Cold sores, or oral herpes, are blisters that form on or near the lips, nose, or mouth. In some cases, cold sores can form on the tongue. Treatments can include medications and home remedies.

There are two strains of the herpes simplex virus (HSV). HSV type 1 (HSV-1) is the strain usually responsible for cold sores.

In this article, we discuss cold sores on the tongue, including their causes, symptoms, and treatment.

cold sore or herpes blister on the tonugeShare on Pinterest
Strains of HSV cause cold sores on the tongue.
Image credit: CDC/Robert E. Sumpter, 1967.

The most prominent symptom of a cold sore is a painful blister.

People may also experience additional symptoms if they have a new HSV infection. These symptoms can include:

A cold sore outbreak occurs in different phases:

  1. A burning, tingling, or itching sensation develops in the area of the outbreak before the blister appears.
  2. One or more fluid filled blisters develop in the affected area.
  3. The blisters rupture and leak fluid, leaving an open wound.
  4. A crusty scab forms over the wound.
  5. The cold sore heals, and the skin returns to normal.

Cold sores often resolve on their own without medical treatment. However, if people take antiviral medication early — within 24 hours of symptom onset — it may help reduce the severity of symptoms and prevent further transmission of HSV.

People who have a weakened immune system and those who experience frequent cold sore outbreaks may benefit from long-term antiviral treatment.

Some research suggests that over-the-counter (OTC) topical creams, gels, and ointments containing acyclovir may help cold sores heal faster. However, these topical treatments are for external use and may not be suitable for cold sores on the tongue or elsewhere inside the mouth.

OTC pain relievers can help reduce inflammation and pain while a cold sore heals.

People who have cold sores on the tongue may wish to consider the following home remedies:

  • gargling with warm salt water
  • gargling with mouthwash
  • avoiding using tobacco products
  • avoiding spicy, salty, and acidic foods
  • avoiding alcohol

Two strains of HSV commonly infect people: HSV-1 and HSV-2. HSV-1 usually leads to cold sores, while HSV-2 can cause genital herpes. However, HSV-2 can sometimes also lead to cold sores.

Herpes lesions, including cold sores, usually develop a few days after the initial infection.

Regardless of the strain, all herpes viruses are highly contagious. HSV spreads through direct contact with herpes lesions and genital or oral secretions.

HSV-1 can spread between people through mouth-to-mouth contact or sharing food, oral care products, or eating utensils.

HSV-2 usually spreads through sexual intercourse. However, engaging in oral sex with a person who has an HSV infection can spread HSV-2 to the mouth or spread HSV-1 to the genitals.

Generally, cold sore symptoms resolve within 2–6 weeks.

Certain factors can influence how quickly a cold sore heals. For instance, eating spicy or acidic foods can irritate a ruptured cold sore and slow the healing process. A person with a weakened immune system may have slow-healing cold sores or more frequent outbreaks.

Although a herpes outbreak only lasts a few weeks, HSV infections last a lifetime.

A cold sore on the tongue occurs when a person comes into contact with the herpes simplex virus. HSV-1 causes most cold sores. However, people can also develop cold sores after coming into contact with HSV-2 through oral sex.

Most cold sores heal within 2–6 weeks and do not require medical treatment. However, antiviral medication may reduce the severity and healing time of the outbreak.

A person may wish to contact a doctor if the cold sore remains for several weeks despite trying OTC or at-home treatments. A doctor can prescribe stronger oral or topical medications. They can also diagnose any underlying condition that may contribute to frequent or slow-healing cold sores.