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Oral Herpes: Symptoms, Causes And Prevention

Oral herpes
Medically reviewed by Dr. Fizza Imtiaz


A cold sore on your lip or tongue can make you panic. Herpes infection can be more than an annoyance. Two types of the herpes virus can affect various areas of your body. Although the condition is lifelong, symptoms of an outbreak can be dealt with if you have the correct information at your fingertips. The following article provides the right information about oral herpes, which will equip you on how best to manage oral herpes.

What is Herpes?

Herpes simplex virus causes skin infections. The infection results in painful or itchy sores and blisters that appear and resolve with time, and sores can recur. Herpes simplex virus usually doesn’t cause severe health problems, but it can be dangerous to infants and people with weakened immunity.

There are two types of herpes simplex:

  • Herpes simplex 1: HSV-1, more widely known as oral herpes, usually affects your mouth or face. It causes cold sores. The herpes sores appear on the tongue, and HSV-1 is transmitted through contact with saliva.
  • Herpes simplex 2: HSV-2, also called genital herpes, is a sexually transmitted disease. It leads to genital sores.

Additionally, a herpes infection can affect other parts of your body, including your eyes or other regions of your skin.

Difference Between HSV-1 and HSV-2

HSV-1 spreads through contact with the saliva or skin of an infected person. It usually affects your face or your mouth. HSV-2 spreads through sexual contact and affects your genital or anal region. Either form of HSV can lead to an infection on the area of skin that comes into contact with the virus.

Mode of Transmission of Oral Herpes

Herpes virus commonly resides on the skin or is presented in saliva. Hence close contact with a person who has the infection results in a condition. The transmission of the virus is more likely if the person has an outbreak or presence of sores. Although, you can infect someone else even if you have no symptoms. This is known as asymptomatic viral shedding.

HSV-1 can be passed on by: 

  • Kissing
  • Coming in contact with a person’s skin near the mouth, especially if he has symptoms of herpes on lips
  • Sharing food utensils, lip balm or razors
  • Receiving oral intercourse from someone with a cold sore may spread a herpes infection to your genitals

Risk Factors for Contracting Herpes Simplex

Herpes can infect anyone. However, the following are some risk factors that make you more prone to developing herpes:

  • If you have multiple sex partners
  • Becoming sexually active at a young age
  • Having a prior sexually transmitted disease (STD)
  • If you are assigned female at birth
  • If you have a weakened immune system
  • Not practising safe sex by not using protection such as condoms or dental dams during intercourse

Most people contract HSV-1, which usually causes cold sores during childhood. It spreads when an adult has the virus or cold sore on the tongue or lips and has close contact with a child. For example, one way of transmission is by kissing a child. Both types of HSV can infect both the mouth and the genitals. Once an individual is infected, they will have the herpes simplex virus for the rest of their life. Even though the virus is not active, it resides in a group of nerve cells. This is primarily why an outbreak can occur at any time. However, the are many people who do not experience any symptoms. 

Common Triggers That Cause an Outbreak

It is still unclear what triggers the virus to return, but the following factors may play a role:

  • Exposure to sunlight
  • Physical injury
  • Emotional stress
  • Fever
  • Menstruation
  • Surgery
Talk with a doctor to get a prescription and a lab test for herpes

Do you get Oral Herpes on the Tongue?

Most adults in the United States are believed to have oral herpes. Herpes-type 1 does not only cause cold sores on your lips. It is possible to develop symptoms of herpes simplex on your tongue. Cold sores can form on the tongue and indicate early-stage herpes on the tongue. However, before converting into sores, herpes bumps on the tongue can develop, indicating mild herpes on the tongue. Herpes outbreak on the tongue is also known as oral herpes or herpes in the mouth, and it can affect your lips, tip of the tongue, nose, gums, cheeks, throat, roof of the mouth, chin, or neck.

