Herpes viruses: diversity and characteristics of dangerous infections

Treatment of herpes in the mouth

Can herpes be in the mouth?
Maybe! Herpes in the mouth requires the same responsible approach and competent treatment as other diseases of the oral cavity. Despite the fact that the infection is often mild and goes away naturally, there are still risks of serious complications, and the possibility of infecting other people remains. Many factors influence the degree of development of the pathology and the presence of possible dangers for the patient. Complete diagnosis and comprehensive treatment can completely stop the manifestations of the infection, although complete elimination of the virus is considered impossible. Herpes, a viral disease known to many as a “cold sore,” is often perceived as a minor problem that does not require treatment. It is characterized by the appearance of a moderately painful blistering rash, but not many people know that this disease is not limited to appearing only on the lips , but can also develop on the oral mucosa . The disease is often accompanied by weakness, general malaise and severe itching, and in some cases can cause complications. During the active phase of the virus, a patient can easily infect others with it through household items, close contact or by airborne droplets.

Types of herpes virus infections

More than 100 representatives of the herpetic family of viruses are known. However, most often a person is affected by 8 of them. Let us consider in detail the features and symptoms of the most common infections.

Herpes simplex virus types 1 and 2

The herpes virus type 1 causes blistering rashes on the mucous membranes of the lips and nose. As a rule, infection occurs in childhood. By the age of 5-7 years, more than 50% of children are carriers of the infection. Infection often occurs from sick parents: through kisses, household items.

The incubation period lasts from 2 days to 2 weeks. In addition to the characteristic rashes, the infection may be accompanied by elevated body temperature and enlarged local lymph nodes. After damaging the mucous membranes, the virus reaches the trigeminal nerve, where it can remain latent for a long time.

Herpes simplex virus type 2, or genital herpes, is primarily transmitted through sexual contact. In Russia, the average is 20% among the adult population. In European countries, the incidence rate is even higher. The risk group includes people who have promiscuous sex. Most infections occur during puberty, at the beginning of active sexual life.

Symptoms of the virus include:

• blistering rashes on the genitals;
• enlargement of regional lymph nodes;
• painful urination;
• itching in the groin area;
• elevated body temperature.

The disease can occur with frequent relapses (6-12 times a year or more).

Herpes virus type 3

This virus can cause two diseases: chickenpox and herpes zoster. As a rule, chickenpox occurs in childhood and is accompanied by characteristic symptoms:

• vesicular rash that lasts about 10 days;
• high body temperature, fever;
• headache;
• itching of the skin;
• symptoms of body intoxication.

Chickenpox in adults occurs rarely and can occur in a more severe form: with damage to the eyes and nervous system. In such a situation, a person requires urgent hospitalization. After the disease, the virus remains in the body for life, remaining latent in the nerve ganglia.

Vaccination is the most effective way to prevent the disease in children and adults who did not have chickenpox in childhood and were not vaccinated against it. Vaccination is given to children from one year of age. The immunobiological drug is administered twice with an interval of 6 weeks. Vaccination is also carried out as an emergency measure in the first three days after a person comes into contact with a patient with chickenpox.

Typically, herpes zoster occurs in people over 65 years of age. The disease is severe and is accompanied by severe symptoms:

• severe pain;
• sleep disturbance;
• high temperature;
• vesicular rashes that appear along the nerve endings.

The disease has a rather difficult rehabilitation period. Even after the rash disappears, a person may remain sore for a long time in those areas that were affected by the infection. In all civilized countries of the world, elderly people are vaccinated to prevent herpes zoster.

Epstein–Barr virus

Herpes virus type 4 or Epstein-Barr virus affects the human body in a complex manner, provoking various and sometimes unrelated pathologies. The virus can cause infectious mononucleosis, lymphoma, hepatitis, affect the nervous and immune systems, and the hematopoietic apparatus.

In the human population, infection with the Epstein-Barr virus reaches 75% or higher. Children over two years of age and adults under 30 years of age are at risk. Children under one year of age rarely get sick due to passive immunity received from the mother.

