Oral Mucocutaneous Herpes Simplex Infection (Herpes Gingivostomatitis, Herpes Labialis or Cold Sore)

Last updated 03.11.12

 

Index

 

Definition

-  Painful vesicular eruprion of the oral cavity &/or lips with infection of HSV

 

Features

-  Primary infection usually in childhood

-  Recurrence commonly in adults

-  May be precipitated by trauma, fever, windy days, sunburn

-  90%+ of adults seropositive

 

Causes

-  Herpes Simplex Virus type 1 (HSV1)

 

Associated S/S

-  Prodrome

-  Pain, burning, tingling or itching hrs to days prior to lesion

-  Primary infection

-  Fever

-  Oral ulceration & pain

-  Usually gingivostomatitis & can be wide spread

-  Macules --> papules --> vesicles by 48hrs

-  Scabs within 3-4 days

-  Usually heals without scarring

-  Heals within several days (infants), up to several weeks for older children/adults

-  Difficulty eating & drinkning from pain

-  Lymphadenopathy

-  Recurrence

-  Oral ulceration & pain

-  Usually on lips (herpes simples labialis)

 

 

Complications

-  Concurrent Erythema multiforme

-  Dissemination in patients with eczema (atopic dermatitis) or immunocompromised

 

Ix

-  +/- Swab for HSV PCR

 

Mx

-  Maintain oral intake

-  Consider admission to hospital if cannot tolerate diet due to pain

-  Avoid corticosteroids

-  Analgesia PRN

-  Lignocaine 2% gel +/-  Chlorhexidine 0.05% 3/24

-  Chlorhexidine 0.2% +/- Benzydamine mouthwash TDS while ulcers present

-  Severe Primary Episode

-  PO Antivirals

-  Aciclovir 400mg (child 10mg/kg, max 400mg) PO 5/day 7/7

-  OR Famciclovir 500mg PO 12/24 7/7

-  OR Valaciclovir 1g PO 12/24 7/7

-  Dysphagia & cannot swallow

-  Specialist opinion

-  Aciclovir 5mg/kg IV 8/24 until PO tolerated then switch to PO

-  Severe Reccurent Episode

-  Within 48hrs of outbreak PO Antivirals

-  Famciclovir 1500mg PO single dose

-  OR Valaciclovir 2g PO 12/24 x2 doses

-  OR Aciclovir 400mg (child 10mg/kg, max 400mg) PO 5/day 5/7

-  Dysphagia & cannot swallow

-  Specialist opinion

-  Aciclovir 5mg/kg IV 8/24 until PO tolerated then switch to PO

-  Recurence prevention

-  Avoid sunburn

-  Antivirals at first sign of recurrence

-  Aciclovir 5% cream topically 4/24 (5/day) 4/7 at first S/S of recurrence

-  OR in pt >12yrs old Penciclovir 1% cream topically 6/day+

-  Suppressive Therapy

-  Indicated if severe frequent recurrence or immunosupressed

-  Valaciclovir 500mg PO Daily up to 6/12

-  OR Aciclovir 400mg (child 10mg/kg, max 400mg) PO 12/24 up to 6/12

 

 

 

References

 

eTG: Oral Mucocutaneous Herpes Simplex, accessed 2013

Pic: hardinmd.lib.uiowa.edu/cdc/5434.html