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Pharm 129 > Cold Sores > Flashcards

Cold Sores Flashcards

1
Q

What virus causes cold sores

A

HPV (herpes simplex virus)

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2
Q

What are other names for cold sores

A

herpes labialis or fever blisters

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3
Q

What other viruses are in the Human Herpesvirus family

A

varicella zoster virus (e.g., chickenpox & shingles) & Epstein-Barr virus (e.g., mononucleosis)

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4
Q

What are the 2 types of HSV

A

HSV-1

HSV-2

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5
Q

Which HSV causes mucocutaneous oral infections

A

HSV-1

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6
Q

Which HSV usually causes genital infections

A

HSV-2

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7
Q

What do both HSV-1 and HSV-2 cause

A

can cause ocular, CNS, or disseminated disease, but these are not common in immunocompetent people

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8
Q

What is the % of the world infected by HSV-1

A

65%

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9
Q

T/F: transmission requires direct contact

A

True

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10
Q

T/F: The virus can be transmitted from normal skin

A

T: “asymptomatic shedding”

Virus present, no cold sore

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11
Q

How are young children likely to get HSV-1

A

Adults transmit through kissing

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12
Q

What are the most common ways to transmit HSV-1

A

Oral-oral, oral-genital, genital-genital

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13
Q

T/F: HSV-1 seropositive patients are at risk of reinfection in a different area

A

False; have antibodies in blood that prevent auto-inoculation
- can get HSV-2 infection

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14
Q

What are the types of primary oral HSV infection

A
  • Asymptomatic
    * Majority of seropositive patients do not recall previous symptoms
  • Symptomatic (~20 to 25%)
    * Gingivostomatitis (most common in young children)
    * Pharyngitis (most common in older children, teens, & adults)
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15
Q

What are the types of reactivation/recurrence oral HSV infections

A

• Asymptomatic (e.g., asymptomatic shedding)

  • Symptomatic (~20 to 40%)
  • Herpes labialis (minor ailment in Ontario & other provinces)
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16
Q

What is gingivostomatitis

A

Painful vesicles with fever & pharyngitis

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17
Q

Where do lesions of gingivostomatitis occur

A

Lesions develop anywhere on pharyngeal or oral mucosa -> progress over several days to soft palate, buccal mucosa, tongue, & floor of mouth -> quickly ulcerate & crust over

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18
Q

What are symptoms of gingivostomatitis

A

local lymphadenopathy, malaise, myalgia, difficulty eating/ drinking/ swallowing

19
Q

How long does it to take for gingivostomatitis to resolve

A

Resolves spontaneously in 7 to 18 days

20
Q

What are symptoms of pharyngitis

A

Severe sore throat

May also demonstrate pharyngeal edema, tonsillar exudate, oral exudative & ulcerative lesions

May also experience local lymphadenopathy, malaise, myalgia, difficulty eating/ drinking/ swallowing

21
Q

How long does it take for pharyngitis to resolve

A

Resolves spontaneously in 2 to 8 days, although lymphadenopathy may last for weeks

22
Q

T/F: Herpes labilis will cause fever, malaise, etc

A

False; no systemic features

23
Q

What prodromal symptoms will occur with herpes labialis

A

Pain, burning, tingling, pruritus at site within 24 hrs of lesions

24
Q

What is the progression of the lesion (herpes labialis)

A

Vesicles develop unilaterally at vermillion border of lip -> rupture & ooze -> crust -> heal without scarring

25
Q

How long does it take for lesion to heal in herpes labialis

A

Pain lasts ~24 hrs, lesions heal in 7 to 10 days

26
Q

How often does herpes labialis reoccur

A

Frequency, location, & severity variable between patients but may be consistent within patients
• Frequency can range from 1 to 12 episodes per year, or none

27
Q

What factors risk reactivation of herpes labialis

A

Immunodeficiency, stress, sun exposure, fever or other infection, menstruation, trauma to area (e.g., dental work)

