According to the American Social Health Association (ASHA), somewhere between 50 and 80 percent of the adult population in the United States has oral herpes, with as many as 90 percent infected by age 50. Most people contract the virus as children, when they are kissed by friends or relatives. Although ASHA notes that herpes can be spread by people who show no symptoms at all, if a person is experiencing oral herpes symptoms, he or she should abstain from kissing and oral sex until symptoms resolve.
Prodrome
According to a 2008 report in the "Archives of Internal Medicine," in approximately 60 percent of cases, an oral herpes outbreak is preceded by prodromal or warning symptoms such as tingling, itching, burning or hypersensitivity in the area where lesions later appear. In some cases, these symptoms are accompanied by subtle signs such as redness or swelling. Prodromal symptoms may last for 2 hours or up to 2 days, when they are replaced by full-blown symptoms of herpes.
Flu-Like Illness
Oral herpes is sometimes accompanied by a flu-like illness, especially during the first episode. According to "Harrison's Principles of Internal Medicine," typical symptoms include fever, malaise, muscle pain, inability to eat, irritability and swollen lymph nodes which last 3 to14 days. Unlike true flu, respiratory symptoms such as cough and runny nose are absent.
Perioral Lesions
Oral herpes produces a characteristic lesion also known as a cold sore or fever blister. Lesions are usually 1 to 2 mm, filled with clear or cloudy yellow fluid and feature a central dimple called an umbilication. They are often extremely painful. After 3 or 4 days, lesions usually rupture and crust or scab and, at this point, they may also itch. First-time lesions tend to be more numerous and widely distributed according to "Harrison's Principles of Internal Medicine," while recurrent lesions may occur on just one side of the body. First-time lesions also take longer to heal--up to 4 weeks, compared to recurrent lesions that usually take about a week.
Intraoral Lesions
Oral herpes also produces lesions inside the mouth, particularly during the first episode. Commonly affected areas include the back of the throat, tonsils, the soft and hard palates, lining of the cheeks, gums and tongue. Lesions inside the mouth may be similar to lesions outside of the mouth (exudative) or they may be somewhat different (ulcerative). Ulcerative lesions, according to "Harrisons Principles of Internal Medicine" present as superficial, well-defined "punched out" areas where a layer of tissue is clearly missing. Regardless of the type of lesion, intraoral lesions can make eating and swallowing extremely painful.
References
- American Social Health Association: Learn About Herpes -- Oral Herpes
- Herpes Simplex Viruses (Chapter); L. Corey; In: "Harrison's Principles of Internal Medicine, 17th edition;" A.S. Fauci, E. Braunwald, D.L. Kasper, S.L. Hauser, D.L. Longer, J.L. Jameson, and J. Loscalzo (Eds); 2008
- "Archives of Internal Medicine;" The Treatment of Herpes Simples: An Evidence-Based Review; C. Cernik, K. Gallina, and R.T. Brodell; June 2008
