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Alternative Names Return to topCold sore; Fever blister; Herpes simplex - oral; Oral herpes simplex
Definition Return to top
Herpes labialis is an infection caused by the herpes simplex virus. It leads to the development of small and usually painful blisters on the skin of the lips, mouth, gums, or lip area. These blisters are commonly called cold sores or fever blisters.
Causes Return to top
Herpes labialis is a common disease caused by infection of the mouth area with herpes simplex virus type 1. Most people in the United States are infected with the type 1 virus by the age of 20
The initial infection may cause no symptoms or mouth ulcers. The virus remains in the nerve tissue of the face. In some people, the virus reactivates and produces recurrent cold sores that are usually in the same area, but are not serious. Herpes virus type 2 usually causes genital herpes and infection of babies at birth (to infected mothers), but may also cause herpes labialis.
Herpes viruses are contagious. Contact may occur directly, or through contact with infected razors, towels, dishes, and other shared articles. Occasionally, oral-to-genital contact may spread oral herpes to the genitals (and vice versa). For this reason, people with active herpes lesions on or around the mouths or on the genitals should avoid oral sex.
The first symptoms usually appear within 1 or 2 weeks -- and as late as 3 weeks -- after contact with an infected person. The lesions of herpes labialis usually last for 7 to 10 days, then begin to resolve. The virus may become latent, residing in the nerve cells, with recurrence at or near the original site.
Recurrence is usually milder. It may be triggered by menstruation, sun exposure, illness with fever, stress, or other unknown causes.
Symptoms Return to top
Warning symptoms of itching, burning, increased sensitivity, or tingling sensation may occur about 2 days before lesions appear.
Exams and Tests Return to top
Diagnosis is made on the basis of the appearance or culture of the lesion. Examination may also show enlargement of lymph nodes in the neck or groin.
Viral culture or Tzanck test of the skin lesion may reveal the herpes simplex virus.
Treatment Return to top
Untreated, the symptoms will generally go away in 1 to 2 weeks. Antiviral medications taken by mouth may shorten the course of the symptoms and decrease pain.
Herpes sores often come back again and again. The antiviral medicines work best if you take them when the virus is just starting to come back -- before you see any sores. If the virus returns frequently, your doctor may recommend that you take the medicines all the time.
Wash blisters gently with soap and water to reduce the spread of the virus to other areas of skin. An antiseptic soap may be recommended. Applying ice or warmth to the area may reduce pain.
Outlook (Prognosis) Return to top
Herpes labialis usually disappears spontaneously in 1 to 2 weeks. It may recur. Infection may be severe and dangerous if it occurs in or near the eye, or if it happens in immunosuppressed people.
Possible Complications Return to top
Herpes infection of the eye is a leading cause of blindness in the US, causing scarring of the cornea.
When to Contact a Medical Professional Return to top
Call for an appointment with your health care provider if symptoms indicate herpes labialis and symptoms persist for more than 1 or 2 weeks.
Call if symptoms are severe, or if you have a disorder associated with immunosuppression and you develop herpes symptoms.
Prevention Return to top
Avoid direct contact with cold sores or other herpes lesions. Minimize the risk of indirect spread by thoroughly washing items in hot (preferably boiling) water before re-use. Do not share items with an infected person, especially when herpes lesions are active. Avoid precipitating causes (especially sun exposure) if prone to oral herpes.
Avoid performing oral sex when you have active herpes lesions on or near your mouth and avoid passive oral sex with someone who has active oral or genital herpes lesions. Condoms can help reduce, but do not entirely eliminate, the risk of transmission via oral or genital sex with an infected person.
Unfortunately, both oral and genital herpes viruses can sometimes be transmitted even when the person does not have active lesions.
References Return to top
Gonsalves WC. Common oral lesions: Part I. Superficial mucosal lesions. Am Fam Physician. Feb 2007; 75(4): 501-7.
Fatahzadeh M. Human herpes simplex virus infections: epidemiology, pathogenesis, symptomatology, diagnosis, and management. J Am Acad Dermatol. Nov. 2007; 57(5): 737-63.Update Date: 5/21/2008 Updated by: D. Scott Smith, M.D., MSc, DTM&H, Chief of Infectious Disease & Geographic Medicine, Kaiser Redwood City, CA & Adjunct Assistant Professor, Stanford University. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.