Oral Herpes Action Plan: Treat Now and Understand the Myths

Oral herpes is an infection of the mouth caused by the herpes simplex virus (HSV). HSV often infects people for the first time when they are children. Many people with oral herpes do not have symptoms, while others may experience painful blisters or ulcers that come and go throughout their lifetime.

How do I tell if I have oral herpes?

Oral herpes does not cause symptoms in most people, so it is possible to have the infection without knowing it. After HSV infects a person, it can stay dormant (inactive) in the body for many years. Occasionally, it can reactivate, causing symptoms. It is also common to have symptoms 1–3 weeks after being infected with HSV for the first time.

Some warning signs that you may have oral herpes include pain, itching, burning, tingling, or redness of the lips or mouth. You may also have symptoms that resemble the flu; this is more common when you develop oral herpes for the first time.

After these warning signs, you may develop blisters — also called cold sores — in or around the lips and mouth. This is called a herpes outbreak. Often, blisters start out small and contain clear or yellowish fluid. At this stage, they can appear as single blisters or form clusters. Blisters can grow, break open, and leak fluid. As they heal, they can turn yellow, red-brown, and crusty. At any stage, blisters can become painful.

Oral herpes is highly contagious. HSV can transfer from person to person anytime there is contact with areas of the mouth infected by the virus (e.g., kissing). Transmission is more likely to occur when one person has active blisters, but it can also occur in the absence of symptoms. Since HSV can live on objects and surfaces, you can also acquire oral herpes by sharing items (e.g., drinks) with someone who has the disease.

How does oral herpes compare to genital herpes?

Both oral and genital herpes cause painful blisters, but in genital herpes, this occurs on or around the genitals (including the inner thighs and anus). Both oral and genital herpes can come and go with time. While oral herpes is transmitted through kissing and other forms of non-sexual contact, genital herpes is one of the most common sexually transmitted infections.

Similar treatments exist for oral and genital herpes. These include:

  • Topical medications for pain (e.g., benzocaine, lidocaine)
  • Oral medications for pain (e.g., Tylenol, ibuprofen)
  • Antiviral medications

There are also specific ways to offer prevention and symptomatic relief for oral or genital herpes based on their location. For example, applying sunscreen can be useful to prevent oral herpes outbreaks. Taking warm sitz baths can help ease the discomfort of genital herpes.

Immediate steps for oral herpes treatment

Although there is no cure for oral herpes, symptoms tend to resolve within 1–2 weeks even without treatment. In the meantime, there are action steps you can try at home to help speed up the healing process.

Natural home remedies for oral herpes

The following are some of the potentially helpful remedies that have been backed by clinical evidence:

  • Lemon balm shows promise in managing the symptoms of oral herpes, according to the results of two human studies. In one study, 66 patients with recurrent oral herpes experienced an improvement in symptoms after two days of treatment with lemon balm cream. In another study of 116 patients, lemon balm improved blister healing compared to placebo cream after 10 days.
  • Kanuka honey may also be effective. In a study of 952 patients, those who used medical grade kanuka honey cream had the same healing time (8–9 days) as those who used acyclovir cream.
  • Propolis, a product derived from bees, has been well-studied for the treatment of oral herpes. Propolis ointment has been shown to reduce the healing time of oral herpes and increase the time between herpes outbreaks. In some studies, propolis performed even better than acyclovir in treating oral herpes.
  • Zinc oxide cream has also been shown to reduce the duration and severity of oral herpes symptoms.
  • Cold or warm compresses can help relieve pain, although they do not affect the natural progression of the disease.

In addition, some home remedies such as aloe vera and essential oils (e.g., tea tree, peppermint, thyme, lavender, eucalyptus, ginger, hyssop, sandalwood) may be effective at inhibiting the growth of HSV-1 outside the human body. However, there is minimal evidence to show whether these are effective in reducing oral herpes among humans. These are generally safe to try, although you must dilute essential oils before applying them to the skin.

Other popular home remedies, such as corn starch and baking soda, do not have good scientific evidence to support their use in treating oral herpes.

Supplements for oral herpes

Some supplements that may be effective for treating oral herpes include:

  • Lysine. Research shows that patients taking oral lysine have significantly fewer herpes outbreaks, reduced symptoms, and shorter healing times compared to placebo. Studies have used lysine doses up to 1 g three times per day.
  • Zinc. One small study showed that patients with recurrent oral herpes outbreaks who took zinc experienced a significant reduction in the number of outbreaks over a one-year period. The dosage used in this study was 22.5 mg of zinc sulfate twice daily.
  • Vitamins A, C, D, and E. According to the National Institutes of Health, these vitamins are beneficial for maintaining general immune health. However, it is unknown whether supplementing with these vitamins directly impacts the development of oral herpes.

While these supplements are generally safe to take, side effects may emerge with extremely high dosages. Consult with your doctor before trying any supplements to treat oral herpes.

Diet for oral herpes

People with symptomatic oral herpes may benefit from consuming diets rich in lysine, zinc, and vitamins A, C, D, and E. This includes fish, poultry, dairy, eggs, and a diversity of fruits and vegetables. While red meats are especially high in lysine and zinc, they are also high in saturated fats and should be consumed in moderation.