Symptoms of Oral Herpes

Herpes symptoms in the mouth usually start about 2-12 days after getting the infection and can last 7-10 days. Oral herpes symptoms include: 

  • Pain, burning, tingling, itching at the site.
  • Blisters initially appear as small, shallow ulcers on a red base and then soon become dry and crusted, appearing yellow. You can also develop herpes blisters on the tongue or herpes under the tongue.
  • Sores can appear on the lips, nose, tip of the tongue, under the tongue, gums, cheeks, throat, roof of the mouth, chin, or neck.
  • Swollen and red gums or bleeding from the gums.
  • Swollen and painful neck lymph nodes.
  • A sore throat with ulcers. A greyish coating on the tonsils can develop.

Prevalence of Herpes

Herpes simplex is a prevalent infection around the world. Studies have revealed that about 2 in 3 people worldwide contract HSV-1 by 50. About 15% of 15- to 49-year-olds contract HSV-2.

Diagnosis of Oral Herpes

Your doctor may diagnose herpes simplex by looking at the sores. Your physician may take a sample from the sore as well. This is known as the viral culture and is done to confirm or rule out the herpes virus. A blood test can be ordered to check for HSV-1 and HSV-2 antibodies if you don’t have any sores. The results can help determine if you’ve been exposed to the virus. The blood test doesn’t show active infection, but it can show if you’ve previously been exposed to the herpes virus. If you have just been exposed, you may not test positive for herpes. This is mainly because there hasn’t been enough time for your body to develop antibodies post-exposure. Therefore, the antibody test may be repeated in 8 to 12 weeks.

How Long do Sores from Herpes Simplex Last?

If you’re infected with oral Herpes or Herpes inside the mouth, you may experience tingling or burning around your mouth a few days before an actual cold sore appears. These blisters break open and ooze fluid before forming a crust. Usually, sores last for 7 to 10 days. Similarly, oral herpes on the tongue or oral herpes throat can initially present as burning and itching on the tongue or in the throat. 

Treatment of Oral Herpes

Avoidance of known triggers such as stress can help reduce herpes outbreaks. Unfortunately, once you have the herpes simplex virus, you have it for a lifetime as there is no cure. However, some treatment options that help ease symptoms during an outbreak of oral herpes include:

Antiviral drugs may be used as pills or creams or intravenously. Some options for oral medications include: 

  • Acyclovir (Xerese, Zovirax)
  • Valacyclovir (Valtrex)
  • Famciclovir (Famvir)

Over-the-counter creams include:

  •  L-lysine, benzocaine (Orajel) 
  •  Docosanol (Abreva)

These can help manage herpes symptoms.

Pain management includes:

Home remedies to manage symptoms include:

  • Application of zinc oxide cream or lip balm.
  • Applying cool compresses or ice packs to reduce redness and irritation.
  • Drinking plenty of fluids.
  • Take lysine supplements in the form of a pill or a cream.
  • Applying rhubarb-sage cream for managing pain. 
  • Apply sunscreen to avoid sun exposure to avoid the trigger.  
  • Use aloe vera gel. It can help heal a cold sore.
  • Propolis is commonly used in formulations such as ointment to treat cold sores.
Talk with a doctor to get a prescription and a lab test for herpes

Prevention of Oral Herpes

You can reduce your risk of contracting herpes by avoiding physical contact with someone who has a cold sore. People can still spread HSV-1 when cold sores aren’t present, but it’s less likely. 

For herpes prevention, you should avoid:

  • Kissing
  • Oral sex
  • Contact with the skin near their mouth
  • Sharing utensils, lip balms or other personal care products

Potential Complications of Herpes

Once you get HSV, the virus resides in your nerve cells forever. It mostly remains inactive, but it can reactivate periodically, resulting in symptoms.

Many people living with HSV can remain asymptomatic, while others experience symptoms every few months. This is known as an outbreak. Usually, you may experience more episodes or outbreaks, but eventually, the severity and frequency decrease over time. Symptoms typically improve over time, and the infection is not considered life-threatening in healthy individuals. However, the virus may cause complications for certain groups, including:

  • newborns
  • immunocompromised individuals such as those with chronic health conditions, namely HIV and cancer

Some complications include:

Herpes Keratitis

You can get herpes keratitis, herpes in the eyes if you touch a herpetic sore and then touch your eye with the same hand.

