Herpes Simplex (HSV) (Continued)
Common viral infection affecting the oral mucocutaneous surface. HSV-1 is most commonly associated with oral-facial lesions.
History & Physical: Most patients have subclinical primary episode, others experience primary gingivostomatitis, i.e., 3 — 5 d of fever, malaise, lymphadenopathy, oral mucosal erosions
■ Recurrent HSV-1 infection (herpes labialis) after primary infection may be reactivated by a number of triggers: stress, fever, UV light, trauma, menstruation; burning and itching precede appearance of grouped umbilicated vesicles on erythematous base, herpetiform arrangement, commonly on the vermilion border of the lip. face; crust over in 7-10 d.
DDx: aphthous stomatitis, hand-foot-and-mouth disease, impetigo HSV-2
Common viral infection affecting the genital mucosa, although oral mucocutaneous involvement reported with increasing prevalence.
History & Physical: Most are sexually transmitted; primary episodes more severe, with painful erosive balanitis, vulvitis, or vaginitis; recurrent infections are milder or subclinical.
DDx: Chancroid, syphilis, fixed drug eruption.
Investigations: Direct fluorescent antibody testing of fluid from base of vesicle; viral culture or PCR from lesion swab; Tzanck smear shows multinucleate giant epithelial cells.
Herpetic whitlow = herpes of fingertip; Herpes gladiatorum =
herpes among wrestlers & rugby players; Eczema herpeticum =
eczema secondarily infected with herpes.
■ Immunocompetent patients, 1st or occasional episode: Tx often supportive; can treat if severe or disseminated.
■ Within 72 hr, oral antiviral therapy may be instituted to reduce pain, viral shedding, and time to healing: Acyclovir, famciclovir, valacyclovir can be used with dosage depending on whether 10 vs 20 episode.
■ If severe, frequent (>6/yr) recurrences, consider chronic suppressive antiviral therapy.
■ Consider antiviral prophylaxis prior to skiing or tropical vacations (& sunscreen), extensive dental work, or cosmetic procedures on the face.
■ Topical antivirals of no benefit.
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