Herpes on Tongue: Symptoms, Transmission & Treatment

Herpes on the tongue is an infection caused by the herpes simplex virus (HSV), leading to small blisters on the tongue, pain or sores, difficulty eating, general malaise, fever, or body aches.

Also known as herpetic stomatitis, tongue herpes is caused by the herpes simplex virus type 1 (HSV-1) and spreads through direct contact with saliva or objects contaminated with the virus.

Treatment for herpes on the tongue is prescribed by a primary care provider, dentist, or pediatrician, and usually involves antiviral or pain relief medications to ease symptoms while the immune system fights off the infection.

Main symptoms

Common symptoms of herpes on the tongue include:

• Small, painful blisters on the tongue;

• Sores or ulcers that appear when the blisters burst;

• Pain in the tongue and mouth;

• Difficulty eating or swallowing;

• Excess saliva production.

Herpes on the tongue can also cause fever, which may develop one to two days before the blisters appear, along with body aches, headache, and general discomfort.

Besides the tongue, this type of herpes can also affect other parts of the mouth, such as the inside of the cheeks, gums, roof of the mouth, and inner lips.

If symptoms of herpes on the tongue occur, it’s important to see a healthcare provider or dentist to begin appropriate treatment.

Confirming a diagnosis

Diagnosis of herpes on the tongue is usually made clinically by a doctor, dentist, or pediatrician through an evaluation of symptoms, medical history, and a physical examination.

During the exam, the healthcare provider observes the appearance of the lesions on the tongue and inside the mouth. In most cases, additional tests are not needed.

Diagnosis can be confirmed by a PCR test (polymerase chain reaction) using a swab of the lesion to detect the herpes simplex virus. Blood tests for HSV antibodies are not typically used to diagnose active oral herpes but may be ordered in specific cases when the diagnosis is uncertain.

Transmission and spread

Herpes on the tongue is transmitted through direct contact with saliva or secretions that contain the herpes simplex virus type 1 (HSV-1).

The virus can spread through saliva exchange (usually from kissing), droplets from coughing or sneezing, and use of contaminated utensils or dental tools.

Possible causes

Herpes on the tongue is caused by an HSV-1 infection that multiplies in the tongue or the lining of the mouth.

After the initial infection, when symptoms are usually more intense, HSV-1 remains dormant in the trigeminal ganglion and can reactivate when the immune system becomes weakened.

Situations that can trigger reactivation include fever or other infections (such as HIV), trauma or injury, sun exposure, excessive stress, autoimmune diseases, and cancer treatments.

Treatment options

The main treatments for herpes on the tongue include:

1. Medications

The main medications a healthcare provider may prescribe include:

• Pain relievers or anti-inflammatories, such as acetaminophen or ibuprofen, to help reduce pain and fever;

• Antiviral tablets, such as acyclovir or valacyclovir, to stop the herpes simplex virus from multiplying and speed up recovery; 

• Intravenous antivirals, like acyclovir, in more severe cases.

Doctors may also recommend mouth rinses or topical gels containing benzocaine or cetylpyridinium chloride to relieve pain and discomfort caused by tongue herpes. (Benzydamine, used in countries like the United Kingdom, is not commercially available in the United States.)

2. Proper hydration

It’s important to stay well-hydrated during an outbreak of herpes on the tongue to prevent dehydration, especially when fever or difficulty swallowing occurs.

Drink small sips of cold water throughout the day and avoid acidic drinks, which can irritate the lesions. In severe cases, hospitalization may be needed for intravenous (IV) fluids.

3. Diet modifications

A soft or liquid diet is recommended during an outbreak. Foods like soups, porridge, and purees are ideal. Acidic or spicy foods should be avoided as they can increase irritation and discomfort.

4. Hospitalization

Hospitalization may be required for children, people with weakened immune systems, or severe cases of herpes on the tongue.

In these situations, there’s a higher risk that the infection could spread to other parts of the body, potentially leading to complications such as pneumonitis or herpetic encephalitis.

While hospitalized, patients typically receive IV fluids and medications until they fully recover.

Possible complications

Possible complications of herpes on the tongue include:

• Dehydration;

• Eczema herpeticum;

• Pneumonitis;

• Herpetic encephalitis.

Because of these risks, it’s important to see a healthcare provider, dentist, or pediatrician as soon as symptoms of herpes on the tongue appear, so treatment can start early in order to prevent serious complications.