Can I get a cold sore on my tongue?

herpes cold sore
An outbreak of herpes sores on a child's face. Similar blisters appear on the genitals during a genital herpes outbreak.. Photo courtesy of the CDC/ Dr. K. L. Hermann

Question: Can I get a cold sore on my tongue?

Most people think of cold sores as an annoyance, which they pretty much are. However, it is important to know that they are a contagious annoyance. Cold sores are caused by a herpes virus, and they can be transmitted by both kissing and oral sex. In fact, cold sores tend to run in families because they are so easy to spread by even the types of casual familial affection that people experience growing up.

A significant fraction of people with oral herpes are infected by the age of 13, not because they've been sexually active at an early age, but because they've been exposed when a relative kissed them on the cheek.

Answer:

Cold sores are generally caused by the HSV-1 virus, although they can also be caused by HSV-2, the virus more commonly associated with genital herpes. Most people get cold sores around their lips; however, they can affect other areas of the face, body, and mouth as well.

Although recurrent herpes outbreaks inside the mouth aren't terribly common in otherwise healthy individuals, it is possible to get cold sores on your tongue, the roof of your mouth, and even on your gums. During times of high stress you may be more likely to experience such extensive outbreaks, but they can also be a sign of other underlying health problems. If your herpes outbreaks are becoming more serious over time, you should discuss it with your doctor.

Worsening outbreaks may be a sign of problems with your immune system. For example, such outbreaks are more common in people who are immunocompromised.

If you get a cold sore on your tongue, it will look and feel similar to the cold sores that you get elsewhere on your body, such as your lips. If you are someone who has frequent, and or painful outbreaks, you might want to discus treatment options with your doctor.

Suppressive therapy can not only reduce the frequency and severity of your outbreaks, it can reduce the likelihood of your transmitting herpes to a sexual partner - either by kissing or during oral sex.

To reduce the likelihood of transmitting herpes to a partner during oral sex, you can also use barrier methods. A condom can be used to cover the penis during fellatio, and a dental dam can be used as a barrier during cunnilingus or rimming. Although these barriers may not be perfectly protective, they will definitely decrease your partner's risk, and individuals with oral herpes may want to consider using barriers even when they do not have cold sores. As with genital-genital herpes transmission, oral-genital herpes transmission can occur even in the absence of symptoms.

Note: HIV infection can also cause ulcers on the tongue. If you have recurrent ulcers present in your mouth, talk to your doctor about HIV testing.

Source:

Arduino PG, Porter SR. Herpes Simplex Virus Type 1 infection: overview on relevant clinico-pathological features. J Oral Pathol Med. 2008 Feb;37(2):107-21.

Sauerbrei A, Schmitt S, Scheper T, Brandstädt A, Saschenbrecker S, Motz M, Soutschek E, Wutzler P. Seroprevalence of herpes simplex virus type 1 and type 2 in Thuringia, Germany, 1999 to 2006. Euro Surveill. 2011 Nov 3;16(44). pii: 20005.

Usatine RP, Tinitigan R. Nongenital herpes simplex virus. Am Fam Physician. 2010 Nov 1;82(9):1075-82. 

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