact with the virus and symptoms – is 2-12 days (average 4-5 days).
The period of manifestation of the disease – signs and symptoms – will last between two and three weeks, and usually they are fever, fatigue, muscle pain, irritability.
– Before the appearance of wounds or blisters many patients reported: pain, burning, tingling or itching at the site of infection. Blisters occurred will break easily and resemble small superficial ulcers, grey-white with red base. A few days later appears a yellowish crust over them.
– Oral lesions can be very painful and will make eating and drinking difficult.
wounds can be located in the gums, throat, lips, in front of the tongue, inside the cheeks and palate – lesions may extend to the bottom of the chin or neck.
gums become inflamed, red and may bleed
lymph nodes of the neck often become inflamed and painful
persons under the age of 20 years may develop unpleasant sores in the tonsils.
When is necessary a medical examination? Up
Because often cold sores are painful, many people have difficulty consuming foods or liquids. To prevent dehydration some medical advice is necessary, if these processes cannot be conducted in an appropriate manner.
Symptoms that suggest dehydration are:
– oliguria – reducing the amount of urine
– sleepiness
– irritability
– dry mouth
The dentist will be announced if a person is not sure about the type of his / her oral lesions (these may belong to other diseases worse than herpes).
If a baby less than 6 weeks has blistering, see your doctor. Severe complications and infections occur mainly by infants. For example, besides the pain inside the mouth, HSV-1 can affect brain function.
People whose immune system is weakened, should contact their physician if such injuries occur, as they can turn into severe infections or complications may occur. Pregnant women should consult their doctor immediately if they notice symptoms of vaginal infection with HSV, especially if the pregnancy is in last stage.
When you should go to the hospital
Signs and symptoms of dehydration are warning signs that require emergency visit to the hospital. Infants, especially those aged less than 6 weeks, should consult a pediatrician or go to the emergency room of a hospital if they have blistering in the mouth or if they manifest oliguria or consume fewer fluids.
Diagnosis
The doctor will make a presumptive diagnosis based on information provided by the patient and on physical examination. The characteristic appearance of the wound specific to herpes simplex virus ease the establishing of the diagnosis. Usually there are not needed other investigations.
In certain situations, to determine precisely the type of disease the physician may request the following laboratory tests:
– Harvesting a sample (tissue or fluid) from the lesions to identify the virus
– Viral culture
– Tzanck smear for cytological diagnose (after which it will be able to observe changes caused by HSV in cell nucleus)
– Analysis of antigen and antibodies (serology and PCR to determine if the infection is caused by HSV-1 or HSV-2, if it is acute or chronic).
Treatment
The following measures can be taken to self-care at home:
– Acetaminophen or ibuprofen will be used to decrease muscle pain and fever. There are new data from research that shows acetaminophen can trigger the development of asthma in case of some children. Therefore, before giving to children, please consult a doctor.
– Drink plenty of fluids to prevent dehydration
– Avoid physical contact with any secretion of the injuries.
Medical treatment includes:
– Use of antipyretics and proper hydration
– Applying local anesthetic for pain relief of vesicles or oral lesions
– In general oral medication is not recommended for people with normal immune systems, but only for children aged less than 6 weeks or people who suffer from severe disease
Hospitalization is required in the following cases:
– Local infection is severe
– Infection has spread to other organ systems
– People with weakened immune systems
– Dehydrated persons who require intravenous hydration
– Infants less than 6 weeks
Light uncomplicated herpes simplex eruptions do not require any treatment. For severe infections following oral antiviral medications are helpful:
– acyclovir
– valacyclovir
– famciclovir
Also acyclovir and pencilovir ointments can shorten recurrent attacks of HSV-1, applied locally, before lesions develop. These medicines may stop viral replication, but will not eliminate HSV virus from the body and can not prevent future recurrences and often are used for infections with HSV-2.
Other useful measures for a person with herpes simplex are:
– Avoid dehydration by drinking plenty of fluids
– Use pain medications only upon medical advice
– When the first symptoms of dehydration appear solicit immediately emergency medical care.
Methods of Prevention
To reduce the risk of acquiring HSV-1: avoid touching saliva, skin and mucosa’s lesions caused by people who have HSV-1. Prevent genital HSV can be done by using latex condoms, although the protection is not 100%.
Prognosis
Oral herpes lesions and symptoms disappear completely, usually in two to three weeks without any scar remains. However, events may recur in stressful situations.
