Oral Herpes: Symptoms, Causes and Treatments

"Herpes" is one of those words that can make anyone very uncomfortable — you may have it and know the symptoms from firsthand experience, or you may have it and not even be aware. 

It may come as a surprise to know that as many as 90 percent of older adults throughout the world have the virus known as oral herpes, and most people get it when they’re children. 

That’s because oral herpes is often caused by coming into close contact with someone who has the infection (e.g., sharing drinking vessels, towels, makeup, razors, etc.). 

Understanding oral herpes, its symptoms and its causes is the first step in making this extremely common virus less taboo. Here’s what you should know: 

TL;DR What You Should Know About Oral Herpes 

• Oral herpes is most commonly caused by herpes simplex virus type 1 (HSV-1), but can less commonly be caused by a different strain called HSV-2. HSV-2 is the most common cause of genital herpes.

• The primary symptom of oral herpes is cold sores, though an initial infection of the virus can cause fever and other, more severe symptoms. 

• Oral herpes is spread by intimate and sexual contact with someone who is infected. It is typically transmitted by kissing, sharing drinking vessels or eating utensils, towels, razors or makeup. Oral herpes can also occur if an uninfected person performs oral sex on an individual who has an active genital herpes infection (transmission from the genitals to the mouth).

• Oral herpes is incurable, but breakouts generally resolve themselves without treatment. 

• Antiviral treatments are available that can lessen the severity and duration of herpes flare-ups.  

What is Oral Herpes? 

There are several different subtypes of the herpes virus. Herpes Simplex Virus Type 1 (HSV-1) is generally the one that causes oral herpes or herpes labialis, while Herpes Simplex Virus Type 2 (HSV-2) is generally the cause of genital herpes. 

Oral herpes, or HSV-1, is contagious and generally spreads from one person to the next by close physical contact, like kissing. But both HSV-1 and HSV-2 can be spread through sexual activity, as well.

Although less common, HSV-1 can be the cause of genital herpes and HSV-2 can be the cause oral herpes. Oral herpes can also be spread through shared towels, eating utensils, straws, razors, etc.

Like other viruses, such as the common cold, there is no cure for herpes. However, medications can help treat the symptoms.

Symptoms of Oral Herpes

Oral herpes is most often asymptomatic, meaning you don’t exhibit any signs that you (or anyone else) carry the virus. That said, the symptoms, when present, are pretty obvious. The most common tell-tale symptom of HSV-1 is a cold sore.

Before a cold sore — also known as a  fever blister — shows up, you may experience tingling, itching, pain or burning around the mouth.

This is known as a “prodrome” and is essentially a warning period that symptoms are imminent. Not everyone will experience a prodrome before a cold sore appears, but it is quite common.

The sores can appear on your lips, around your nostrils and inside your mouth. These lesions and sores can sometimes be confused with pimples, chapped lips, bug bites and other benign conditions.

The first incidence of HSV-1 symptoms is often the worst, though personal experiences vary. During this initial infection, you may also experience a fever, muscle aches, sore throat and swollen lymph nodes.

Once the cold sores go away — and they will — they may or may not make a reappearance, as the herpes virus is a life-long infection that can lie dormant for years. 

Symptoms/Triggers in an HSV-1 Recurrence 

The American Sexual Health Association estimates one-quarter of people with HSV-1 experience recurrences of their symptoms. These recurrences aren’t likely to be any more severe than the first bout of symptoms, and  they often decrease in frequency and severity over time.

Oral herpes symptoms may resurface without an obvious cause, but there are known triggers for cold sores. These possible triggers include: illness or fever, stress, fatigue, exposure to extreme weather conditions and changes in your immune function.

If you're trying to avoid an outbreak, the best way to do it is by taking care of yourself — eating a proper diet, getting proper rest, etc.

Causes of Oral Herpes 

Oral herpes can be spread by kissing or any other close physical contact. The World Health Organization calls HSV-1 “common and endemic” and says most infections of HSV-1 occur during childhood. They estimate as many as 3.7 billion people around the world have oral herpes, including 40-50 percent of people under age 50 in the U.S.

While it’s mostly transmitted from oral-to-oral contact, oral herpes can be transmitted from and to the genitals. Symptomatic people are more likely to spread the virus, but it can also be spread when the skin appears normal or without symptoms — this is called viral shedding.

In other words, just because someone doesn’t have herpes sores on their face or genitals doesn’t mean they can’t pass HSV-1 or HSV-2 onto you.

Oral Herpes Treatments 

Because there is no cure for herpes, treatments for HSV-1 are generally designed to address the symptoms of the virus — or the cold sores. Without treatment, the symptoms generally subside within one to two weeks.

However, you can get prescription antiviral medications to reduce pain and speed resolution. Drugs with the generic names acyclovir, valacyclovir, famciclovir and penciclovir work best if they’re taken when you first experience signs a cold sore is coming and before the blisters develop. 

For people with frequently recurring cold sores, the medications may be taken regularly as a preventative measure called “suppressive therapy.”

In addition to prescription antivirals, over the counter cold sore ointment may shorten healing time. Also, you can ease the pain and discomfort of the sore with lip balms or creams, pain relieving ointments and cool compresses.

Prevention of HSV-1 Oral Herpes 

It’s not always obvious that someone is infected with oral herpes. However, if your partner has a cold sore, it’s best to avoid close physical contact including kissing and oral sex, and even sharing straws, glasses and eating utensils.