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Learn More About The 7 Most Common Sore Throat Ailments

Herpes Stomatitis & Cold Sores

Herpes Stomatitis and Cold Sores

Initial Herpes Stomatitis usually occurs during infancy or childhood. It presents with multiple intraoral vesicular blisters and erosions which often have a red border. These blisters occur on the buccal mucosa (soft tissue on the inside of the cheeks), the gums, on the inside of the lips and sometimes the soft palate. Sometimes a fever is present, the child feels ill and may stop eating and drinking. Recurrent Herpes Cold Sores occur only months or years after an initial infection, and are sometimes preceded by a prodrome (premonitory symptom) of a day of tingling, burning or pain on the lip. There is usually no fever and the child is usually not ill.


Figures 1-3. Shows grouped vesicles on a reddened base on the outer surface of the lips. When these vesicles erupt, they will eventually form a crusted scab. This is a recuurent herpetic infection.

Figure 2.

Figure 3.

Find links to the other common sore throat ailments in our Sore Throat Guide at the bottom of the page.

Normal Throat 

Herpes/Cold Sores

A Normal Throat is pink rather than fire-engine red, and has no sores or ulcers. Size of tonsils will vary, but the tonsils will not be a very different color from the surrounding throat tissue.

Initial Herpes Stomatitis multiple blisters inside the lips (a.) or on the soft palate (b.). Recurrent Herpes (Cold Sores) small blisters on lips and skin near nose and chin (c.).

A persons initial infection with the Herpes Simplex Type 1 virus may result in multiple diffuse vesicles in the mouth called Stomatitis, though many initial infections are without any symptoms. Recurrent Herpes Cold Sores only occur after an initial infection, and only after a latency period of months to years. These recurrent sores are located on the lip/skin border.

Initial Herpes Simplex virus type 1 is transmitted through close contact with oral secretions. Transmission is greatest when the blisters are present. Incubation period is usually about one week, but may be as long as a month or a short as 2-3 days. Recurrent Herpes Cold Sores represent reactivation of a latent or sleeping virus that has survived for months or years after the initial infection. Sometimes the trigger for reactivation can be sunlight exposure, trauma, or emotional stress. If you have had Herpes Simplex type 1 infection already and you have a normal immune system, you cannot catch it again from another person. Rather, you reactivate your old sleeping virus.


Initial Herpes Stomatitis and recurrent Herpes Cold Sores usually can be diagnosed by inspection. The blisters of the Herpes Cold Sores will eventually dry out and begin to scab, and it can then be difficult to determine if they have been secondarily infected by bacteria. If the diagnosis is in doubt, your provider may swab an unroofed blister for a viral culture, or scrape the base of a blister for a smear on a microscope slide, or for a newer test called a direct immunofluorescent smear.


Most Herpes infections resolve in about a week on their own, and are self-limited. Initial Herpes Stomatitis may lead to dehydration from inadequate fluid intake. Recurrent Herpes Cold Sores can be painful, and embarrassing for children and adolescents. Herpes viral infections may be very dangerous in newborns and individuals with compromised immune systems. They can be spread to the cornea of the eye, to skin sites far from the mouth, and can cause infections of the brain.


Most experts would recommend treating the initial Herpes Stomatitis with oral antiviral medication if started in the first 72 hours, in order to shorten the illness and decrease the severity. Initial Herpes Stomatitis also may need pain medication and encouragement of fluid intake. At this time, there is no medication to consistently benefit the Recurrent Cold Sores once they have been detected. There is evidence that oral antiviral medication taken every day or at the first sign of the prodrome may be helpful.