28
Q

Red flags for referral

A
  • Suggestion of alternative diagnosis:
  • Lesions have been present > 14 days
  • Lesions follow dermatomal distribution
  • Lesions present beyond lips & perioral area
  • Lesions excessively red or swollen, or contain pus
  • Frequent recurrences (e.g., > 6 per year)
  • Immunocompromised (due to disease or therapy)
  • Primary infection (e.g., first ever cold sore, any systemic features, gingivostomatitis or pharyngitis)
29
Q

What are goals of therapy for herpes labialis

A
  1. Prevent complications
  2. Reduce spread to others (& self?)
  3. Reduce intensity & duration of symptoms
  4. Prevent recurrence
30
Q

T/F: HSV infection can be cured

A

False

31
Q

What are Non-Pharmacological Strategies to Prevent Complications

A
  • Lip adhesions:
  • Barrier use (e.g., petroleum jelly, cocoa butter, zinc oxide, etc.)
  • Secondary bacterial infection:
  • Avoid touching lesions
  • Wash hands before touching lesions
  • Keep lesions clean with mild soap & water
32
Q

What are Non-Pharmacological Strategies to Prevent Spread

A
  • Apply products with a disposable cotton swab
  • Avoid kissing & barrier-free oral-genital contact
  • Avoid touching lesions & wash hands frequently
  • Do not share cups, utensils, cosmetics, towels, etc.
  • Consider keeping young children who cannot yet control saliva out of daycare until lesions are crusted
33
Q

What are 3 ways to manage symptoms

A
  • cool compresses (reduce pain and swelling)
  • systemic analgesics (acetaminophen, NSAIDS; max 3 days)
  • topical analgesics
34
Q

Camphor/ menthol/ phenol (e.g., Blistex®, Lypsyl®)

A

Camphor, menthol – counterirritant
Phenol – anesthetic

Apply TID to QID

Mild tingling, cool sensation, white residue
Camphor >3% or menthol >1% can cause irritation or inflammation

35
Q

Benzocaine (e.g., Anbesol®, Zilactin-B®, Orajel®)

A

Anesthetic

Apply for 1 to 5 hrs then remove

Numbness, tingling
Allergic contact dermatitis (more likely)

36
Q

Lidocaine (e.g., Maxilene®, Lidodan®)

A

Anesthetic

Apply for 1 to 5 hrs then remove

Numbness, tingling
Allergic contact dermatitis (less likely)

37
Q

Lidocaine/ prilocaine (EMLA®)

A

Anesthetic

Apply for 1 to 5 hrs then remove

Numbness, tingling
Allergic contact dermatitis (less likely)

38
Q

Pramoxine (e.g., Gold Bond Anti-Itch®, Polysporin Itch Relief®)

A

Anesthetic

Apply for 1 to 5 hrs then remove

Burning, stinging
Allergic contact dermatitis (least likely)

39
Q

What is the OTC treatment for herpes labialis

A

Docosanol 10% (Abreva® cream)

  • results in faster healing time
  • may have mild burning or stinging upon application
40
Q

What topical treatment (Rx) can be used

A

Topical acyclovir

  • inhibits viral DNA synthesis
  • > 12 years
  • 5% cream, ointment, or combined with hydrocortisone (cream has best penetration)
  • Use 5x/day x 4 days
  • less effective than oral antivirals
41
Q

What are the oral antivirals (Rx) available

A

Acyclovir 400 mg po 5x/day x 5 days
Famciclovir 750 mg po BID x 1 day (or 1500 mg po x 1)
Valacyclovir 2 g po BID x 1 day

42
Q

Which is the most convenient oral antiviral

A

Valacyclovir 2 g po BID x 1 day

> 12 years

43
Q

What triggers to avoid to prevent recurrence

A

Emotional stress, fatigue, sun exposure

Pharm 129 (14 decks)

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