Cold Sores Flashcards
What virus causes cold sores
HPV (herpes simplex virus)
What are other names for cold sores
herpes labialis or fever blisters
What other viruses are in the Human Herpesvirus family
varicella zoster virus (e.g., chickenpox & shingles) & Epstein-Barr virus (e.g., mononucleosis)
What are the 2 types of HSV
HSV-1
HSV-2
Which HSV causes mucocutaneous oral infections
HSV-1
Which HSV usually causes genital infections
HSV-2
What do both HSV-1 and HSV-2 cause
can cause ocular, CNS, or disseminated disease, but these are not common in immunocompetent people
What is the % of the world infected by HSV-1
65%
T/F: transmission requires direct contact
True
T/F: The virus can be transmitted from normal skin
T: “asymptomatic shedding”
Virus present, no cold sore
How are young children likely to get HSV-1
Adults transmit through kissing
What are the most common ways to transmit HSV-1
Oral-oral, oral-genital, genital-genital
T/F: HSV-1 seropositive patients are at risk of reinfection in a different area
False; have antibodies in blood that prevent auto-inoculation
- can get HSV-2 infection
What are the types of primary oral HSV infection
- 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)
What are the types of reactivation/recurrence oral HSV infections
• Asymptomatic (e.g., asymptomatic shedding)
- Symptomatic (~20 to 40%)
- Herpes labialis (minor ailment in Ontario & other provinces)
What is gingivostomatitis
Painful vesicles with fever & pharyngitis
Where do lesions of gingivostomatitis occur
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
What are symptoms of gingivostomatitis
local lymphadenopathy, malaise, myalgia, difficulty eating/ drinking/ swallowing
How long does it to take for gingivostomatitis to resolve
Resolves spontaneously in 7 to 18 days
What are symptoms of pharyngitis
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
How long does it take for pharyngitis to resolve
Resolves spontaneously in 2 to 8 days, although lymphadenopathy may last for weeks
T/F: Herpes labilis will cause fever, malaise, etc
False; no systemic features
What prodromal symptoms will occur with herpes labialis
Pain, burning, tingling, pruritus at site within 24 hrs of lesions
What is the progression of the lesion (herpes labialis)
Vesicles develop unilaterally at vermillion border of lip -> rupture & ooze -> crust -> heal without scarring
How long does it take for lesion to heal in herpes labialis
Pain lasts ~24 hrs, lesions heal in 7 to 10 days
How often does herpes labialis reoccur
Frequency, location, & severity variable between patients but may be consistent within patients
• Frequency can range from 1 to 12 episodes per year, or none
What factors risk reactivation of herpes labialis
Immunodeficiency, stress, sun exposure, fever or other infection, menstruation, trauma to area (e.g., dental work)
Red flags for referral
- 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)
What are goals of therapy for herpes labialis
- Prevent complications
- Reduce spread to others (& self?)
- Reduce intensity & duration of symptoms
- Prevent recurrence
T/F: HSV infection can be cured
False
What are Non-Pharmacological Strategies to Prevent Complications
- 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
What are Non-Pharmacological Strategies to Prevent Spread
- 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
What are 3 ways to manage symptoms
- cool compresses (reduce pain and swelling)
- systemic analgesics (acetaminophen, NSAIDS; max 3 days)
- topical analgesics
Camphor/ menthol/ phenol (e.g., Blistex®, Lypsyl®)
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
Benzocaine (e.g., Anbesol®, Zilactin-B®, Orajel®)
Anesthetic
Apply for 1 to 5 hrs then remove
Numbness, tingling
Allergic contact dermatitis (more likely)
Lidocaine (e.g., Maxilene®, Lidodan®)
Anesthetic
Apply for 1 to 5 hrs then remove
Numbness, tingling
Allergic contact dermatitis (less likely)
Lidocaine/ prilocaine (EMLA®)
Anesthetic
Apply for 1 to 5 hrs then remove
Numbness, tingling
Allergic contact dermatitis (less likely)
Pramoxine (e.g., Gold Bond Anti-Itch®, Polysporin Itch Relief®)
Anesthetic
Apply for 1 to 5 hrs then remove
Burning, stinging
Allergic contact dermatitis (least likely)
What is the OTC treatment for herpes labialis
Docosanol 10% (Abreva® cream)
- results in faster healing time
- may have mild burning or stinging upon application
What topical treatment (Rx) can be used
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
What are the oral antivirals (Rx) available
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
Which is the most convenient oral antiviral
Valacyclovir 2 g po BID x 1 day
> 12 years
What triggers to avoid to prevent recurrence
Emotional stress, fatigue, sun exposure
