Herpes Simplex Virus type 1 (Oral Herpes)

Herpes Simplex Virus type 1 (Oral Herpes)

What is the herpes simplex virus (HSV-1) – cold sores and fever blisters?

Herpes, also known as the herpes simplex virus (or HSV) is an infection that can affect various portions of the body. Two primary areas of the body that HSV affects are the mouth and genitals. As such, an infection is usually broken down into two main types.

Two types of herpes simplex virus exist:

  • HSV-1: Oral herpes (also known as herpes labialis) usually causes very uncomfortable fever blisters or cold sores around the mouth.
  • HSV-2: Genital herpes infections usually cause blisters and sores on the male and female genital areas.

Defining oral herpes (HSV-1)

Herpes simplex virus type 1 (HSV-1) is more commonly referred to as ‘cold sores’ or fever blisters. These are groups of small sores or blisters which form around the lip areas on the mouth when a person becomes infected with the virus.

Blisters can also develop on other tender areas of the face including the cheeks, chin, roof of the mouth or on the gums, and even inside the nostrils.

These sores are often quite painful due to swelling and inflammation (redness), and can be very tender to the touch. When a blister forms and the surrounding skin becomes inflamed, burning and itching can also occur. If a blister breaks open, a clear fluid leaks out and then scabs over. Once a scab or crust forms, these blisters can take anywhere between a few days and up to four weeks to fully heal. Usually, these blisters do not leave a scar on the sensitive skin around the mouth.

Is HSV-1 contagious?

A result of a viral infection, cold sores are contagious and can be easily spread from person to person. Any close contact with an infected person, such as kissing or oral sex, can result in the spread of the HSV-1 virus. HSV-1 is still a contagious infection, even if blisters have not developed (i.e. aren’t visible on the face).

Although contagious, HSV-1 is not a life-threatening infection. There is, however, no cure and blisters can recur at any stage. The best means of treatment is antiviral medication which can help to clear sores and blisters quicker than their natural healing process and reduce the frequency at which they return.

Once the virus is contracted, it is highly likely that a person will be a carrier for the rest of their lives. The virus is easily transmitted from a variety of general every day interactions such as sharing lip products (lipstick or lip balm), sharing eating utensils and hygiene products (such as razors) or kissing. Infected parents can easily transmit the virus to their young children through every day interactions.

Transmission happens more quickly when an infected individual has an outbreak of blisters or sores. It is possible to carry the virus and never experience an outbreak. It is also possible to contract HSV-2 (genital herpes) from close contact with person infected with HSV-1 if you engage in oral sex at the time of a cold sores outbreak.

Couple enjoying some cake at a coffee shop.

The virus typically enters the body through a break in skin, either just around the mouth or inside. A person merely needs to touch a blister or cold sore or leaked fluid and then themselves – it’s that easy to contract. Contact with an infected person’s saliva is another very easy way to contract the virus. Once infected, it’s just as simple for the virus to affect other areas of the body, especially the genitals.

Once infected, the virus typically lays dormant in the body’s nerve cells, but can be triggered by any of the following and result in an outbreak of blisters:

  • Immune system changes
  • Hormonal changes (particularly during a woman’s menstrual period)
  • Stress
  • Fatigue
  • Fever
  • Or other viral infection, such as the common cold or flu

One person can have as many as two or three outbreaks in a year, while others can carry the virus for years and never experience one (dormant).

Signs and symptoms of herpes

woman with lips infected with herpes simplex virus (HSV-1)You may only ever really know that you are carrying the HSV-1 virus once cold sores appear. Other than painful, swollen blisters, what other symptoms can you experience?

  • Itching or tingling at the site of sores or blisters
  • Swelling of the lips
  • Pain or discomfort in the mouth or tongue
  • Fever (a high body temperature)
  • Headaches
  • Swollen lymph nodes or a sore throat
  • Fatigue / tiredness
  • Loss of / lack of appetite
  • Herpes keratitis (an infection that spreads to the eyes causing eye pain, a discharge or gritty sensation in the eye)
  • Eroded gums (this is generally quite painful)
  • Muscle aches
  • Lesions on the inside of the mouth (common in children under the age of 5)
  • Dehydration
  • Nausea

Symptoms may also develop other infections, such as:

  • Gingivostomatitis, pronounced jĭn'jə-vō-stō'mə-tī'tĭs (an infection of the mouth and gums)
  • Pharyngo-tonsillitis (an infection of the throat and tonsils)

Cold sores generally clear up on their own, but if you find that you experience frequent outbreaks or have noted the following, you can seek advice from your doctor:

  • If you notice that you have a weak immune system
  • Your cold sores don’t appear to heal within 2 weeks
  • Your overall symptoms are severe
  • Your eyes become sore and irritated

In most instances, the dominant symptom or sign of discomfort will be the appearance of painful, swollen blisters, which recur from time to time. The first outbreak may be the most severe too. Symptoms are generally more severe in young children who are still growing and building up antibodies in their system as a means of defence against infections. Recurring outbreaks usually occur in the same spots on the body each time and aren’t as severe or painful with each occasion.

