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Oral Herpes

more about Oral Herpes

Cold sores

  • Oral Herpes refers to the infection of the mouth (floor and roof), lips, tongue, gums, cheeks, and back of the throat (pharynx) by the Herpes Simplex Virus (HSV).  The virus affects males and females equally, and is transmitted by contact with bodily secretions (saliva, urine, blood, stools, skin lesions, and eye discharge).
  • The Herpes family has two viruses: HSV-1 and HSV-2, both of which can cause diseases in humans of all ages, including newly born babies of infected mothers.  Both viruses can infect any area on the body, but generally the HSV-1 causes infections above the waste (fingers, lips, mouth, eyes), while HSV-2 causes infections in the lower regions (Vagina or penis) of the body.

  • Symptoms can occur anywhere from 2 days, to 2-3 weeks after exposure to the virus
  • 6-48 hours before sores appear on the lips there may be a tingling, itching, or burning at the site where lesions will appear.
  • There may be flu like symptoms -- Headaches, fatigue, poor appetite, fever, and swollen neck glands
  • The lesions are multiple tiny clear to yellow colored blisters or bumps packed tightly together, fixed upon on a red irritated base.
  • The blisters are not only uncomfortable, but are at times, itchy and extremely painful.
  • Blisters may form on any part of the lips and mouth (tongue, gums, cheeks)
  • After 24-48 hours, the blisters open, and a clear to yellowish liquid starts to leak out.  When this dries, it causes a thin scab to form over the lesions.
  • The crusted blisters heal after 8-10 days without scaring

  • HSV -- a DNA virus that infects the top layer of the skin (Epithelium) over the lips and the lining that covers the structures of the mouth.
  • HSV spreads via direct contact such as kissing someone when one has a cold sore or is developing one.
  • After the first infection, the virus hides inside the nerve ganglions (collection of nerves around the spine), stays there permanently, and causes recurrent infections
  • Recurrences that occur up to 4 times per year are often triggered by stress, such as illness, surgery, trauma, emotional or physical stress (athletes), poor diet, menstruation, fatigue, and sunburns.
  • Recurrent infections often occur in the same area as the site of the original infection.
  • The recurrences are most likely due to conditions that weaken the Immune system (body's defenses), which normally can keep the virus in check.
  • Patients with HSV can have the virus in their saliva (and other secretions) between attacks, and without any lesions or sores.  This means that they can spread the virus weeks before or after the sores appear.

  • Usually made based on the patients history coupled with a direct examination
  • If the doctor is not sure that the infection is due to HSV-1, the following tests can help:
    1. Tzanck smear -- if it is needed, the doctor can scrape the surface of the blisters and smear the collected material over a glass slide.  Afterwards, it is sent to a laboratory where it will be examined under a microscope and to see if virus colonies (intranuclear inclusions) are present.
    2. A sample of the blister fluids can be collected by rubbing a sterile cotton swab over the blisters.  The materials are then sent to the lab for viral culturing, where the virus is grown artificially, and is identified using special techniques.
    3. Blood samples from a vein can be analyzed for certain Proteins called antibodies that can determine the type (HSV-1 Vs HSV-2).  These are rarely done, and are not always reliable.

  • Weakened Immune system (Immune compromised) -- As in major stresses on the body (see causes) or with AIDS, cancers, and treatments with Chemotherapy (cancer killing drugs) or Radiation (cancer killing rays or medicines).
  • Previous HSV-1 or 2 infection
  • Being kissed by someone with a cold sore.  This can happen when a mother kisses their child, which can pass the infection to the child's eyes, mouth, and lips.  Obviously, kissing your honey is a risk factor as well.
  • Performing oral sex on someone with Genital Herpes  (vagina, anus, or penis).
  • A mother with Genital Herpes can pass it to a baby as he/she passes through the vagina.
  • A doctor or dentist with lesions on their fingers can pass it on to the patient's mouth, eyes, or genitals.
  • Diets high in amino acid Arginine (nuts) and Low in amino acid Lysine (cheeses, milk, and vegetables).

  • Good diet low in nuts and high in protein and vegetables and fruits.
  • Plenty of fluids, water, juices, and teas
  • Avoid caffeine and sodas.
  • Rest
  • Cold water compresses every 15 minutes can help to ease the pain
  • 2 Tylenol tablets for pain and fever
  • Avoid alcohol, tobacco, and illegal drugs because they can lower your resistance.
  • Medications are now available such as Denavir cream and in severe cases, pills such as Acyclovir (Zovirex) or Valtrex can be prescribed

  • Call your physician.  Avoid, kissing, sharing toothbrushes or utensils, especially with babies, elderly people, and others with major illnesses.  Avoid giving oral sex to others.  Do not touch the sore and then touch other parts.  Make sure you wash your hands often, which you should be doing anyway.

  • Other blistering or lesions of the skin or mouth:
    1. Impetigo -- An infection caused by bacteria
    2. Aphthous Ulcers -- Grayish-white shallow lesions in the mouth
    3. Herpangina -- Blisters over the tonsils, roof of the mouth, and back of the throat caused by a virus called Coxsackie
    4. Stevens Johnson syndrome -- This results from a bad reaction to a medication or drugs.

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