Oral herpes


Infection due to the herpes simplex virus. Primary infection typically occurs in children aged 6 months to 5 years and may cause acute gingivostomatitis, sometimes severe. After primary infection, the virus remains in the body and causes in some individuals periodic recurrences which are usually benign (herpes labialis).

Clinical features

– Primary herpetic gingivostomatitis
Multiple vesicles on the oral mucosa and lips which rupture to form painful, yellowish, at times extensive ulcers. Local lesions are usually associated with general malaise, regional lymphadenopathy and fever.

– Recurrent herpes labialis
Clusters of vesicles at the junction between the lip and the skin.

In patients with frequent recurrences or extensive forms, consider HIV infection (see HIV infection and AIDS, Chapter 8).

Treatment

Primary herpetic gingivostomatitis

– Treat pain: paracetamol or ibuprofen PO (Chapter 1)

– In the event of severe lesions, inability to drink and significant pain:
• Admit the child to hospital (high risk of dehydration).
• If the child presents within the first 96 hours of symptoms onset, aciclovir PO for 5 to 7 days:
Children under 2 years: 200 mg 5 times daily
Children 2 years and over and adults: 400 mg 5 times daily

– In the event of secondary bacterial infection: amoxicillin PO 7 days.

In immunocompromised patients: see HIV infection and AIDS, Chapter 8.

Recurrent herpes labialis

Spontaneous resolution within 7 to 10 days. An antiseptic (chlorhexidine or povidone iodine) may be applied; paracetamol PO if necessary.


Both forms of herpes are contagious: do not touch lesions (or wash hands afterwards); avoid oral contact.