What are the different stages of an HSV-1 outbreak?

When cold sores develop, they typically occur in three stages:

  • Tingling and itching sensations: You may notice sensitivity around the mouth or feel sensations such as itching, tingling and even burning as skin begins to become inflamed.
  • Blisters: The fluid-filled blisters then develop within a day or two, most often around the edges of the lower lip. Lymph nodes or glands in the neck may also begin to swell and become enlarged. Blisters can also break out on the cheeks or around the nose (nostrils). Once sores develop, you will feel sensations of pain as well as tenderness and itching or burning.
  • Blister leakage and crusting: Once a group of blisters form, they soon break open and begin oozing the fluid inside. Sometimes the group of blisters that surface on the skin merge together and then burst open. Once they have split, a yellow scab or crust forms over the inflamed area, covering the inflamed pink / red skin underneath. The crust then heals within a week or two and disappears without leaving a scar.

Diagnosing herpes

Generally, a doctor will make a diagnosis just by looking at you during a physical exam. Your doctor will initially sit you down and discuss your symptoms with you. He or she will then request a physical exam and examine the sores wherever they occur on your body. If you notice any sores on your genitals, it’s important that you admit so to your doctor. It will be uncomfortable during your consultation, but your doctor will handle this with utmost professionalism and care.

Your doctor may ask you a series of questions during the discussion. This is to start narrowing down potential reasons for feeling unwell. If he or she strongly suspects the HSV virus, you may be asked if you have potentially been exposed to someone with an active infection (i.e. Have you been around anyone recently who has sores or blisters around their mouth or nose?)

You may also be asked if you have had similar symptoms before, or whether you have a history of problematic skin and inflammatory breakouts (such as sores, blisters or even a rash). Other questions can include:

  • Have you noticed anything specific that may have triggered your overall symptoms?
  • If you’ve experienced cold sores and applied treatment, what did you use and was it effective?
  • Are you currently going through any stressful situations in your personal life or at work or school?
  • Do you regularly interact with babies and young children who experience illnesses?
  • If you’re a woman, is there a possibility or are you pregnant?

If you are taking any medications or supplements, your doctor will wish to note these as well.

Tests for HSV

If your doctor feels it necessary, he or she may recommend a blood test to look for signs of the HSV-1 and HSV-2 viruses in your system. Your doctor may also suggest a herpes viral culture or lesion test. For this he or she will swab or scrape one of your fluid-filled blisters or sores (usually this is best done at the peak of your outbreak) and send to the laboratory for testing. Once at the laboratory, the sample is placed in a dish and observed for a minimum of 16 hours or up to 7 days. This is to monitor the growth of a virus, once the type of virus is confirmed. Your doctor should likely be in-the-know about your sample within a period of two to four days.

Tests may only really be recommended if there are any signs that a potential infection poses a significant health risk. The virus can, for instance, be quite serious for children and adults with impaired or compromised immune systems. Any type of virus in the body can become, in severe instances, life-threatening for anyone with a weakened or compromised immune system. A correct and accurate diagnosis can ensure that appropriate treatment is implemented timeously.

If your symptoms include any problems or concerns with one or both eyes, tests may be ordered as well. If you are pregnant, your doctor will automatically recommend tests as any viral presence in the body can lead to serious complications for an unborn baby.
Both tests can confirm the presence of infection and help to make a diagnosis. A blood test may be preferred if you do not have any blisters but display other associated symptoms that your doctor may want to check for or rule out in the diagnosis process.

The final results of a herpes viral culture of lesion test depends on whether or not the virus displayed any growth during observation in the laboratory. Results will be classified as negative if the virus did not grow during the period of observation / testing. For your doctor, this will indicate that you do not have an active herpes infection. A negative result does not necessarily mean that you do not have a herpes infection, however. Signs of growth during observation indicates a positive result and that the blisters or sores are infected (active) with the virus.

Chances are tests may not be necessary and your doctor will physically assess you and then recommend the best ways to care for your symptoms and the outbreak of sores. If you’re familiar with cold sores and blisters, you yourself will be able to recognise a recurrence when it happens. If mild enough, you may not even need to consult your doctor.