On the other hand, there are certain foods you may want to avoid if you have oral herpes. This includes foods high in:

  • Arginine. Like lysine, arginine is an amino acid found in meats. Arginine is also abundant in seeds, nuts, beans, and grains. The evidence for arginine is mixed. While some studies show that arginine promotes the growth of HSV, one study showed that it inhibits HSV. Because lysine and arginine are found in similar foods, it can be challenging to separate the two in your diet. This is when supplementing with lysine in pill or powder form may be useful.
  • Refined carbohydrates. These may lead to insulin resistance and type 2 diabetes. These conditions weaken the immune system, which may increase the severity and frequency of oral herpes outbreaks.

You may also want to avoid salty, spicy, or acidic foods as well as hot beverages, as these can irritate your cold sores.

Medical treatment for oral herpes

The standard medical treatment for oral herpes is an oral antiviral medication such as acyclovir, valacyclovir, or famciclovir. These medications prevent HSV from replicating. Evidence shows that they can reduce the duration of oral herpes by 1–2 days when taken as soon as symptoms develop. Treatment typically lasts 7–10 days.

Oral antiviral medications are most useful for people who have severe symptoms. Those with mild-to-moderate symptoms may benefit simply from topical benzocaine or lidocaine mouth rinses. The most common side effects of oral antivirals include nausea, vomiting, diarrhea, and headaches.

Acyclovir can also be applied as a cream or ointment, but this is inconvenient because it requires up to 5–6 applications per day. Oral antivirals are also preferred because they are more effective than topical antivirals.

If you experience frequent severe herpes outbreaks, your doctor may place you on chronic antiviral medications to prevent outbreaks from occurring.

How to prevent oral herpes outbreaks

Stress and environmental triggers can reactivate HSV, leading to oral herpes outbreaks. Frequent outbreaks can lead to mental and emotional challenges.

The following actions can reduce the chances of outbreaks:

  • Apply sunscreen before going outdoors. Ultraviolet light from the sun can reactivate HSV, and sunscreen has been shown to reduce cold sores from developing. A good option is lip balm containing zinc oxide.
  • Avoid weather extremes. Some people notice that cold sores emerge in very hot or cold weather. While it is not always possible to avoid weather extremes, staying indoors until the weather improves can potentially prevent outbreaks.
  • Reduce stress. Physical and emotional stress can trigger outbreaks. A possible explanation is that stress hormones inhibit the immune system. By practicing stress reduction strategies such as good sleep, exercise, and meditation, you can reduce your stress hormone levels.
  • Try to avoid getting sick. Frequent handwashing and wearing masks around those who are ill can prevent you from getting sick, which is a common trigger for oral herpes.

Despite these strategies, some people may still experience oral herpes outbreaks. This is because it is not known entirely what triggers HSV reactivation, and it is not always preventable.

Common myths about oral herpes

Let’s debunk the following misconceptions about oral herpes:

Oral herpes can be cured completely

Oral herpes is a chronic infection that may come and go over time. Once HSV infects the body, it stays in it throughout your lifetime. HSV typically remains in an inactive state but can cause symptoms when it reactivates due to a trigger such as those described above. Many people who have HSV can live a long time without any symptoms of oral herpes, but for others, the virus reactivates more often leading to more frequent outbreaks. Because HSV remains in the body, herpes cannot be eliminated completely or cured.

Only prescription medications can manage oral herpes

Prescription medications are the standard medical treatment for oral herpes, but many healthy people do not need them. Without treatment, most people will improve within 1–2 weeks. Home remedies, supplements, diet changes, and avoidance of triggers may all help reduce the duration and frequency of oral herpes.

Oral herpes always presents visible symptoms

Sometimes, oral herpes can be present without any symptoms at all. Other times, oral herpes begins with burning, pain, or tingling around the mouth without visible blisters.

Toothpaste can treat oral herpes lesions

There is no scientific evidence that toothpaste treats oral herpes. While some people report benefits, this is based on anecdotal (personal) evidence and not clinical research.

Using mouthwash can cure oral herpes

A chemical called cetylpyridinium chloride (CPC) found in some mouthwashes has been shown to inhibit the growth of HSV outside the human body. However, human studies are lacking.

Risks if oral herpes is not treated

Left untreated, oral herpes is usually not a problem in most healthy people. However, complications can occur, especially in people who have weakened immune systems. This includes people with the human immunodeficiency virus (HIV), recipients of organ transplantation, or those taking steroid medications.

Some major complications of untreated oral herpes include the following:

  • Spread to the eye, causing blindness
  • Spread to the brain, causing a condition called encephalitis
  • Spread to the fingers causing a painful condition called herpetic whitlow
  • Spread to the genitals causing genital herpes

In rare cases, oral herpes can cause a painful, life-threatening skin rash throughout the body in patients with eczema.

See your doctor if you are concerned you might have oral herpes. Your doctor may be able to diagnose you by your symptoms alone, or by swabbing a blister to test for the presence of HSV.

In summary, oral herpes is a chronic infection of the mouth and lips caused by HSV. While oral herpes cannot be cured, symptoms such as pain and redness can be managed and sometimes prevented with appropriate measures. Left untreated, oral herpes typically resolves on its own, although in some cases it can spread to other parts of the body.

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