The symptoms of the disease are many-sided and can have various manifestations: from mild discomfort to severe health problems. The most common symptoms of the disease are:

• high temperature, fever;
• sore throat, muscles;
• enlarged lymph nodes, liver, spleen;
• the appearance of rashes, peeling, inflammation, bruising on the skin;
• photophobia;
• nausea.

It is characteristic that the use of antibiotics does not affect the duration of fever.

Herpes virus type 5

Cytomegalovirus infection, caused by herpes virus type 5, occurs in both children and adults. It can occur as a mononucleosis, with high fever, intoxication, purulent sore throat, and damage to the salivary glands. In addition, the infection may be asymptomatic.

There are also congenital forms of the disease, which often lead to the development of hearing loss, microcephaly in the child, cause enlargement of the liver and spleen, and hematological disorders.

Herpes viruses type 6 and 7

The range of diseases caused by these viruses is diverse. Often infections occur in the form of a sudden exanthema. Hepatitis virus type 6 can provoke chronic fatigue syndrome and infectious mononucleosis. It is believed that a consequence of viruses can be a lymphoproliferative process (the formation of tumors of the lymphatic system).

As a rule, sudden exanthema affects children under two years of age. The disease occurs with high fever and intoxication of the body. Febrile convulsions may occur and a rash appears, which goes away on its own after a few days.

Chronic fatigue syndrome (CFS) is accompanied by rapid fatigue and decreased performance. Patients are concerned about low-grade fever, enlarged lymph nodes, and the appearance of catarrhal manifestations in the pharynx.

Symptoms of herpes on the oral mucosa

Symptoms of herpes are individual, have varying degrees of manifestation, and can occur in different parts of the oral cavity. For most cases, there are a number of signs that indicate the occurrence of herpes:

• Regular headache;
• Fever;
• A person gets tired quickly;
• Discomfort when eating and drinking;
• The appearance of water bubbles filled with transparent white or yellowish exudate, up to 3 mm in diameter;
• The appearance of ulcers at the site of burst blisters;
• Inflammation of the soft tissues of the oral cavity, redness, itching, burning, swelling of the lesion.

According to clinical studies, blisters in the mouth can form in different areas: on the palate, on the inside of the cheeks, on the tongue, on the gums, on the tonsils.

Possible complications

If no attempts are made to cure the disease, over time the lesion will spread further to the mucous membrane and will inevitably lead to serious health problems in general. In the worst case scenario, there may be a threat of an abscess, and it will have to be removed surgically. In this case, the person will experience throbbing painful sensations, and the tongue will increase in size, unevenly.

The photo shows a tongue abscess

Stages of development of herpes in the oral cavity

The disease develops sequentially, including passing through several distinct stages:

• At first, the patient may experience drowsiness, malaise, and tingling or itching of the mucous membrane. Sometimes body temperature rises slightly;
• Next comes redness and swelling of the lesion, minor pain occurs due to the appearance of herpes on the tongue or lip;
• Blisters appear in the oral cavity, filled with transparent contents. During this period, the patient is most contagious, blood counts change;
• The blisters become cloudy and open, and yellowish, shallow, painful ulcers form in their place;
• A hard, fragmented crust forms on the ulcers, damage to which causes bleeding. After a few days, the crusts disappear.

In the best case, the disease resolves naturally within two weeks and without treatment. All wounds heal quickly and without scars.

But there are also complications that lead to infection of internal organs. Suppuration occurs at the site of the wounds, the temperature rises to 40 C. Inflammation of the lymph nodes in the jaw and neck may begin.

How is the disease treated?