If you note any other unusual symptoms or physical irritations, as well as if your sores and overall symptoms do not resolve on their own within a week or two, consult your doctor to be on the safe side. Your doctor can then step in and assist with more effective measure to treat your symptoms.

Treating herpes

Woman lubricates cold sores with herpes ointment.Treatment is essentially a way to alleviate discomfort or pain and help to reduce the healing time, and potentially limit the amount of recurring outbreaks in the future. Once a person is infected with HSV, there is no available means to cure this virus.

The nature of an outbreak is not debilitating and generally, blisters and sores resolve and heal on their own within a matter of days, and if severe, up to several weeks. Your doctor will, however, recommend medications to help clear an outbreak which also helps reduce the risk of spreading the virus to others while active in your body.

Medications are also helpful in reducing the frequency of future outbreaks and their severity too.

Your doctor may prescribe medications in oral form (pills) or applied lotions and creams. Your doctor will likely recommend a cream that contains either acyclovir or penciclovir to treat an infection. These are best applied at the beginning stages of an outbreak, before a blister surfaces on the skin. These creams usually require application up to 5 times a day for at least 4 to 5 days. If the outbreak is severe, your doctor will consider administering antiviral medications via injection to help alleviate symptoms. He or she may also recommend painkillers containing paracetamol in either pill or liquid form to provide relief.

Your doctor may also recommend the following treatment to ease discomfort while you heal:

  • Apply a cool compress or cool damp cloth on the affected areas to help reduce redness and inflammation. This also helps to promote healing once the blisters have crusted over.
  • Apply over-the-counter old sore ointments, as well as pain-relieving creams with lidocaine or benzocaine. These can be applied frequently for relief and also shorten the outbreak considerably. Some over-the-counter lotions may also contain drying agents, such as alcohol which can help speed up the healing process as well. These may not speed up the healing process necessarily, but certainly provide some relief from the discomfort (pain, itching and dryness) of an outbreak. If your doctor doesn’t recommend anything specific, chat to your pharmacist for assistance in choosing one that will help. All creams should be dabbed onto blisters or sores and not rubbed on the affected areas. Your doctor will also advise that you wash your hands each time you apply or touch an infected area (to curb the spread of infection). You will also be advised not to share any ointments with anyone else for the same reason.
  • Use a lip balm or cream with zinc oxide which offers sun protection (sunlight exposure can trigger outbreaks), and keeps your lips moist. For added moisture, if your lips become particularly dry, you can also apply a good moisturising cream.

For those who have compromised or weakened immune systems, treatment will focus on reducing the risk of spreading to other parts of the body. Those who are most at risk are individuals with HIV / AIDS or perhaps being treated with chemotherapy for instance. Infection spreading can result in further physical complications such as in the eye/s, and the brain. Inflammation in these areas can become serious for those with compromised immune systems especially.

To prevent this, doctors will prescribe antiviral medications, and possibly recommend seeing a specialist if symptoms are severe or at high-risk of further complications. Overall treatment will depend on the nature of symptom severity and general medical condition.

Home remedies may include taking zinc, vitamin E and C supplements, or the amino acid L-Lysine (in their tablet or cream form) to prevent and treat cold sores.

Who is most at risk of herpes?

The honest truth is, we are all at risk, young and old. Any one of us can be exposed to the HSV virus. It is estimated that up to 90% of adults, worldwide, have been exposed to and carry the HSV virus, even if symptoms have not been experienced.

Risk increases for those who have compromised immune systems or certain existing conditions. The reason for this is that risk of further medical conditions increases with an active infection.

Risk factors include:

  • Chemotherapy (for the treatment of cancer)
  • Eczema
  • Severe burns
  • Anti-rejection medications (for those who have undergone organ transplants)

What types of complications or side-effects are common?

Those with weakened immune systems are generally at most risk for the various types of complications, affecting the following areas of the body:

  • The eyes: Eye infections (known as kerato-conjunctivitis) can happen and if experienced frequently can cause vision problems, such as blindness and scarring if the infection affects the cornea. Sores and blisters on the eyelids can also cause considerable swelling and discomfort.
  • The fingertips: Herpes whitlow (or herpetic whitlow) is an infection of the fingertips which often occurs in children who suck their thumbs. An infection can easily then be spread from the mouth to the thumbs. Cold sores can spread to any area of the hands, resulting in an outbreak of blisters and sores on the fingers, especially if there is a cut or graze on the skin at the time.
  • The skin (widespread): If you are prone to skin condition such as eczema, the development of blisters and cold sores can easily be spread to other portions of the body. In severe instances this can become a medical emergency.
  • Organs: The most notable concerns are when an infection spreads to the spinal cord or brain, resulting in conditions such as encephalitis, and causes swelling in these areas of the bodies. Swelling increases the risk of brain damage and can be extremely life-threatening.
  • Dehydration: If pain in the mouth and throat is so severe, you may be reluctant to drink fluids during an outbreak. Care should be taken not to dehydrate. Rather see your doctor for diagnosis and treatment recommendations to help alleviate symptoms.