Symptoms of herpes keratitis include:

  • redness and pain in the eye
  • discharge or watering eyes
  • sensitivity to light
  • blurred vision
  • a gritty sensation in the eye

Untreated herpes keratitis can lead to corneal scarring and, ultimately, vision loss. Therefore, if you’re diagnosed with HSV and notice such symptoms, contacting a doctor as soon as possible is necessary to prevent herpes complications.

Herpes esophagitis

The esophagus is known as the food pipe, carrying food and liquids from your mouth to the stomach. Herpes esophagitis is an infection of this pipe caused by the herpes simplex virus. Herpes-type 1 most commonly causes herpes esophagitis. Although, type 1 and type 2 can result in this. 

Herpes esophagitis is uncommon in healthy individuals. However, individuals with a weak immune system, particularly those with cancer, HIV, or AIDS, are at an increased risk.

Herpes esophagitis leads to:

  • inflammation of the oesophagus
  • damage to the lining of the oesophagus
  • painful or difficult swallowing
  • chest pain
  • throat pain

Your doctor will monitor you if you develop such a condition. 

Conditions That are Mistaken for Oral Herpes

There are several things mistaken for herpes, some of which include:

Contact Dermatitis vs Herpes

Contact dermatitis is a skin condition that can result in a red, itchy, dry, or scaly rash. Blisters can also appear. Like herpes, it can recur, but the rash can occur anywhere on the skin and usually resolves once direct contact with an irritant is removed. 

Herpes vs Canker Sores

Herpes sores are highly contagious. The sores present as fluid-filled blisters. Canker sores are painful and they appear inside the mouth and can be caused by various factors. The sores appear as flat sores or ulcers.

When to Consult a Doctor

If you are worried about a cold sore on your lip or have symptoms of a herpes outbreak connect with our online doctor at Your Doctors Online. You can get a prescription instantly.

Do you have a cold sore? Chat with a doctor to get a prescription and a lab test for herpes

FAQs About Oral Herpes Answered by Your Doctors Online Team

Can you get herpes on your tongue?

Yes, you can get herpes on your tongue. HSV-1 can cause sores on the lips, nose, tip of the tongue, under the tongue, gums, cheeks, throat, the roof of the mouth, chin, or neck.

What does herpes look like on your tongue?

Initially, you may notice redness, swelling, itchiness, bumps on your tongue or pain in a specific region. The sore will appear at this site. Next, a white mark can appear on the tongue and develop into yellowish ulcers.

How to get rid of herpes on the tongue?

Sores can sometimes resolve on their own. In case of frequent outbreaks, antiviral treatments such as a pill, topical cream, or ointment are prescribed by a doctor. Some common antivirals include:

What does a herpes sore look like?

Herpetic sores look like blisters which initially appear as small, shallow ulcers on a red base and then soon become dry and crusted, appearing yellow. You can also develop herpes blisters on the tongue or herpes under the tongue.

What causes an HSV mouth infection?

HSV infection can be passed by kissing, sharing infected objects such as lip balm or utensils or touching the infected person’s skin. 

How is an HSV mouth infection diagnosed?

Some tests to diagnose herpes include virus culture (PCR), blood test or biopsy.

What is the best prescription for cold sores?

Treatment options include over-the-counter creams, benzocaine (Orajel), and docosanol (Abreva). Some oral antiviral pills include famciclovir or valacyclovir.

What can I do to prevent an HSV mouth infection?

Some measures that may help prevent oral herpes include:
Avoid direct contact with someone who has herpes sores. 
Don’t share glasses, straws, or other items with someone who has HSV-1.
Wash towels and bedding in boiling water after each use.
Don’t have oral sex if you or your partner is diagnosed with oral herpes.

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