Updated: 2/26/2016

Oral Herpes

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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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