RECURRENT ORAL HERPES SIMPLEX

Question 1

Definition of recurrent herpes simplex

Answer 1

a common, mild, self-limiting re-manifestation of the Herpes

Simplex virus, re-activated in immunocompromised patients

Question 2

How is it differentiated?

Answer 2

as intraoral herpes simplex and herpes labialis.

Question 3

What is herpes labialis

Answer 3

“cold sores” or “fever blisters,” and is most

communicable while acute

Question 4

Diagnosis of intraoral herpes simplex

Answer 4

(1) Prodromal symptoms of pain, burning, or tingling in areas where vesicles develop.
(2) 1 – 5 mm vesicles with erythematous border that ulcer and may coalesce to form larger
scalloped ulcers.
(3) Occurs on keratinized and non-keratinized mucosa.

Question 5

Treatment for intraoral herpes simplex

Answer 5

(1) Disease is usually self-limiting. Lesions heal spontaneously in 7-14 days.
(2) Acyclovir 200-800 mg five times daily for 7-14 days may speed recovery time.
(3) Treat symptoms
(a) Systemic analgesia
(b) Hydration
(c) Antipyretics
(d) Soft bland diet
(4) Provide oral hygiene instruction
(5) MAGIC MOUTHWASH, 1:1:1 ratio of
(a) 2% viscous lidocaine
(b) Liquid diphenhydramine
(c) Kaopectate or Maalox

Question 6

Differential diagnosis for intraoral herpes simplex

Answer 6

(1) Mononucleosis (Epstein-Barr virus)
(2) Herpangina (Coxsackie A virus)
(3) Aphthous Ulcer
(4) Herpes Zoster (Varicella-Zoster virus)

Question 7

Disposition for intraoral herpes simplex

Answer 7

Retain

Question 8

Diagnosis for herpes labialis

Answer 8

(1) May have prodrome of itching, tingling, or burning at blister sites.
(2) Primarily found on vermillion border and/or commissure of lips.
(3) May present on facial epidermis surrounding oral cavity and nose.
(4) Pain usually only present first 2 days, but may be acute for 5.
(5) Presents as papules, that become pustular and ulcerate before scabbing.

Question 9

Treatment for herpes labialis

Answer 9

(1) Disease is usually self-limiting. Lesions heal spontaneously in 7-14 days.
(2) Topical antirals AAA at first sign of prodrome or lesion.
(a) 5% acyclovir cream
(b) 3% penciclovir cream
(c) 10% docosanol cream
(3) Systemic antiviral at first sign of prodrome or lesion.
(a) Acyclovir
(b) Famciclovir
(c) Valacyclovir
(4) Treat symptoms
(a) Ice
(b) Warm cloth
(c) OTC creams
(d) NSAID

Question 10

Complications for herpes labialis

Answer 10

(1) Highly communicable to other people

(2) Can be spread to eyes which can scar cornea

Question 11

differential diagnosis for herpes labialis

Answer 11

(1) Syphilis

(2) Oral lip cancer