Herpes in the mouth

Marian Grosser studied human medicine in Munich. In addition, the doctor, who was interested in many things, dared to make some exciting detours: studying philosophy and art history, working on the radio and, finally, also for a Netdoctor.

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Herpes in the mouth is a type of herpes that mostly affects young children and rarely adults. Small blisters and damage to the mucous membrane form in the mouth and throat, which are very painful. Read here the most important things about herpes in the mouth.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. B00

Herpes in the mouth: description

Herpes in the mouth, also called stomatitis aphtosa, gingivostomatitis or oral rot, occurs mainly in childhood. In the vast majority of cases, it is caused by herpes simplex virus type 1 (HSV1).

How does herpes in the mouth come about?

When first infected with the herpes simplex virus, the so-called primary infection, the virus gets into superficial skin cells and multiplies there. Depending on where the herpes penetrates the body, the typical symptoms can appear in a wide variety of places. Herpes on the mouth is just as possible as herpes in the nose, eye herpes, herpes on the hand or herpes on the leg also occur. The most common is herpes on the face.

For example, if the herpes spreads from the lip to the entire oral mucosa, it can lead to herpes in the throat, in extreme cases even herpes can be found in the throat.

How is herpes transmitted in the mouth?

Herpes in the mouth is usually transmitted by smear infection, i.e. by direct transmission of the virus from one sick person to another. This does not necessarily have to be herpes in the mouth, rather the much more common cold sore is the source of infection.

The viruses are mainly found in the vesicle fluid and they are also distributed in the saliva, which is a major risk factor in the transmission of herpes. The corners of the mouth and lips are the preferred entry points for the viruses because the skin is relatively thin and has small cracks here.

Transmission through the air is also possible over short distances - i.e. via droplet infection from droplets of saliva that occur when sneezing or speaking. Herpes is particularly common among children. Fingers or hands are often infected with viruses from scratching, especially in children. When playing, there is close physical contact, and the viruses quickly get from one child's hand to another's mouth.

Indirect infection with cold sores through infected objects is also possible because the herpes virus can survive outside the body for up to two days. Therefore, used glasses, napkins or cutlery come into consideration as a source of infection.

In rare cases, an HSV2 infection can also trigger herpes in the mouth if the herpes simplex-2 viruses are transferred from the genital area to it. Herpes in the mouth caused by HSV2 is then in turn contagious in the same way as the HSV1-caused form.

When and how long is herpes in the mouth contagious?

An active herpes simplex disease is always contagious as long as viruses are excreted from the body. The risk of infection can exist shortly before the first symptoms appear and for a few days afterwards and also depends on the so-called viral load. The more viruses are excreted, the greater the risk of transmission.

Who Does Mouth Herpes Affect?

Herpes in the mouth almost exclusively affects younger children when they become infected with herpes simplex type 1 for the first time. Most infections, however, are uncomplicated and without extensive involvement of the oral mucosa.

In adults, the typical symptoms of herpes usually appear on the lip, sometimes also on the nose. The mouth and throat, on the other hand, are rarely affected - often associated with a pronounced immune deficiency.

Herpes in the mouth: symptoms and complications

In contrast to ordinary herpes infections or simple reactivations, herpes in the mouth is often associated with severe discomfort. Most of the very young patients experience high levels of suffering and often pain when eating and drinking. After infection, the symptoms usually appear within a week.

Early symptoms of herpes in the mouth

In principle, initial infections with herpes simplex are usually more violent than reactivations. In particular, the so-called prodromal symptoms, i.e. those that occur before the actual outbreak of the disease, are more pronounced when the virus is infected for the first time. These include, for example, general symptoms such as fever and chills, headache and body aches and fatigue.

Sometimes the symptoms start a few days before the herpes breaks out, in other cases hours before. These symptoms often persist even during the outbreak of herpes.

Main symptoms of herpes in the mouth

Those affected suffer from inflammation of the entire oral mucosa in this form of herpes. The symptoms can appear on the palate as well as on the inside of the cheeks and in the throat area. Sometimes symptoms of herpes even show up on the tongue.

The affected areas in the mouth are initially painful and reddened, the small blisters typical of herpes appear, which are filled with a transparent or slightly cloudy liquid. If the vesicles burst, the mucous membrane is now open and temporarily damaged, so-called canker sores develop.

The front of the mouth is usually the most severely affected by herpes, including the gums. In some cases, the lips are also affected, and sometimes there is even herpes on the chin. Often the immediate lymph nodes on the lower jaw and neck swell during the outbreak of herpes. If the herpes extends into the throat and pharynx, swallowing disorders may also occur.

Complications from herpes in the mouth

The numerous canker sores are extremely painful for those affected by herpes. The tongue, gums and oral mucosa are particularly sensitive to pain. Infants often refuse to eat or drink because of the pain, which can lead to additional complications and require treatment.

In the case of herpes in the throat and pharynx, the viruses can pass through the numerous blood vessels in this region directly into the body's circulation and multiply throughout the body. This condition is known as herpes sepsis and can be life threatening.

Herpes on the face

A majority of HSV1 outbreaks are variants of herpes on the face. There are a particularly large number of sensory nerve fibers along which the herpes viruses can move. Herpes not only develop in the mouth and lips, but also on the nose, cheek or forehead. The eyes and ears - usually rarely affected - are critical points of infection, as this can lead to visual and hearing impairments. Herpes in the nose (herpes nasalis) is the most common variant of reactivations after cold sores (herpes labialis), but is usually harmless.

Another virus in the herpes family causes similar symptoms on the face: the varicella zoster virus (VZV). It triggers chickenpox when it is first infected, and herpes zoster (shingles) when it is reactivated later. The typical patches are similar to those of a herpes simplex infection, but do not occur in the mouth. Herpes in the Ear or herpes on the nose, on the other hand, are typical locations of a varicella-zoster outbreak and are rarely affected in herpes simplex disease.

Herpes in the mouth: diagnosis

The so-called eye diagnosis is usually sufficient for the doctor to recognize herpes in the mouth. Additional tests may be used to rule out other conditions with similar symptoms or to determine the type of virus. A relatively simple procedure is the so-called Tzanck test. The doctor first takes a smear, usually of already burst vesicles, and stains the examination material obtained with a dye. If the Tzanck test is positive, the examiner can observe so-called mononuclear or multinucleated giant cells under the light microscope, which are typical of a herpes or varicella-zoster infection.

To determine the virus type, the viruses either have to be grown or their genetic material has to be reproduced and analyzed using a special procedure.

Herpes in the mouth: treatment

If used early, medication can reduce the duration and severity of symptoms, but usually cannot prevent an outbreak. Pain relieving drugs are often used, especially in young children, to make it easier to eat and drink.

Herpes in the mouth: prognosis

Herpes in the mouth usually heals without any treatment. As the canker sores heal after about a week, the pain also subsides.Since herpes in the mouth usually only occurs with initial infections, it is unlikely that it will occur again. Temporary immune deficiencies that lead to herpes reactivation often only result in herpes in the nose or on the lip.

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