Treatment of herpes on the tongue can be quickly and effectively provided only by a doctor after making an accurate diagnosis and identifying a specific form of pathology. And in each individual case, the treatment method will largely depend on the individual clinical picture. Below are several general principles for combating the disease:

• elimination of all accompanying pathologies of the oral cavity - treatment of carious cavities, removal of plaque and dental deposits,
• rinsing with antiseptic solutions - Miramistin, Laripront, Chlorhexidine, Furacilin. If there is an advanced stage, the doctor may prescribe a course of antibiotics,
• compresses - it is recommended to smear the affected areas with products that promote wound healing and eliminate pain. Among such ointments are “Kamistad”, “Vinizol”, “Malavit”, “Solcoseryl” and others1,
• treatment with oils: experts advise treating the affected areas with oil, for example, rosehip or sea buckthorn - they perfectly help in normalizing the microflora of the oral cavity,
• multivitamin complexes: taking healthy vitamins and minerals is necessary to restore the body's defenses.

The recommendations described above are relevant for most forms of glossitis, however, targeted therapy is necessary to effectively eliminate the disease.

Causes of oral herpes infection

Herpes that affects the oral cavity develops when infected with the herpes simplex virus type 1, which not only provokes the appearance of a blistering rash, but can also cause complications in 10% of cases. The second type of herpes virus (genital) also causes a rash in the mouth, but does not cause serious disruption to the body and differs in its mode of transmission (through sexual contact).

Most often, primary infection with a herpes virus occurs in childhood, after which it is introduced into the genome and remains in an inactive form for life.

The main routes of infection with a viral agent are close conversation, skin-to-skin contact, kissing, and the use of shared hygiene products or utensils. However, the entry of viral particles into the body does not guarantee that the disease will develop, since the immune system can suppress the action of the pathogen. In this case, situations that worsen the overall health of the body, on the contrary, provoke a clear manifestation of infection:

• surgical interventions;
• emotional and physical stress;
• lack of sleep, overwork;
• colds;
• chronic pathologies;
• long-term use of antibiotics;
• periods of menstruation, pregnancy or lactation;
• vitamin deficiencies;
• AIDS;
• abuse of nicotine or alcohol;
• the appearance of microtraumas from excessive exposure to the sun or frost.

Herpes virus type 8

Herpes virus type 8 can cause Kaposi's sarcoma and Castleman's disease. Kaposi's sarcoma is a serious pathology that is accompanied by the appearance of malignant skin tumors. It is quite difficult, especially with immune deficiency. May be complicated by inflammation of the mucous membrane of the palate and lymph nodes.

Castleman's disease is a rare disease in which fever, enlargement of the liver and spleen, anemia, and a sharp decrease in body weight are observed.

Diagnosis and treatment of herpes infection

It is better to start treatment of herpes in the mouth at earlier stages of development to reduce the risk of complications and reduce the likelihood of infecting other people. In order to identify the disease, specialists carry out diagnostic measures:

• collect anamnesis;
• conduct an examination, determine the location of the rash and its nature;
• take a smear to identify the herpes virus and determine its type;
• laboratory tests are prescribed.

Modern methods for identifying the pathogen are a patient’s blood test to detect antibodies to the pathogen and a PCR study of tissues aimed at searching for the DNA of the viral particle. Differential diagnosis is of great importance, since herpetic infection must be distinguished from other similar diseases: stomatitis (not herpetic), tonsillitis, etc.

How to treat herpes on the lip, tongue or gum? Herpes therapy is based on an integrated approach that combines:

• The use of local antiviral agents to stop the process of reproduction and spread of the pathogen;
• Prescribing antiviral medications for internal use (usually indicated for those whose symptoms occur frequently and acutely, or who are immunosuppressed);
• The use of antiseptic drugs for treating blisters and ulcers, rinsing;
• Use of topical anesthetic gels;
• Prescribing non-steroidal anti-inflammatory drugs to alleviate general well-being;
• Strengthening the immune system by taking vitamins and immunomodulators.

To eliminate symptoms, advanced technologies such as laser radiation are also used. The technique allows you to quickly and painlessly destroy viral particles without harming mucosal cells and effectively healing damaged tissue. In most cases, several short procedures are sufficient for complete disappearance of symptoms in 2-4 days.

How is diagnostics carried out?

