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Updated: Apr 30 2022

Oral Herpes

  • Snapshot
    • A 19-year-old woman with no significant past medical history presents to her primary care clinic with a blister on her outer lip, which started yesterday. She recalls a more severe prior episode about 1 year ago. She is sexually active with men and uses condoms for contraception. She denies any recent illness or sore throat. On physical exam, a cluster of erythematous, crusting vesicles are present along the oral commissure.
  • Introduction
    • Infection of the oral mucous membrane by Herpes Simplex Virus (HSV)
      • typically HSV-1 but also HSV-2
    • Primary infections seen mainly in children
      • fever, systemic illness
    • Following primary infection the virus is latent in the trigeminal ganglia
      • reactivation following sunlight exposure, stress
    • Highly contagious
      • transmitted via mucous membranes
  • Presentation
    • Primary HSV
      • fever, lymphadenopathy
      • red, swollen, and painful vesicles
      • typically on lips, gums, palate, and tongue
      • known as herpetic gingivostomatitis
    • Recurrent HSV
      • classically described as "grouped vesicles on an erythematous base," which eventually crust over
      • typically on vermillion border of lips (see figure) or mucosa of hard palate
      • known as herpetic labialis
      • can be preceded by prodrome of itching, tingling or burning
  • Diagnosis
    • Usually clinical based on appearance
    • If non-specific, can perform viral culture and PCR of an unroofed vesicle
  • Management
    • Oral medication
      • acyclovir or valacyclovir
    • Topical, less effective than oral medication
      • acyclovir, penciclovir, docosanol cream
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