Fever Blisters: An Overview of Type 1 Oral Herpes

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Guest: Dr. J. Mark Barry - DDS, MBA

Host: Dr. Linda Austin – Psychiatrist

Dr. Linda Austin: I am Dr. Linda Austin. I am talking today with Dr. Mark Barry, who is Associate Dean for Clinical Affairs for the MUSC College of Dental Medicine. Dr. Barry, let’s talk about herpes. Herpes is an illness for which there has always been a certain amount of stigma, why is that?

Dr. J. Mark Barry: Well, because of the sexual connotations with herpes. The herpes that we deal within dentistry is the oral herpes and that’s caused by the herpes simplex virus, which in the layman’s term we commonly refer to that as a fever blister.

Dr. Linda Austin: Way back when I was in Medical School, I remember there was type 1 herpes, which back then at least was oral and type 2 which was genital, do you still use that designation type 1 and type 2?

Dr. J. Mark Barry: Yes, we do. The herpes simplex virus 1 is associated with the oral cavity and the HSV2 with genital herpes.

Dr. Linda Austin: How does someone get type 1 herpes or oral herpes?

Dr. J. Mark Barry: It’s a virus and as most viruses, it’s contagious, it can be contracted simply from contact and so statistically over half a million people are exposed to the virus every year. The herpes simplex virus 1 comes in two stages. There is an early stage or a primary stage and then there is a secondary stage. Primary stage usually affects children and typically babies and when a baby is affected with herpes simplex virus 1, you really don’t know because babies can’t talk. They will cry, but they cry for when they are hungry or when they wet their pants, and we really don’t get much of an opportunity to treat herpes virus 1 with children. It’s a virus and like any virus it runs its course and so it will resolve. What we are primarily concerned with, is with adults and that’s the recurrent or the secondary herpes because once you have the herpes virus as a child or as a young adult, you will always have it. I always say it’s the gift that keeps on giving. So, the virus lives in your body, it lives in the nerve of cells.

Dr. Linda Austin: Now, I know some people listening to this, who have secondary herpes will be very concerned about not wanting to pass it on, should they have that concern or there are things they can do not to pass that on?

Dr. J. Mark Barry: Yes, it’s only contagious during certain stages when the virus is shedding, when you have the active lesion which is very apparent on looking at yourself. When the virus is shedding, it’s in the contagious stage about. Probably about 20% to 25% of the population, the adult population is plagued with these fever blisters or herpes.

Dr. Linda Austin: What are the symptoms of secondary herpes, what is it feel like, how severe can it get?

Dr. J. Mark Barry: It’s a great question and part of the answer of treating herpes is, knowing the symptoms. Because there is a stage and for any of your audience listeners, who have been afflicted with fever blisters they know what I am talking about. There is a stage and we call it the prodrome stage. What that means is, it’s about a 24 to 48-hour period prior to the little lesions or bubbles or vesicles or blisters that pop up. You experience a tingling, numbing, and sort of a affect that you know that within the short period of time, these lesions or these little blisters are going to show themselves, so it’s a kind of a tingling, numbing, and feeling or sensation and that’s we call the prodrome and the reason that’s important is because you can actually prevent the herpes from occurring if you treat the herpes during that stage or that prodrome stage.Dr. Linda Austin:Treat with what?

Dr. J. Mark Barry: There are different therapies and there are different medicines that can be used for treating herpes and during that prodrome stage of that tingling, itching, and burning sensation that the patients will feel, you can have your dentist prescribed an antiviral medication and typically medication acyclovir is what we use and assist a short regimen that we put you on. It’s about a five-day regimen and if you take it during that prodrome stage that I described the itching, tingling, and numbing sensation then the lesion may actually not occur. So, it can essentially abort the lesion before it ever occurs. Once the lesion or the blister type lesion occurs then taking the medication will not do anything, so that’s one way to treat it with the viral medication.

Dr. Linda Austin: Are there other ways to treat it?

Dr. J. Mark Barry: There are patients who are plagued with recurrent herpes, in other words say, you get fever blisters once a month or twice a month and you are just continually plagued and it’s quite bothersome for you then your dentist can put you on what we call a prophylactic or preventive regimen of acyclovir. There are other antiviral drugs too, but we will just use acyclovir as the example and you can be placed on a daily regimen of acyclovir for six months or may be up to a year and what this does, is this prevents the lesion from ever recurring, prevents the viral replication and so the lesion just don’t ever occur. Once the lesions or the little blisters we call them have occurred and you haven’t taken anything to prevent them or you are not taking anything prophylactically, really the treatment there is aimed at symptomatic relief or trying to eliminate the pain because they can be quite painful. They start off these blisters and then within 24 hours or so they will ulcerate, the blisters will pop and the little lesions will ulcerate and they will become quite painful. So, at this stage of the game, then a topical anesthetic a benzocaine or ever an over-the-counter topical anesthetic that your dentist can prescribed an anesthetic can be used simply to provide relief of the pain during the course of the lesions and again it’s a virus, so you have to let it run its course and eventually within 7 to 10 or 14 days it will go away.

Dr. Linda Austin: I have heard that there are home remedies for herpes, are those effective?

Dr. J. Mark Barry: It’s interesting you asked that because actually, I have recommended to my patients who are plagued with herpes lesions or the fever blisters that when they go through that prodrome stage that I described earlier that numbing, itching, and tingling stage that they apply ice to their lips or to the area that’s tingling and numb as much as they can stand for as long as they can stand it. Now, this is sort of a home remedy kind of a wives? tale, but it actually works in many cases. The ice will denature the protein and stop the replication of the virus and the lesions may not occur. It’s not 100%, but it’s something that our patients can try if they are plagued with these lesions and just see what happens.

Dr. Linda Austin: Dr. Mark Barry, thank you so much for talking with us today.

Dr. J. Mark Barry: Thank you very much.

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