The appearance of neoplasms on the tongue of an adult or child should at least alert you. If redness, pain and swelling are added to everything else, it’s most likely glossitis. However, to make an accurate diagnosis and choose the appropriate treatment method, you must consult a doctor. Already as part of the initial visual examination, the specialist will be able to draw certain conclusions regarding the clinical picture, and to identify the specific cause of inflammation, it may be necessary to undergo the following types of examination:

• general blood analysis,
• blood chemistry,
• scraping from the damaged area.

Only tests can determine the true cause of the problem.
Only with the results of the studies in hand, the doctor will be able to make a final verdict and prescribe the necessary therapy. Do not self-medicate under any circumstances - such arrogance can lead to a worsening of the situation.

Eppstein-Barr virus

The Epstein-Barr virus predisposes to premature termination of pregnancy, fetal malnutrition, and in newborn children it causes damage to the nervous system, visual organs, recurrent chroniosepsis, hepatopathy and respiratory distress syndrome. However, this virus provokes the listed pathologies only under certain conditions, under which it becomes dangerous during pregnancy. It is very bad if a pregnant woman has not previously encountered the Eppstein-Barr virus, which is why she does not have antibodies to this virus in her body. If there was contact, and antibodies were detected after treatment, then this is a good sign, because in this case there is nothing to be afraid of. This serves as evidence that if a woman’s body becomes infected again, she will cope with this dangerous disease on her own. This means that a pregnant woman will not have to take medications that are heavy and quite dangerous for the development of the fetus.

Choosing tablets for herpes -

Herpes treatment in adults: drugs in tablets

• Acyclovir,
• Valaciclovir,
• Famciclovir.

Below we will compare the effectiveness of these antiviral tablets against the herpes simplex virus. It should be noted that Acyclovir tablets are approved for use from 0 years of age, and the drugs “Valacyclovir” and “Famciclovir” - only from 12 years of age. All these drugs are available only with a doctor's prescription.

Acyclovir in tablets of 200 and 400 mg –

Tablet acyclovir has the same disadvantages as creams: low tropism for the virus (i.e., acyclovir molecules do not find viral particles well); in patients with poor immunity + frequent courses of acyclovir use in the past - in 10-27% of cases the herpes virus may be resistant to acyclovir; plus low oral bioavailability. Pros: no age-related contraindications, affordable price, fairly few side effects.

We recommend choosing the original drug with acyclovir - Zovirax 200 mg tablets (instructions for use, see PDF). Moreover, its cost is not much higher than that of Russian generics.

Examples of drugs with acyclovir -

Acyclovir tablets certainly work, especially when it comes to patients with good immunity and rare relapses of herpes. If you have a weakened immune system, if you have taken acyclovir too often in the past, if you decide to start taking the drug more than 24-48 hours after the onset of herpetic rashes, acyclovir will not be particularly effective. In this case, it is better for you to immediately start taking the drug Famciclovir, which works better even at later dates of initiation of therapy, as well as in patients with immunodeficiency conditions.

The regimen of use - if you look at the official instructions, the standard regimen for adults and children over 2 years old - is to take acyclovir 200 mg 5 times a day (for 5 days). A single dosage of 400 mg is recommended in the official instructions - either only for severe herpes infection, or in patients with weakened immune systems. However, most clinical studies (source) show that a dosage of 200 mg has virtually no effect on either the duration of symptoms or the healing time of herpes.

Studies have shown that only 400 mg (respectively, 5 times a day, for 5 days) is an effective single dose. In children under 2 years of age, the dosage is reduced by exactly 2 times - from the adult dosage. In case of severe herpes infection, taking the drug can be extended to 7-10 days. By the way, abroad, at the moment, acyclovir is practically not used for chronic recurrent herpes, giving preference to valacyclovir and famciclovir.

Valacyclovir (Valtrex) tablets –

We have already said above that tableted acyclovir has poor bioavailability, i.e. only about 10-20% of its amount is absorbed in the intestine, which makes it difficult to achieve high concentrations of acyclovir in tissues. This problem is solved by Valacyclovir, which has a bioavailability of 50%. Valaciclovir is a precursor to acyclovir (i.e., it is converted to acyclovir once it enters the bloodstream). Taking tablets with valacyclovir allows you to create a concentration of acyclovir in tissues that can be achieved with traditional acyclovir - only through intravenous infusions of the latter.

