May 24, 2016
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Herpes Simplex Infections (Non-Genital) (cont.)

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What is the prognosis for oral herpes (cold sores)?

Cold sores usually resolve on their own within one to two weeks. However, the virus may become reactivated, causing a recurrence of symptoms in the same location.

Herpes infection may be severe in people with a weakened immune system. It is also dangerous if it infects the eye or the brain.

What other conditions can look like oral herpes (cold sores)?

There are many conditions that can be confused with herpes, including abrasions, razor burns, pimples, impetigo, angular stomatitis, and canker sores (aphthous ulcers).

What is angular stomatitis?

Angular stomatitis refers to inflammation, cracking, or irritation at the corners of the mouth. In contrast, herpes infections usually appear on the upper or lower lip margins, not in the corners. Angular stomatitis may be an initial sign of anemia or vitamin deficiency. It can also occur in people who wear dentures, whose saliva can accumulate and lead to the overgrowth of yeast.

What are canker sores?

Canker sores, or aphthous ulcers, are ulcerations that occur inside the mouth along the mucosa. They are found on the inner cheeks and lower lip as well as on the tongue, palate, and the covering of the gums. Canker sores are small, round, and painful. They are gray in color with a distinct edge. They are not contagious and are caused by stress or trauma to the area.

How is oral herpes diagnosed?

The diagnosis of herpes (cold sores) is usually based solely on the appearance of the lesions. Less commonly, viral culture or polymerase chain reaction (PCR) tests are used to help in the diagnosis of herpes infection.

Swabbing the blister in an attempt to culture the virus in the lab is only productive in the first 48 hours and before the blister has crusted over. If lesions resolve, then cultures are of no help, because there's nothing left to culture. Culture results take a minimum of three to five days.

PCR testing detects herpes DNA, but it is not as readily available as culture. PCR is done on clinical specimens obtained from swabs of active lesions as described above.

Blood tests are often irrelevant, since finding antibodies to herpes just means that the body has been exposed to this virus at some point in the past. It does not determine if the current lesion is due to herpes.

If the diagnosis is in doubt, the best approach is to encourage the person to see a doctor at the first sign of a sore. That will allow the clinician to see active lesions that can be tested by culture or PCR.

Medically Reviewed by a Doctor on 2/18/2015


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