What viruses cause oral ulcers (mouth ulcers)?

From the Guidelines

Herpes simplex virus (HSV-1) is the most common viral cause of mouth ulcers, typically producing painful sores called cold sores or fever blisters. Other viruses that can cause mouth ulcers include coxsackievirus (causing hand, foot, and mouth disease), varicella-zoster virus (causing chickenpox and shingles), Epstein-Barr virus (causing infectious mononucleosis), and cytomegalovirus 1. For viral mouth ulcers, treatment focuses on symptom relief while the immune system fights the infection. Some key points to consider in the management of viral mouth ulcers include:

• Over-the-counter pain relievers like acetaminophen or ibuprofen can help manage discomfort.
• Topical anesthetics such as benzocaine gel or lidocaine can temporarily numb the area.
• For herpes-related ulcers, antiviral medications like acyclovir (400mg five times daily for 5 days), valacyclovir (1g twice daily for 7-10 days), or famciclovir (250mg three times daily for 7-10 days) may reduce healing time if started early 1.
• Maintaining good oral hygiene, staying hydrated, avoiding spicy or acidic foods, and using saltwater rinses (half teaspoon salt in 8 ounces warm water) can provide additional relief.
• Viral ulcers typically heal within 1-2 weeks without scarring.
• If ulcers persist beyond two weeks, are extremely painful, or are accompanied by high fever, seek medical attention as this may indicate a more serious condition requiring professional evaluation 1. It's also important to note that the diagnosis and treatment of oral ulcers can be complex and may require a comprehensive approach, including detailed medical history, physical examination, and laboratory tests 1. In some cases, a biopsy may be necessary to determine the underlying cause of the oral ulceration 1. Overall, the management of viral mouth ulcers should prioritize symptom relief, prevention of complications, and prompt evaluation for any underlying conditions that may require medical attention.

From the Research

Viruses Causing Oral Ulcers

• Herpes simplex virus (HSV) is a major cause of oral ulcers, particularly in immunocompromised patients 2, 3, 4, 5.
• Cytomegalovirus (CMV) can also cause oral ulcers, often in conjunction with HSV 2, 5.
• Epstein-Barr virus (EBV) has been found to be present in oral ulcers, along with HSV and CMV, in some cases 2.
• Coxsackie A16 virus, which causes hand-foot-and-mouth disease, can also lead to oral ulcers, although the treatment with acyclovir is effective due to other mechanisms 6.

Immunocompromised Patients

• Immunocompromised patients are more susceptible to oral ulcers caused by viruses such as HSV, CMV, and EBV 2, 3, 4, 5.
• These patients may experience more severe and persistent oral ulcers, and may require antiviral therapy to manage their symptoms 3, 5.

Antiviral Therapy

• Acyclovir is a commonly used antiviral medication for the treatment of oral ulcers caused by HSV and other viruses 3, 4, 5, 6.
• Other antiviral medications, such as ganciclovir and famciclovir, may also be effective in treating oral ulcers caused by CMV and other viruses 3, 5.