Herpes Simplex Infections ( Herpetic Stomatitis, Herpes Labialis, Recurrent intra-oral herpes ): Clinical features, Incidence, Etiology, Diagnosis, Management

1. Herpetic Stomatitis

– Incubation period is 3-7 days.

– Mouth ulcers: multiple vesicles and round scattered ulcers with yellow slough
and erythematous halo; ulcers fuse to produce irregular lesions.

– Gingivitis: diffuse erythema and oedema, occasionally haemorrhagic.

– Cervical lymphadenitis.

– Fever.

– Malaise, irritability and anorexia.

– Common cause of mouth ulcers in poor areas, with fever in children.

– It is also seen in adults, especially in more affluent communities.

– Herpes simplex virus (HSV), usually type 1.

– Differentiate from other causes of mouth ulcers, especially hand, foot and mouth disease, chickenpox and shingles, herpangina, erythema multiforme and leukaemia.

– Smear for viraldamaged cells or immunostaining.

– Viral culture or electron microscopy is used occasionally.

– A rising titre of antibodies is confirmatory.

– Soft diet and adequate fluid intake, antipyretics/ analgesics (paracetamol/acetaminophen elixir), local antiseptics (0.2% aqueous chlorhexidine mouthwashes), aciclovir orally or
parenterally in immunocompromised patients.

2. Herpes Labialis

– Prodromal paraesthesia or irritation. Erythema, then vesicles at/near
mucocutaneous junction of lip.

– Heals in 7-10 days.

– Common, especially in immunocompromised.

– Herpes simplex virus (HSV), usually type 1.

– HSV latent in trigeminal ganglion is reactivated by sun, trauma, menstruation, fever,
HIV disease, immunosuppression, etc.

– Viral damage can be confirmed by smear.

– Differentiate from zoster, impetigo or (rarely) carcinoma.

– Penciclovir 1% cream or aciclovir 5% cream applied in prodrome.

– Immunocompromised may need systemic aciclovir (oral or i.v.).

3. Recurrent intra-oral herpes

– Localised area of unilateral vesiculation followed by ulceration (erosion).

– Rare.

– Viral damage can be confirmed by smear.

– Differentiate from zoster or herpetiform ulcers (recurrent herpes is monolateral).

– Aciclovir: 5% cream applied in prodrome.

– Immunocompromised patients may need systemic aciclovir (oral or i.v.), famciclovir
or valaciclovir.

ــــــــــــــــــــ► ⒹⒺⓃⓉⒶⓁ–ⓈⒸⒾⒺⓝⓒⒺ ◄ــــــــــــــــــــ