Tuesday, September 2, 2014
What does HSV-2 look like in the mouth? Does it have the same appearance as cold sores?
The first infections by either herpesvirus type I (the type that usually affects the mouth) or II (so-called "genital herpes") appear identical. The affected person has small painful ulcers scattered all over the inside of the mouth, and they may have a slight fever. The condition clears up on its own after 10-14 days. During this initial infection, the virus travels up the nerves and exists in a dormant state in normal anatomic structures called ganglia. In about 25% of the population, the virus will become activated - sunlight exposure is a common reason for activation - and travel down the nerve to produce a "fever blister" or "cold sore" on the dry part of the lip (lipstick area or around the mouth). Strangely enough, this most commonly happens with Type I herpes, the form of virus that usually affects the mouth. Even if a person has been infected orally with the Type II herpesvirus, it doesn't seem to produce recurrences as often.
Also, don't confuse aphthous ulcers or "canker sores" with recurrent herpes. Sometimes canker sores are lumped with cold sores, but the two are completely different. Canker sores are not caused by any virus, but are instead a localized attack by the body's immune cells on the lining of the mouth. Canker sores occur on the inside (wet part) of the lips, as well as the tongue, buccal mucosa (inner cheek) and soft palate (roof of the mouth, toward the back).
Consultation with an oral pathologist can clarify which process you are dealing with.
Carl M Allen, DDS, MSD
Professor Emeritus of Oral Pathology
College of Dentistry
The Ohio State University