The drug Valtrex is the original drug of Valaciclovir (we recommend this drug), but there are also a large number of cheaper generics. The cost of the original drug “Valtrex” (UK) is from 1350 rubles for 10 tablets. 500 mg each. There is a good Bulgarian generic “Valvir” - it costs from 750 rubles for a package of 10 tablets. 500 mg each. The cost of the Russian “Valacyclovir-Akos” will be from 450 rubles (for a package of 10 tablets of 500 mg).

Regimen: There is a short 1-day treatment regimen. Clinical studies have shown that taking high dosages of the drug for 1 day was the most effective for the treatment of herpes on the lips and facial skin, as well as herpetic stomatitis. In this case, the dosage regimen is 2000 mg 2 times a day, with an interval of 12 hours (1 day in total). But it should be noted that such a short regimen will be effective only if treatment begins no later than 12 hours from the moment the herpetic eruptions appear, and also in patients with satisfactory or good immunity.

If more than 12 hours have passed since the appearance of the rash, and also if you have a weakened immune system, it is optimal to use the standard treatment regimen of 500 mg 2 times a day for 3-5 days (for severe herpes infection - up to 10 days). When choosing a drug, keep in mind that if your herpes virus is resistant to acyclovir, taking valacyclovir will also be ineffective.

Famciclovir tablets (Favirox, Famvir) –

Famciclovir products are the most modern and effective tablets for herpes. Above we told you about the cream “Fenistil-pencivir” (based on penciclovir), which is used on the skin of the face and the red border of the lips. So, drugs with famciclovir are tablet analogues of penciclovir. Most often in pharmacies you can find drugs with famciclovir - under the trade names “Favirox” or “Famvir”.

The advantage of famciclovir drugs like Favirox is their rapid antiviral effect due to maximum bioavailability (for famciclovir it is about 74%, for example, for valacyclovir it is only 54%, and for acyclovir only 10-20%). Therefore, a package of three 500 mg tablets is enough for a short 1-day course of therapy to relieve the manifestations of herpes on the lip. Read more about this application scheme below.

→ Favirox instructions for use (view PDF)

Regimen for using famciclovir - there is a short 1-day treatment regimen: either take 1500 mg once, or 750 mg 2 times a day (with a 12-hour interval between doses) - our experience suggests that the second option is still better. This 1-day regimen is effective only if you start taking the drug before 12 hours from the moment the herpetic rash appears, and also if the patient’s immunity is normal. In case of weakened immunity, and/or if treatment is started later than 12 hours from the moment of the appearance of herpetic eruptions, the standard dosage regimen should be used.

The standard regimen according to the instructions is 250 mg 2 times a day for 5 days (however, in severe cases of herpes infection, dosage can be extended to 7-10 days). Here I would like to add that numerous clinical studies show the weak effectiveness of this standard regimen - especially in patients with poor immune system conditions. Studies have shown that the effectiveness of therapy increases significantly when famciclovir is prescribed in higher dosages. In patients with good immunity, a more effective regimen will be 500 mg 2 times a day (for 5 days). In immunocompromised patients - 500 mg 3 times a day (for 7 days).

Important: once again we draw your attention to the fact that short 1-day treatment regimens for herpes in adults (herpes on the lips and skin around the mouth, on the face) work well only if the following conditions are met. Firstly, only if you start taking medications no later than 12 hours from the moment the herpetic rash appears. Secondly, if you have a satisfactory or good immune system. If treatment is started later than 12 hours from the onset of the rash, as well as in patients with weakened immune systems, short 1-day courses of therapy are usually ineffective. Here we already need a standard regimen of administration.

Important : if more than 12 hours have passed since the first rash appeared (and even more so if more than 24 or 48 hours), it is better to opt for famciclovir, because the latter works better at later dates of initiation of therapy for herpetic infection.

