Oral Herpes (HSV-1)

Fever Blisters & Cold Sores

Fever blisters, also called cold sores, are the main symptom oral herpes. Fever blisters and canker sores are two of the most common disorders of the mouth, causing discomfort and annoyance to millions of Americans. Both cause small sores to develop in or around the mouth, and often are confused with each other.

Canker sores, however, occur only inside the mouth--on the tongue and the inside linings of the cheeks, lips and throat. Fever blisters, also called cold sores, usually occur outside the mouth--on the lips, chin, cheeks or in the nostrils. When fever blisters do occur inside the mouth, it is usually on the gums or the roof of the mouth. Inside the mouth, fever blisters are smaller than canker sores, heal more quickly, and often begin as a blister. They appear as red sores, usually on the roof of the mouth.

In most people, the initial infection causes no symptoms. About 15 percent of patients, however, develop many fluid-filled blisters inside and outside the mouth 3 to 5 days after they are infected with the virus. These may be accompanied by fever, swollen neck glands and general aches. The blisters tend to merge and then collapse. Often a yellowish crust forms over the sores, which usually heal without scarring within 2 weeks.

The herpes virus, however, stays in the body. Once a person is infected with oral herpes, the virus remains in a nerve located near the cheekbone. It may stay permanently inactive in this site, or it may occasionally travel down the nerve to the skin surface, causing a recurrence of fever blisters. Recurring blisters usually erupt at the outside edge of the lip or the edge of the nostril, but can also occur on the chin, cheeks, or inside the mouth.

The symptoms of recurrent fever blister attacks usually are less severe than those experienced by some people after an initial infection. Recurrences appear to be less frequent after age 35. Many people who have recurring fever blisters feel itching, tingling or burning in the lip 1 to 3 days before the blister appears.

Causes of Herpes

Fever blisters are caused by a contagious virus called herpes simplex type 1. The herpes simplex virus is highly contagious when fever blisters are present. The virus usually invades the moist membrane cells of the lips, throat or mouth. The virus is  frequently spread by kissing. Children often become infected by contact with parents, siblings or other close relatives who have fever blisters. A child can spread the virus by rubbing his or her cold sore and then touching other children. About 10 percent of oral herpes infections in adults result from oral-genital sex with a person who has active genital herpes (type 2). These infections, however, usually do not result in repeat bouts of fever blisters. Most people infected with the type 1 herpes simplex virus became infected before they were 10 years old.

Recurrent  Fever Blisters

Several factors weaken the body's defenses and trigger an outbreak of herpes. These include emotional stress, fever, illness, injury and exposure to sunlight. Many women have recurrences only during menstruation. One study indicates that susceptibility to herpes recurrences is inherited. Research is under way to discover exactly how the triggering factors interact with the immune system and the virus to prompt a recurrence of fever blisters.

Oral Herpes Treatment

Currently there is no cure for fever blisters. Some medications can relieve some of the pain and discomfort associated with the sores, however. These include ointments that numb the blisters, antibiotics that control secondary bacterial infections, and ointments that soften the crusts of the sores.

If fever blisters erupt, keep them clean and dry to prevent bacterial infections. Eat a soft, bland diet to avoid irritating the sores and surrounding sensitive areas. Be careful not to much the sores and spread the virus to new sites, such as the eyes or genitals. To make sure you do not infect others, avoid kissing them or touching the sores and then touching another person.

There is good news for people whose fever blister outbreaks are triggered by sunlight. Scientists at the National Institute of Dental and Craniofacial Research have confirmed that sunscreen on the lips can prevent sun-induced recurrences of herpes. They recommend applying the sunscreen before going outside and reapplying it frequently during sun exposure. The researchers used a sunblock with a protection factor of 15 in their studies. Little is known about how to prevent recurrences of fever blisters triggered by factors other than sunlight. People whose cold sores appear in response to stress should try to avoid stressful situations. Some investigators have suggested adding lysine to the diet or eliminating foods such as nuts, chocolate, seeds or gelatin. These measures have not, however, been proven effective in controlled studies.

Oral Herpes Medications

Docosanol (Abreva) is an over-the-counter drug that was approved in July 2000 for the treatment of oral-facial herpes simplex. Two double-blind, placebo-controlled trials established the effectiveness of n-docosanol (the active ingredient) in treating recurrent oral herpes legions (cold sores/fever blisters). The studies showed that Abreva helped shorten the duration of outbreaks as well as helped prevent outbreaks from progressing to a full blown blister. Side effects were few and included possible headaches. Docosanol works by inhibiting fusion between the human cell plasma membrane and the herpes simplex virus (HSV) envelope, thereby preventing viral entry into cells and subsequent viral replication.

ZENMED™ AvaCare - This all natural herpes simplex treatment is designed to inhibit both oral and genital Herpes Simplex Virus I and II. It enhances your system’s natural healing abilities andhelps relieve the pain and inflammation of post herpetic neuralgia. You may combine AvaCare with ZENMED Zenhance to further protect your system. Restore your body’s natural immune system response with ZENMED™ Zenhance. This inspired formula bio-medically targets factors associated with weakened or under-active immunity and works to reawaken your vital energy stores. Boost immune function and protect your body’s overall health.

Acyclovir is an antiviral drug that prevents the herpes simplex virus from multiplying. The U.S. Food and Drug Administration has approved the drug for use in treating genital herpes, and is considering its approval for use in treating oral herpes.

Researchers have found that acyclovir taken in pill form reduces the symptoms and frequency of fever blister recurrences in some patients. In one study, 50 percent of patients who took four acyclovir pills daily for 4 months had no fever blister outbreaks. Before taking the drug, they had an average of one recurrence every 2 months. In separate studies, pills taken at the onset of symptoms or acyclovir cream applied to the blisters or to areas of the lip that tingled or itched were found to be only minimally effective. The long-term effects of daily oral doses of acyclovir are not known, nor are the effects the drug might have on an unborn child.

Vaccines for Oral Herpes

Currently there is no vaccine for herpes simplex virus available to the public. Many research laboratories, however, are working on this approach to preventing fever blisters. For example, scientists at the National Institute of Dental and Craniofacial Research and the National Institute of Allergy and Infectious Diseases have developed a promising experimental herpes vaccine. In tests on laboratory mice, the vaccine has prevented the herpes simplex virus from infecting the animals and establishing itself in the nerves.

Although these findings are encouraging, the scientists must complete more animal studies on the safety and effectiveness of the vaccine before a decision can be made whether to test it in humans. The vaccine would be useful only for those not already infected with herpes simplex virus.