Can herpes be prevented?

If it can’t be cured, is it possible to prevent herpes outbreaks? When it comes to prevention, outbreaks may not be entirely avoidable, but there are measures you can take to reduce recurrences and spreading of the virus. These include:

  • Practicing good hygiene habits, especially when an infection is active. Wash your hands frequently with soap and water.
  • Avoid sharing objects that increase transmission risks such as lip balms or lipsticks, towels, clothing, razors, toothbrushes, cutlery and crockery.
  • Avoid skin contact where possible, such as kissing or any form of sexual contact, especially when an infection is active and blisters or sores are present.
  • Avoid touching other areas of the body when an infection is active, especially the genitals and eyes.
  • Take care to avoid possible outbreak triggers such as other infections, like the common cold or flu, and stress.
  • Use lip balms and sunscreen frequently to reduce the risk of outbreak flares.

An infection essentially remains in the body for life, even if no symptoms ever manifest. Outbreaks vary from person to person. Some experience many outbreaks, and others hardly ever during their lifetime. Medical professionals tend to agree that recurrent infections are typically less intense than an initial experience (primary) or once a growing child develop antibodies. A generally healthy person does not develop further health complications with this virus.

Woman using sunscreen for sun protection.

How can you tell the difference between herpes and psoriasis?

What is psoriasis?

Also a condition that manifests symptoms in the skin, psoriasis is an inherited autoimmune disease that can range from mild to severe. The condition typically causes cell production in the skin to significantly speed up and accumulate on the surface. This causes skin thickening and as a result, considerable irritation and discomfort.

The most common areas this condition affects include the face, elbows, knees, back, scalp, palms of the hands and soles of the feet. Psoriasis can also affect the genital area.

The main symptoms of this condition include:

  • Dry and cracked skin (surface)
  • Patches of red skin (sometimes accompanied by silver scales)
  • Inflammation – itching or burning sensations on the affected areas of skin
  • Swollen or stiff joints
  • Pitted (thick) nails

Unlike herpes, psoriasis is not a contagious skin condition and cannot be transmitted from one person to another through contact.

Man pointing to Psoriasis skin irritation on elbow.

How to tell the difference

  • Psoriasis: Affected skin areas appear smooth and flat, sometimes with scales. Irritation is also experienced in areas of the body such as the elbows and knees.
  • Herpes: Affected areas manifest symptoms of blisters and sores, sometimes ulcers, accompanied by other symptoms such as fever and fatigue.

Any skin irritation that develops, especially when it doesn’t resolve on its own in a short period of time should be thoroughly checked by a medical professional for proper diagnosis and treatment. If you are unsure, see your doctor (general practitioner / GP or dermatologist).

What is birth-acquired herpes?

Birth-acquired herpes (or congenital herpes) is an infection that affects an unborn baby during pregnancy. The infection can also occur during birth, especially if a mother is infected with the HSV-2 virus (genital herpes).

When an infant is born with an infection, they typically display what is known as systemic herpes (a system-wide infection of the skin). This is regarded as severe and can cause a variety of very serious health concerns for a new-born. Complications which can easily arise as a result include problems with breathing, damage to the brain (such as inflammation) and seizures. The entire body can become infected with herpes.

Organs such as the lungs, liver and kidneys are also at risk of serious complications. This is known as disseminated herpes.

Birth-acquired herpes is effectively passed from mother to child, more often during a vaginal birth. A virus can be dormant in a mother and become active at any time. If active at the time of birth and a baby comes into contact with genital herpes blisters during delivery, a baby will become infected. The chances of passing on an infection during delivery when the virus is dormant is slim, but not impossible either.

A mother can also pass on HSV-1 through direct contact between a baby and an active outbreak of blisters or sores. A new mother with an active outbreak should take care not to kiss or place the baby at risk of direct contact while sores and blisters occur.

Herpes in babies with birth-acquired herpes may show up as clusters of fluid-filled blisters, mainly on the torso and around the eyes. A baby may also have symptoms of extreme fatigue and feeding problems.

Doctors may perform various tests to check the nature of infection and whether various areas of the body, such as the brain and organs are at high-risk of further health complications. Tests can include blood and urine samples and even an MRI scan.

Treatment will involve managing symptoms with IV (intravenous) administered antiviral medications and general hygiene and inflammation care. If other complications are present, associated symptoms and concerns will be appropriately treated as well.

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