Tongue Herpes: Detailed Symptoms, Causes, and Treatment Options

Herpes simplex virus (HSV or herpes virus) is a common viral infection that causes painful blisters or ulcers (herpes sores) in the affected area. 

Once a person is infected with HSV, the virus remains in their body for the rest of their life. While the virus is dormant, it remains inactive in nerve cells. Some people never experience any symptoms from HSV, while others have an initial (primary) infection with symptoms, and others have periodic outbreaks of herpes throughout life.

The National Institutes of Health, CDC fact sheet, and World Health Organization estimate that about 90% of adults have been exposed to HSV-1 (oral herpes simplex virus) by age 50. Experts believe 50-80% of adults in the US have the virus in their bodies. 

Common Symptoms

The initial (primary) infection with oral herpes simplex virus causes the most severe symptoms. Symptoms during subsequent periodic outbreaks tend to be milder. 

As noted, some people may have no symptoms at all from an HSV infection, others have symptoms only during the initial infection, and yet others have recurrent outbreaks of oral (mouth and tongue) herpes.

When present, the most common symptoms include flu-like symptoms (fever, body aches, muscle aches, headache, and swollen lymph nodes). Painful, fluid-filled ulcers develop on and around the lips and in the mouth, including the tongue, the insides of the cheeks, and the roof of the mouth. 

Causes of Herpes on the Tongue

Herpes Simplex Virus Overview

There are two types of HSV virus:

• Herpes simplex virus type 1 (HSV-1) spreads through oral contact and causes mouth infections. This infection is called oral herpes, cold sores, fever blisters, mouth herpes, or tongue herpes. 

• Herpes simplex virus type 2 (HSV-2) spreads through sexual contact and causes genital herpes.

Note: Both types of herpes viruses can cause both mouth and genital herpes infections.

How Does Herpes Spread?

Most people get infected with HSV-1 during childhood or young adulthood through skin-to-skin close contact with an infected person. Transmission of the virus occurs through infected saliva through both sexual and nonsexual contact (kissing, touching, and sharing objects like cosmetics, razors, and eating utensils).

HSV-2 (which causes genital herpes) spreads mainly through sexual activity (direct contact during sex with an infected person through touching of the genital or anal skin or contact with fluid leaking from herpes sores). 

HSV-1 and HSV-2 can be transmitted from person to person even if there are no visible sores, i.e., even if the skin looks normal and the infected person does not have any symptoms.

Can You Get Genital Herpes from Cold Sores?

Yes, you can get genital herpes from cold sores through oral sex. A person who has cold sores (caused by HSV-1) can transmit the virus to their sexual partner during oral sex, and HSV-1 can cause genital herpes in the person receiving oral sex. 

Remember, a person with an HSV mouth infection can pass on the infection through oral sex even if they don’t have any visible sores. Using a condom during oral, vaginal, and anal sex can prevent a sexually transmitted infection such as genital herpes. When receiving oral sex, women should have their partners use a dental dam to protect against genital herpes. 

Learn about the best cold sore treatment.

Risk Factors

Risk factors for oral (mouth and tongue) herpes include activities that can expose you to an infected person’s saliva, such as mouth-to-mouth contact (kissing or touching) and shared items such as razors, cosmetics (lip balm), eating utensils, and drinkware.

Outbreaks of oral (mouth and tongue herpes) can be triggered by stress, hormonal changes, sun exposure, and illnesses.

Symptoms of Herpes on the Tongue

How Do I Know If I Have Herpes on my Tongue?

You may be able to tell you have herpes on your tongue if a cold sore starts to form there. Before a sore becomes visible, the area typically becomes red, swollen, painful, and warm. You may have an itching, tingling, or burning sensation in the area. Following this, one or more painful sores or blisters may appear and leak highly contagious fluid. After about 4-6 days, the herpes blisters will start to crust over and heal.

What Does Oral Herpes Look Like?

Oral (mouth and tongue) herpes can cause a single sore or a cluster of sores in or near the mouth. These sores are painful, fluid-filled blisters that break open, ooze fluid, form a crust, and heal. Cold sores or fever blisters are highly contagious.

Duration of Oral (Tongue) Herpes 

Symptoms of mouth herpes typically appear 4-12 days after exposure to the virus. There are five stages of a cold sore:

• Tingling, itching, burning, redness, and swelling at the site where the sore will form (this is called the prodrome phase).

• Formation of the blister 1-2 days later

• Bursting of the blister after 4-6 days.

• Scab formation or crusting over after 5-8 days.

• Healing time (2-4 weeks in an initial infection and 7-10 days for recurrent outbreaks).

