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Patient information: See related handout on cold sores, written by the authors of this article. Nongenital herpes simplex virus type 1 (HSV-1) is a common infection that most often involves the oral mucosa or lips (herpes labialis).
A cross-sectional study of herpes simplex virus types 1 and 2 in college students: occurrence and determinants of infection.
Longitudinal evaluation of herpes simplex virus DNA load during episodes of herpes labialis.
The natural history of recurrent herpes simplex labialis: implications for antiviral therapy. Comparison of Chemicon SimulFluor direct fluorescent antibody staining with cell culture and shell vial direct immunoperoxidase staining for detection of herpes simplex virus and with cytospin direct immunofluorescence staining for detection of varicellazoster virus. Acute herpetic gingivostomatitis in adults: a review of 13 cases, including diagnosis and management.
Treatment of herpes simplex gingivostomatitis with aciclovir in children: a randomised double blind placebo controlled study.
Interventions for the prevention and treatment of herpes simplex virus in patients being treated for cancer. Single-dose, patient-initiated famciclovir: a randomized, double-blind, placebo-controlled trial for episodic treatment of herpes labialis. Valacyclovir and topical clobetasol gel for the episodic treatment of herpes labialis: a patient-initiated, double-blind, placebo-controlled pilot trial.
Clinical efficacy of topical docosanol 10% cream for herpes simplex labialis: a multi-center, randomized, placebo-controlled trial. Four individuals with high-frequency recurrences of genital herpes virus of at least 2 years' duration were treated with two behavioral stress-reduction treatments. JavaScript is currently disabled, this site works much better if you enable JavaScript in your browser. Recurrent genital herpes is an incurable disease that may give rise to considerable psychological disturbance.
Genital herpes is one of the most common sexually transmitted infections (STI), and is caused by the herpes simplex virus – the same virus that can cause facial cold sores. Now, partly because oral sex is more common, the traditional distinctions between the two strains are breaking down and both types of herpes simplex virus can appear both orally and genitally. The primary oral infection may range from asymptomatic to very painful, leading to poor oral intake and dehydration. The virus travels from the skin during contact to the sensory dorsal root ganglion, where latency is established.
The mouth lesions (herpetic gingivostomatitis) consist of painful vesicles on a red, swollen base that occur on the lips, gingiva, oral palate, or tongue. However, if the pattern of the lesions is not specific to HSV, its diagnosis can be made by viral culture, PCR, serology, direct fluorescent antibody testing, or Tzanck test.
In one randomized controlled trial (RCT), children receiving acyclovir had oral lesions for a shorter time than children receiving placebo (median of four versus 10 days). Subjects were given 10 weekly sessions of frontalis EMG biofeedback (2 subjects) or progressive muscle relaxation treatment (2 subjects). The diagnosis of an infection with herpes simplex virus type 1 is usually made by the appearance of the lesions (grouped vesicles or ulcers on an erythematous base) and patient history.


Oral HSV-1 infections reactivate from the trigeminal sensory ganglia, affecting the facial, oral, labial, oropharyngeal, and ocular mucosa.Primary infection appears two to 20 days after contact with an infected person. Presession and postsession frontalis EMG measures were recorded for all subjects across treatment. The population study was also used to provide additional validation data for the French version of the RGHQoL (the Recurrent Genital Herpes Quality of Life) measure. However, if uncertain, the diagnosis of herpes labialis can be made by viral culture, polymerase chain reaction, serology, direct fluorescent antibody testing, or Tzanck test. The vesicle should be unroofed with a scalpel or sterile needle, and a swab should be used to soak up the fluid and to scrape the base. Outcome was measured by daily and weekly symptom charting mailed in weekly over 6 months, or by telephone interview after 6 months. Other nonoral herpes simplex virus type 1 infections include herpetic keratitis, herpetic whitlow, herpes gladiatorum, and herpetic sycosis of the beard area. The swab should be sent in special viral transport media directly to the laboratory (or placed on ice if transport will be delayed).
The measure was then developed and tested simultaneously in several countries, including France.
The differential diagnosis of nongenital herpes simplex virus infection includes aphthous ulcers, acute paronychia, varicellazoster virus infection, herpangina, herpes gestationis (pemphigoid gestationis), pemphigus vulgaris, and BehA§et syndrome.
There were more aborted lesions in the valacyclovirclobetasol group compared with the placebo-placebo group (50 versus 15.8 percent).
Statements in the measure were translated into French by a bilingual panel and then by a lay panel. Oral acyclovir suspension is an effective treatment for children with primary herpetic gingivostomatitis. Usatine, MDFigure 2.Primary herpetic gingivostomatitis caused by herpes simplex virus type 1 shown in (A) a four-year-old girl with lower lip ulcers and crusting on the upper lip, and (B) a two-year-old girl with ulcers on the lower lip and tongue.
Direct fluorescent antibody testing may be performed from air-dried specimens, and can detect 80 percent of true HSV-positive cases compared with culture results.10 Immunoglobulin G antibodies that are type-specific to HSV develop the first several weeks after infection and persist indefinitely. Field-testing in France took place with 15 patients who judged the instrument to be relevant and easy to complete. Oral acyclovir, valacyclovir, and famciclovir are effective in treating acute recurrence of herpes labialis (cold sores). A Tzanck test is difficult to perform correctly without specific training in its use, but it may be done in the office setting by scraping the floor of the herpetic vesicle, staining the specimen, and looking for multinucleated giant cells.
Follow-up at 1-year posttreatment showed that treatment effects were maintained by one subject, partially maintained by two, and reversed in one subject. The final version of the questionnaire was assessed for reliability and construct validity.
Recurrences of herpes labialis may be diminished with daily oral acyclovir or valacyclovir.
Usatine, MDIn recurrent herpes labialis, symptoms of tingling, pain, paresthesias, itching, and burning precede the lesions in 60 percent of persons.5 The lesions then appear as clusters of vesicles on the lip or vermilion border (Figure 1). They applied penciclovir cream or placebo within one hour of the first sign or symptom of a recurrence, and then every two hours while awake for four days. