Herpes Labialis Flashcards
What type of infections does HSV-1 vs HSV-2 cause?
HSV-1: oral
HSV-2: genital
How does primary HSV infection present?
Can be asymptomatic
Can be symptomatic:
in young children, we get gingivostomatitis– painful vesicles with fever and pharyngitis.
In older children, we can pharyngitis. Severe sore throat that resolves spontaneously in 2-8 days, but associated lymphadenopathy may last weeks
How does recurring HSV present?
Can be asymptomatic
Symptomatic: presents as herpes labialis
Generally no systemic features. Patients may experience prodrome. Lesions develop at the vermillion border and heal in 7-10 days
What are red flags when assessing for HSV?
Suggestions of alternative diagnosis: lesions present >14 days, follow a dermatomal distribution, present beyond the oral area, or are excessively red/swollen or contain pus
Lesions occur >6 times a year
Immunocompromised
Primary infection
What are non-pharmacologic strategies for treating cold sores
Lip adhesions (use of barriers) Cool compresses for pain and swelling
What are non-prescription pharmacologic strategies for treating cold sores?
Systemic analgesics (max 3 days) Topical analgesics: counterirritants such as camphor, methol, phenol), or anesthetics (benzocaine, lidocaine, prilocaine, pramoxine) Docosanol 10% (Abreva)
What are prescription pharmacologic strategies for treating cold sores? Which ones are Health Canada approved?
Topical acyclovir Oral antivirals: Acyclovir 400mg 5 tabs dy Famicyclovir 750mg BID F1D Valacyclovir 2g BID F1D-- this is the only HC approved treatment
How can we prevent recurrent episodes of cold sores?
Avoid triggers
Intermittent suppression with oral antivirals when the patient anticipates they’re going to have a trigger that’ll cause cold sores
Chronic suppression with oral antivirals (not preferable– significant financial and pill burden)
