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What is herpes?
Herpes is a common and usually mild recurrent skin condition; most infections are unrecognized and undiagnosed. Herpes is caused by a virus: the herpes simplex virus (HSV). HSV is in a family of viruses called herpesviruses. This family includes Epstein-Barr virus (the cause of mono) and the varicella zoster virus (the cause of chicken pox and shingles). Although there are several viruses in the herpesvirus family, each is a separate virus and different from one another. Having one virus does not mean you will have another.
There are two types of herpes simplex: herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2). HSV can cause oral herpes (sometimes called cold sores or fever blisters) on the mouth or facial area as well as genital herpes. The majority of oral herpes cases are caused by HSV-1 and the majority of genital herpes cases are caused by HSV-2; however, type-1 or type-2 can occur in either the genital or oral area.
How common is oral herpes?
About 50 percent to 80 percent of the adult population in the United States has oral herpes, with as many as 90% having the virus by age 50. Most people contract oral herpes when they are children by receiving a kiss from a friend or relative.
How does a person get oral herpes?
Oral herpes is transmitted through direct contact between the contagious area and broken skin (a cut or break) and mucous membrane tissue (such as the mouth or genitals). Herpes can also be transmitted when there are no symptoms present. There are several days throughout the year when the virus reactivates yet causes no symptoms (called asymptomatic shedding, viral shedding, or asymptomatic reactivation).
If a person is experiencing symptoms orally, we recommend abstaining from performing oral sex and kissing others directly on the mouth until signs have healed and the skin looks normal again. Because most adults have oral herpes, we do not advise that a person stop giving or receiving affection altogether between outbreaks (when there are no signs or symptoms) simply because they have oral herpes. However, using a barrier (such as a dental dam) or condom when performing oral sex (even though there are no symptoms present around the mouth) can reduce the risk of contracting genital herpes.
By performing oral sex on someone who has genital herpes, it would be possible to contract oral herpes - but this is rare. Most cases of genital herpes are caused by HSV-2, which rarely affects the mouth or face. Also, and even more importantly, most adults already have oral HSV-1, contracted as a child through kissing relatives or friends.
What happens when herpes enters the body?
One thing that distinguishes viruses in the herpesvirus family from other types of viruses is something called latency. Herpes simplex and other herpesviruses have a way of creating a small but permanent colony of viral particles inside the body. This colony is often completely inactive – “asleep” – but it persists for a lifetime.
Here's how it works: once HSV gains a foothold, the virus begins making copies of itself and spreading. This can lead to a range of signs and symptoms, everything from subtle symptoms that go unrecognized to severe illness. In response, the immune system mobilizes its forces for an assault and limits HSV's spread.
Whether there are severe symptoms or not, virus will persist in the body. To avoid the immune system, HSV will retreat along the nerve pathways, finding safe sanctuary in a nerve root called a “ganglion.” In cases of genital herpes, HSV retreats to the sacral ganglion:hyperlink , located at the base of the spine. In “oral” or facial herpes (cold sores), HSV finds its way to the trigeminal ganglion:hyperlin k, at the top of the spine. In the ganglion, the virus remains inactive (“latent”) for an indefinite period of time.
The phenomenon of latency is similar to a sleep cycle. In essence, the virus returns to a safe haven and sleeps, sometimes for long periods. Unfortunately, while HSV is latent, various biological events can cause it to become active and begin traveling the nerve pathways back to the skin. There it can cause signs and symptoms again, though it doesn't always do this.
How often the virus “wakes up” is a complicated question. It used to be thought that all of the HSV's “waking times” were marked by outbreaks— an irregularity in the skin (defined as a “lesion”) such as a pimple, for example, or else some kind of symptom like an itch. Then researchers learned that the virus could wake and become active without causing noticeable signs or symptoms: no itch, no pain, no pimples, no blisters. This phenomenon has been called a number of things, including “asymptomatic shedding,” “asymptomatic reactivation,” and “subclinical shedding.”
Asymptomatic shedding applies to the following situations: 1) some lesions are overlooked because they occur in places we simply never look or can't see; 2) some are mistaken for something else—an ingrown hair, for example; and 3) some can't be seen at all with the naked eye.
The point is that when herpes “wakes” and travels to the surface of the skin or mucous membranes, it is often subtle and hard to recognize, even for a health care provider, and sometimes impossible to spot. Also, even if you're a person with recurring signs and symptoms that you can usually recognize as herpes, there are almost certainly days when you won't be aware that the virus has reactivated and traveled to the skin or mucous membranes.
Signs and symptoms
Oral herpes is commonly referred to as “cold sores” and “fever blisters.” While symptoms of oral herpes most commonly appear on or around the lips, oral herpes is not always limited to this area. For some, symptoms may appear between the upper lip, on or inside the nose, or on the chin or cheek. In these instances, herpes is referred to as oral-facial herpes.
Oral HSV-1 is especially common, with many people acquiring it during early childhood or adolescence. You have most likely seen someone experiencing an oral herpes outbreak before.
First episode
A primary infection with oral herpes can be similar to a first episode of genital herpes in that pronounced symptoms occur. During the first episode, classic lesions tend to form as small fluid-filled blisters that can appear as a single blister or in a cluster. Sores may also appear inside the mouth or on the back of the throat, and the lymph nodes in the neck may swell.
Much like genital herpes, however, symptoms of oral herpes can be very mild and go unnoticed. Subtle symptoms can be easily mistaken for another infection or condition such as a small crack or cut in the skin, chapped lips, bug bite, or a pimple, to name a few examples.
Recurrences
At least a quarter of people with oral herpes experience recurrences. Again, as with the first episode, symptoms vary from person to person. Lesions may appear as either a blister or a cluster of blisters or sores. It is possible that a recurrence will involve only the subtle symptoms described above.
Signs and symptoms of a recurrent episode (when they occur) tend to last about 8 – 10 days on average. Blister- or sore-like lesions will usually crust over during the healing phase. If the first episode produced fairly mild symptoms, then subsequent recurrences also tend to be mild. The frequency of recurrences varies from person to person and tends to decrease over time. Exposure to sunlight's ultraviolet rays may trigger a recurrence.
Prodrome
Many people will experience a “prodrome” or warning symptom prior to developing an outbreak. As you may recall from the section on genital herpes, a “prodrome” is an itching, tingling, or painful sensation in the area where their recurrent lesions will develop. The prodrome often precedes lesions by a day or two. During this time, it is best to assume virus is active (and, therefore, can be spread through close contact).
Treatment
Click here for information on treating oral herpes.>>
For more information
Call our National Herpes Hotline and speak with a counselor about your concerns, or speak to your health care provider.
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