Preventive measures

To avoid the development of such an unpleasant and even dangerous disease as herpetic glossitis, you should adhere to the following tips and recommendations:

• you need to carefully care for your oral cavity, brush your teeth and tongue twice a day, rinse your mouth every time after eating,
• It’s better to stop smoking and drinking alcohol at least for a while,
• it is necessary to carefully control your diet, avoid too salty, spicy and sour foods, cold and hot dishes and drinks,
• it is important to regularly undergo preventive examinations not only with a dentist, but also with a gastroenterologist and immunologist,
• At the first symptoms of pathology, you should immediately seek medical help.

Regular brushing of teeth and tongue will help reduce the risk of disease.
Any form of glossitis, including herpetic, in the vast majority of cases develops against a background of weakened immunity. Therefore, an equally important condition for maintaining complete disease prevention is a healthy lifestyle. Walk outdoors more often, play sports, eat right, and don’t forget to take a responsible approach to oral hygiene.

1. Borovsky A.L. Diseases of the mucous membrane of the oral cavity and lips, 2001.

How does the virus become infected?

The virus can be infected in different ways: airborne droplets, contact (through shared towels, cutlery, through kissing), sexual intercourse, self-expression (when the virus from ulcers enters healthy mucous membranes and infects them). You can become infected through a blood transfusion and a child can receive the virus from the mother in utero. The incubation period (from the moment of contact until the first signs appear) is 2-14 days. A person becomes contagious as soon as sores appear on the lip, and is contagious to others until the scabs fall off .

Photo: One of the most common ways of transmitting herpes is contact.

Stomatitis: how to overcome the “language barrier”?

Stomatitis on the tongue is just one of the manifestations of this “popular” disease. There are a huge number of reasons for its appearance, as well as ways to treat it.

There are several types of stomatitis, when it manifests itself specifically on the tongue: glossitis, viral stomatitis, vesicular stomatitis, enteroviral vesicular stomatitis, catarrhal stomatitis, fungal stomatitis, etc.

In general, stomatitis on the tongue is most common. Its notable feature is small ulcers, from which the patient suffers greatly. If inflammation is observed only on the tongue, and, for example, there are no signs of stomatitis on the palate, cheek or gum, then this disease is called glossitis.

Herpes during pregnancy

The influence of genital herpes on the course of pregnancy and the condition of the fetus is realized by two mechanisms:

• infection of the fetus, amniotic fluid, placenta and membranes, and varying degrees of spread of infection are observed (generalized infection of the fetus and placenta, local infection of the fetus, teratogenic effects on the embryo and fetus, latent infection of the fetus with clinical manifestations in the postnatal period);
• indirect influences in the form of fever, disturbances in general homeostasis due to severe infection, dysfunction of the fetoplantar complex, disturbances in the immune and hormonal balance.

In case of primary herpes during pregnancy, HSV can enter the fetoplacental link due to maternal viremia (spread of the virus in the mother’s blood).

Herpes during early pregnancy

Herpes during pregnancy in the first trimester causes severe congenital anomalies and spontaneous abortion.

The results of recent studies suggest that primary herpes infection in the second and especially in the third trimester of pregnancy poses an even greater risk to the fetus and newborn.

Perinatal HSV morbidity and mortality occur in 40-50% of fetuses and newborns whose mothers had their first episode of genital herpes during pregnancy.

If the disease recurs during pregnancy, the incidence of the disease in the newborn is much lower, but the risk is still significant - 3-4%.

How to treat a disease with folk remedies

Treatment of herpetic glossitis at home can only be as a concomitant therapy. To put an end to the problem once and for all, you need competent diagnosis and the help of a specialist. Let us remind you: only a doctor has the right to prescribe medications, and without his consent, you should under no circumstances make any attempts to cure the disease yourself. All this can end not only in vain, but also very disastrously.

If the specialist has given the go-ahead for the use of traditional methods, you should pay attention to medicinal herbs. For example, tea tree oil effectively promotes the restoration of mucosal tissue. Also, in the fight against glossitis, rinsing with a decoction of chamomile and a light solution of hydrogen peroxide have proven themselves to be excellent.