Oral herpes is a common viral infection that often manifests as sores in and around the mouth. This condition is caused by the herpes simplex virus (HSV). Many adults carry the virus, with estimates suggesting that between 50% and 80% of adults in the United States have HSV-1. While often associated with lips, oral herpes can also affect other areas, including the tongue.
Signs and Symptoms
The appearance of herpes on the tongue progresses through several stages. An outbreak often begins with a prodromal stage, where individuals may feel a tingling, itching, or burning sensation in the affected area of the tongue, accompanied by some redness or swelling. This sensation is an early warning sign.
Small, fluid-filled blisters may then appear on the tongue’s surface. These blisters can look reddish, whitish, yellowish, or grayish and might cluster together. Herpes on the tongue can also appear as open sores or ulcers, sometimes with a thin white coating, and may not always form classic fluid-filled blisters that scab over. These sores are painful and can develop anywhere on the tongue, including underneath.
After a few days, blisters break open, releasing a clear or yellowish fluid. This stage is painful and can make eating, drinking, or speaking uncomfortable. Sores then dry and may form a yellowish or golden-brown crust as they heal. Full recovery typically occurs within one to two weeks from symptom onset. An oral herpes outbreak can also present with other symptoms, especially during the initial infection:
Fever
Sore throat
Body aches
Headache
Swollen lymph nodes in the neck
Causes and Risk Factors
Oral herpes is primarily caused by the herpes simplex virus type 1 (HSV-1), although herpes simplex virus type 2 (HSV-2), more commonly associated with genital herpes, can also lead to oral lesions. Once an individual is infected with HSV, the virus remains in the body for life, lying dormant in nerve cells. The virus is highly contagious and spreads through direct contact with an infected person’s skin or saliva, even when no visible symptoms are present.
Transmission often occurs through close personal contact like kissing, or by sharing contaminated objects such as eating utensils, drinking cups, or lip balm. Oral sex can also transmit HSV from the mouth to the genitals or vice versa. Certain factors can trigger the virus to reactivate and cause an outbreak. Common triggers include:
Physical or emotional stress
Other illnesses (such as a fever)
Exposure to strong sunlight
Fatigue
Hormonal changes (e.g., during menstruation)
When to Seek Medical Attention
While oral herpes outbreaks often resolve on their own, consulting a healthcare professional is advisable in several situations. If it is your first oral herpes outbreak, seeking medical attention can help confirm the diagnosis and rule out other conditions with similar appearances. A healthcare provider can typically diagnose oral herpes by examining the sores.
It is also recommended to see a doctor if symptoms are severe, persistent, or do not improve within two weeks. Individuals who experience frequent outbreaks, or have a weakened immune system due to certain medical conditions or medications, should also seek medical advice. If sores appear near the eyes, or if there are signs of a bacterial infection, such as increased redness, swelling, or pus, prompt medical attention is important. A doctor can discuss various treatment options, including antiviral medications, which can help reduce the severity and duration of outbreaks, especially if started early.