Otolaryngology Book

http://www.fpnotebook.com/

Oral HerpesAka: Herpes Simplex Virus, Cold Sore, Herpes Labialis, Herpes Simplex Stomatitis, Acute Herpetic Mucositis, Oral HSV, Orolabial Herpes, HSV I, Primary Herpetic Gingivostomatitis, Herpes Gingivostomatitis, Fever Blister

Advertisement

  1. See Also
    1. Genital Herpes
    2. Neonatal Herpes Simplex Virus
  2. Epidemiology
    1. Prevalence: 15-45% in United States
  3. Pathophysiology
    1. Etiology: HSV I or HSV II
    2. HSV lies dormant after initial infection
      1. Distributed in the trigeminal ganglion
      2. Reactivation with triggers as described below
  4. Symptoms
    1. Primary (Initial) HSV I: Usually asymptomatic
      1. Fever, chills
      2. Cervical Lymphadenopathy
      3. Ulcers deep in mouth on Gingival surface
    2. Secondary (Later) HSV I (Recurrent labial lesions)
      1. Provocative factors for recurrence
        1. Stress
        2. Febrile illness
        3. Sunlight (ultraviolet)
        4. Fatigue
        5. Menses
      2. Lesions form along vermillion border
        1. Fever Blisters form on outer vermillion border
        2. Cold Sores form on inner lip
      3. Course
        1. Prodrome: Itch, burn, or tingling for 12-36 hours
        2. Vesicle forms
        3. Vesicle ruptures, ulcerates and crusts in 48 hours
        4. Lesion heals in 7-14 days
  5. Signs
    1. Grouped Vesicles on erythematous base
    2. Forms on epithelial surface at vermillion border edge
    3. Vesicular lesions rupture to form painful Ulceration
  6. Differential Diagnosis
    1. Differs from Aphthous Ulcers in that:
      1. Found on keratinized (bound-down) intraoral mucosa
      2. Vesicles rupture into coalescing ulcers
    2. HSV lesions are anterior compared with:
      1. Herpangina
      2. Hand Foot and Mouth Disease
  7. Labs: Rapid Giemsa (Dif-Quik) stain
    1. Multinucleated giant cells
  8. Management
    1. Systemic Antiviral agents
      1. Acyclovir (not FDA approved)
        1. Dose: 15 mg/kg (max: 200 mg) PO 5x/day for 7 days
        2. Shortens first HSV infection by 6 days in children
        3. Amir (1997) BMJ 314:1800
      2. Famciclovir (not FDA approved)
        1. Shortens healing time by 2 days in UV-induced cases
        2. Spruance (1999) J Infect Dis 179:303
      3. Valacyclovir (FDA approved for age 12 and older)
        1. Adult dose: 2 g PO bid for one day
    2. Topical Antivirals
      1. General
        1. Reduce healing time by 0.7 days
      2. Penciclovir (Denavir) 1% Cream
      3. Docosanol (Abreva)
    3. Magic Mouthwash
      1. Indicated for analgesia
  9. References
    1. Colgan (2003) Am Fam Physician 67(4):757

Navigation Tree