Can you get herpes on the tongue?

Herpes Infection on the Tongue: Clinical Features and Management

Yes, herpes simplex virus can definitely infect the tongue, causing painful lesions that require prompt treatment to reduce morbidity and discomfort. 1

Pathophysiology and Transmission

Herpes infections on the tongue can be caused by both HSV-1 and HSV-2, though HSV-1 is more commonly associated with oral infections. These infections occur through:

• Direct contact with infected lesions or body fluids (typically saliva) 2
• Oro-genital sexual practices that can transmit both HSV-1 and HSV-2 to the oral cavity 1
• Autoinoculation from existing herpes lesions elsewhere on the body

Clinical Presentation

Herpes infections on the tongue present with distinctive features:

• Primary infection:

  • Vesicular eruptions on the tongue following an incubation period of about 1 week 2
  • May involve other oral sites including gingiva, buccal mucosa, hard and soft palate 2
  • More severe symptoms including fever, malaise, and significant pain

• Recurrent infection:

  • Painful vesicles that rupture to form ulcers on the tongue 3
  • In immunocompromised patients, may present as "herpetic geometric glossitis" with distinctive cross-hatched, branched, and/or linear fissures on the dorsal aspect of the tongue 4
  • Extreme pain is a hallmark symptom, distinguishing it from similar-appearing but painless tongue lesions of other conditions 4

Diagnosis

Diagnosis of herpes infection on the tongue is primarily clinical but may require laboratory confirmation:

• Grouped vesicles or ulcers on the tongue with associated pain 5
• Laboratory confirmation is particularly important in immunocompromised patients 2
• Viral culture or nucleic acid amplification tests (NAATs) are the preferred diagnostic methods 1

Treatment

Treatment should be initiated promptly, ideally during the prodromal stage or within 48 hours of lesion onset:

• Oral antiviral medications:

  • Acyclovir (Zovirax)
  • Valacyclovir (Valtrex) - better bioavailability than acyclovir
  • Famciclovir (Famvir) - better bioavailability than acyclovir 5

• For immunocompromised patients:

  • Systemic acyclovir therapy has been shown to resolve symptoms within 1-2 days and heal fissures within 3-12 days 4

Prevention and Suppressive Therapy

For patients with frequent recurrences (six or more episodes per year):

• Chronic daily suppressive therapy with oral antivirals is recommended 5
• This approach reduces frequency and severity of recurrences

Special Considerations

• Immunocompromised patients are at higher risk for more extensive and aggressive recurrent HSV-1 infections in the mouth 2
• Quality of life impact is significant, with both physical discomfort and psychological implications 6
• Contagious nature requires patient education about avoiding close contact during active outbreaks 5

Clinical Pitfalls to Avoid

• Do not rely solely on clinical diagnosis without laboratory confirmation, especially in atypical presentations or immunocompromised patients 1
• Do not delay treatment - early intervention (within 48 hours) is crucial for optimal outcomes 5
• Do not overlook the possibility of HSV-2 causing oral lesions, which is becoming increasingly common 2
• Do not confuse herpetic lesions with other conditions that can cause similar-appearing but typically painless tongue lesions 4

Prompt recognition and treatment of herpes infections on the tongue are essential to reduce the duration of symptoms, hasten healing, and improve quality of life for affected patients.