Classically, the oral symptoms are familiar to most people who either have had an outbreak or seen them in others. The initial symptoms are a sense of tingling or itching that can occur 24 hours before any lesions appear on the skin. The first visible symptoms are redness, followed by the forming of a papule or elevation of the skin affected (usually on the very edge of the lips where they transition to the skin of the face). Then, the small roundish elevations become filled with fluid (a vesicle), which can burst and reveal a small ulcer or divet in the skin. This will be painful and ooze fluid and within just a few days heal, usually without a scar. These lesions do not form solely on the edge of the lip. They can form anywhere on the face, particularly a region between the nose and lips and out to the first fold on the cheek called the “nasolabial fold.”
The virus hides in the nerves in the back of the neck called the dorsal root ganglion. When HSV-1 reactivates and comes out of that nerve it can take a route other than to the edge of the lip. It can even cause an outbreak on the back of the neck but, most often, it is the lips where outbreaks will recur.
Oral symptoms can be more easily seen but often are not understood to be related to herpes. Minor irritations that disappear quickly might easily be dismissed as a simple cut or reaction to spicy food.
Other people might mistakenly consider unrelated irritations to be herpes on the mouth when they are not. For example, canker sores that occur inside the mouth and can recur just like herpes are sometimes misdiagnosed by patients and doctors alike as being due to the HSV-1 virus when, in reality, it is possibly an immune reaction and not an infection. The same sometimes occurs with irritation on the corners of the mouth, called angular cheilitis or perleche. This can be idiopathic, meaning it has no known cause, or can be due to the buildup of fluid at the corners of the mouth or due to certain vitamin deficiencies. It is a perfect spot to nurture growths of yeast or fungus (think Candida) and the irritation can even lead to small cuts and sores.
We always advise patients to confirm their diagnosis with a qualified healthcare practitioner if recurrent oral lesions are completely unresponsive to herpes antiviral therapy.
This information is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment, and should never be relied upon for specific medical advice. If you have any questions or concerns, please talk to your doctor.