Aphthae and herpes
What are Aphthae?
Aphthae (or canker sores) are ulcers that are typically round or oval and occur on the inside of the lips or underneath the tongue. They are very common and affect between 30-60% of the population.
The cause of aphthae is still uncertain but hereditary factors are certainly significant with approximately 40% of people who get them having a family history of aphthae.
The main causes of aphthous ulcers include: emotional stress and lack of sleep, local injury by an accidental self-inflicted bite, nutritional/vitamin deficiencies (especially iron and folic acid, vitamins B1, B2, B6, B12 and vitamin C), the menstrual cycle and certain foods (including coffee and chocolate). Aphthae can be divided into three types of ulcers.
Recurrent minor ulcers amount for over 80% of aphthae cases. These are usually between 1-10 mm in diameter and heal spontaneously within 7-10 days. Recurrent major ulcers can be in excess of 10mm in diameter and can take months to heal. When they do they usually leave a scar behind. Herpetiform ulcers are multiple, clustered 'pin-prick' ulcers that usually occur on the tongue and can take up to a month to heal. Usually numbering between 2-10, they can number as many as 100.
In all cases, but especially with recurrent major ulcers, the sores can be painful, particularly if irritated by certain foods.
What is Herpes?
The herpes simplex virus is very common and can cause painful blisters and sores almost anywhere on a persons body. However infections are most common around the mouth and the genitals. Consequently herpes can be divided into two types: type 1 and type 2.
Herpes Simplex Type-1 (Herpes Labials, also known as Cold Sores) : It is estimated that between 60% and as many as 95% of people are infected with HSV-1 although only between 10-30% of these will develop recurrent oral-facial herpes infections. Most people catch the virus during childhood from close contact with family or friends who carry the virus. The virus can be transmitted by kissing, or by using glasses, cups and eating utensils or towels used by an infected person.
The main symptom of HSV-1 infection is the outbreak of blisters filled with fluid around the lips or nose. These can be painful and itchy. Other flu-like symptoms may accompany these outbreaks including fever, headache, muscles aches, and tiredness.
Usually the blisters will disappear by themselves within ten days but the virus will remain dormant in the body among clusters of nerve cells until the next outbreak is triggered. Common triggers include: illness, stress, fatigue and menstruation.
Many people are able to tell when an outbreak is going to occur because they notice a tingling sensation (known as the prodome stage). It is also at this stage when a person is particularly contagious.