Recurrent herpes simplex labialis, also known as oral or orolabial herpes, is an infection of the mouth area caused by the herpes simplex virus. It is a common and contagious infection that spreads easily. According to the National Institutes of Health, most people in the United States are infected with the virus by the time they reach age 20 (NIH, 2011).
The infection causes blisters and sores on the lips, mouth, or gums. After an initial infection, the virus stays dormant inside the nerve cells of the face. Later on in life, the virus can reactivate and result in more sores. These are commonly referred to as cold sores or fever blisters. When this occurs, the herpes is said to be “recurrent.”
Recurrent herpes simplex labialis is usually not serious, but the relapses are common. Many people choose to treat the recurrent episodes with over-the-counter creams. The symptoms will usually go away without treatment in a few weeks. A doctor may prescribe medications if relapses occur often.
Herpes simplex labialis is caused by a virus called herpes simplex virus type 1 (HSV-1). The initial infection usually occurs before age 20. It affects the lips and areas around the mouth.
You can get the virus from close personal contact with someone who is infected. You can also get oral herpes from touching objects where the virus may be present. These include towels, utensils, razors for shaving, and other items that may be shared.
After the first infection, the virus lays dormant inside the nerve cells of the face for the rest of a person’s life. This means that symptoms aren’t always present. However, certain events can make the virus awaken and lead to a recurrent herpes infection. Events that trigger a recurrent infection of oral herpes might include:
- strong sunlight
- hormone changes
- upper respiratory infection
- extreme temperatures
- weakened immune system
- dental work or surgery
The primary infection may not cause symptoms at all. If it does, blisters may appear near or on the mouth within one to three weeks after first contact with the virus. The blisters might last up to three weeks. In general, a recurrent episode is milder than the initial infection.
Symptoms of a recurrent episode may include:
- blisters or sores on the mouth, lips, tongue, nose, and/or gums
- burning pain around the blisters
- tingling or itching near the lips
- “outbreaks” of several small blisters that grow together and may be red and inflamed
Tingling on or near the lips is usually a warning sign that the cold sores of recurrent oral herpes are about to appear in one or two days.
A doctor will typically diagnose oral herpes through a physical examination of the blisters and sores on your face. Samples of the blister might be sent to a laboratory to test specifically for HSV-1.
Recurrent herpes simplex labialis can be dangerous if the blisters or sores occur near the eye. The infection can lead to scarring of the cornea. The cornea is the clear tissue covering the eye that helps to focus images that you see. According to the NIH, herpes infection is the top cause of blindness in the United States (NIH, 2011).
Other complications include:
- frequent recurrence of the sores and blisters requiring constant treatment
- spread of the virus to other parts of the skin
- widespread bodily infection, which can be serious in people who already have a weakened immune system, such as people with AIDS or HIV
You cannot get rid of the virus itself. Once infected, HSV-1 will remain in your body forever, even if you do not have recurrent episodes. Symptoms of a recurrent episode usually go away on their own within one to two weeks without any treatment. The blisters will usually scab and crust over before they disappear.
Applying ice or a warm cloth to the face or taking a pain reliever like acetaminophen (Tylenol) might help to reduce any pain. Some people choose to use over-the-counter skin creams. However, these creams generally only shorten an oral herpes relapse by less than a day.
Your doctor may prescribe oral antiviral medicines such as acyclovir, famciclovir, or valacyclovir, to fight the virus. These medicines work better if you take them when you experience the first signs of a mouth sore, such as tingling on the lips, and before the blisters appear. These medications do not cure herpes and may not stop you from spreading the virus to other people.
For cases of recurrent herpes simplex labialis that result in frequent mouth sores, your doctor may advise you to use the medication all the time.
The following tips may help prevent the infection from reactivating or spreading:
- use sunscreen or a lip balm containing sunscreen or zinc oxide before going outdoors
- wash any items that may have contacted the infected sores (like towels) in boiling hot water after use
- do not share food utensils or other personal items with people who are infected with oral herpes
- do not share cold sore creams with anyone else
- do not kiss or participate in oral sex with someone who has cold sores
- do not touch the blisters or sores to keep from spreading the virus to other parts of the body. If you do, wash your hands with soap and water immediately.
Symptoms usually go away within one to two weeks. However, the recurrent cold sore episodes can return frequently. The rate and severity of the sores usually diminish as people get older.
Infections near the eye or in immune-compromised individuals can be serious. You should see your doctor if a blister appears close to the eye.