Possible Complications

A herpes infection can be dangerous if the sores develop in or near the eyes (herpes keratitis). A herpes mouth infection can also cause problems in people who have a weakened immune system, for example, those with cancer or HIV. Possible complications of oral herpes include spread of the infection to other parts of the body, secondary bacterial infections, and widespread infection in the body.

Diagnosis of Herpes on the Tongue

Your healthcare provider can diagnose oral (tongue) herpes based on the location and appearance of the blisters on physical examination. 

Diagnostic Tests

To confirm a diagnosis of tongue herpes, your doctor may order tests including a blood test, virus culture, and biopsy.

What Can Be Mistaken for Herpes on Tongue?

The following conditions can be mistaken for herpes on the tongue or mouth:

• Aphthous ulcers (canker sores), which are painful yellow or white ulcers that form on the mucous membranes (lips, gums, insides of the cheeks, tongue). However, unlike cold sores, canker sores are not contagious. 

• Stevens-Johnson syndrome, a rare but serious skin reaction to medications that causes flu-like symptoms, rash, and blisters. 

• Erythema multiforme, an allergic reaction to medications that causes red, raised areas in the skin.

• Herpangina, a viral illness caused by coxsackie viruses that causes small blisters or bumps in the mouth. 

Your doctor can differentiate between these conditions based on your symptoms, history, and physical exam.

Medical Treatment: How Do You Get Rid of Herpes Sores On Your Tongue?

Oral Antiviral Medication to Treat Herpes

Your doctor may prescribe oral antiviral medications such as acyclovir, valacyclovir, or famciclovir to treat an active infection. These drugs can lead to faster healing of the blisters, decreased pain, and a shorter duration of the illness. They work best if you start taking them within 72 hours of symptom onset. Check out: Valacyclovir for Treating Herpes: What to Know.

Treatment of oral (tongue) herpes with antiviral drugs can also reduce viral shedding and lower the risk of spreading the infection to others. Keep in mind that the dosage and duration of treatment can be different for genital herpes. 

The usual treatment duration is 7-10 days, and the recommended dosing is as follows:

• Acyclovir 400 milligrams (mg) by mouth 3 times a day or 200 mg by mouth 5 times a day.

• Valacyclovir 2 grams by mouth every 12 hours for 1 day (2 doses total).

• Famciclovir 1,500 mg by mouth as a single dose.

Topical Antiviral Medicines: Creams for Tongue Herpes

Topical antivirals, such as acyclovir cream, work best when they are applied during the prodrome phase (when there is tingling and itching but a cold sore has not yet formed). However, they can be applied at any time during an oral herpes outbreak. The usual dose is application 5 times a day for 4 days. 

Other Treatments for Herpes of the Tongue and Mouth

• Topical analgesics for pain relief, for example, mouth rinses containing local anesthetics such as lidocaine or benzocaine.

• Oral over-the-counter (OTC) pain relievers such as Tylenol (acetaminophen) and Advil (ibuprofen).

• Antibiotics are only used for secondary bacterial infections. A virus causes herpes infections. Therefore, antibiotics should never be used to treat herpes infections, as they are ineffective and can be harmful. 

Home Remedies and Self-Care

In addition to prescribed medical care, you should keep the infected area clean and dry. Avoid touching the sores. Use a cotton swab to apply topical antiviral medications to the herpes blisters. Wash your hands with soap and water if you do touch the blisters. 

Prevention and Precautions

Preventing Transmission of Mouth Herpes

• Avoid direct skin-to-skin contact with a person who has herpes sores.

• Don’t share items such as lip balm, glasses, straws, and utensils with an infected person.

• Use dental dams and condoms during oral, vaginal, and anal sex.

• Avoid oral sex if you or your sexual partner has oral herpes.

Lifestyle Changes

Certain things can trigger oral (tongue) herpes outbreaks. Avoiding them can lower your risk of getting recurrent infections.

• Eat a healthy, balanced diet to support your immune system.

• Get enough sleep to strengthen your immune system.

• Manage stress (chronic stress can weaken your immunity). 

• Protect yourself from the sun, wind, and extreme temperatures.

Does Oral (Tongue) Herpes Go Away On Its Own?

In most people, oral herpes goes away on its own in 1-2 weeks. However, an oral (mouth and tongue) herpes infection can be dangerous in some situations. Call your doctor if: 

• This is your first herpes outbreak.

• You are getting frequent outbreaks of herpes.

• You have a weakened immune system from a medical condition such as cancer or HIV.

• You are taking immunosuppressive drugs.

• You develop a cold sore in or near your eye. 

• The sores don't heal within 2 weeks.

• You have severe herpes symptoms, and pain from tongue herpes is causing problems with eating or drinking.