Red spots on roof of mouth — Oral herpes?

Dear Alice,

I was just curious about the symptoms of oral herpes... Can it be inside of your mouth, too? How can you tell if you have it or not without taking the tests? I have never had sex or oral sex, but I have red spots on the roof of my mouth... they are small, and I was just wondering if that could be a sign of herpes or not...


Dear Curious,

Red spots on the roof of your mouth could be a sign of a number of different things, which is why it's a good idea to see your health care provider. No one can diagnose without examining your symptoms in person, and because of this, the Internet is not the best resource for getting a diagnosis for specific symptoms.

Oral herpes, also called herpes labialis or cold sores, is caused by the herpes simplex virus type 1 (HSV-1). This virus causes small and painful blisters on the lips, gums, or skin around the mouth. Oral herpes can be passed on through contact with an infected individual's saliva, such as through kissing or sharing eating utensils. Though not typically thought of as a sexually transmitted infection (STI), this is not to say that HSV-1 can never be transmitted sexually. HSV-1 can be passed from the mouth to the genitals during oral sex (or vice-versa in more rare cases).
The red spots in your mouth could be a sign of oral herpes if they precede a white or grey ulcer. The ulcer takes longer to develop than the red spot, so you might wait a few days to see if you develop such an ulcer in the middle of the red spot.

Red areas inside of the mouth that are not blisters or surrounding ulcers could be a sign of a number of things. One possibility is that you injured the roof of your mouth, perhaps something hard (a pretzel, for example) jabbed your mouth. This type of temporary injury should only last a week or two, and is less likely to be an explanation if you have numerous red spots. Red areas in the mouth also can be a sign of an oral infection that you need to have a health care provider or dentist examine. The list could go on: mono, candidiasis, lichen planus...

Another possibility is that the lining of the mouth is thinning. When this happens, capillaries (small blood vessels) are closer to the surface, making it appear more red in color. These areas, called erythroplakia, are slightly raised and bleed easily if scraped. They can sometimes be a predictor of cancer, so it's important to go see your health care provider to have the red area examined. Your health care provider, in addition to physically examining the spots, can talk with you about other aspects of your health, like whether you are experiencing other symptoms, such as pain or fever, which will help narrow down the diagnosis of the potential cause(s) and treatments, if any, of your red spots. Consider reaching out to your health care provider or dentist. Even if it's nothing serious, just knowing will help bring peace of mind.

Last updated May 28, 2014
Originally published Feb 20, 2004

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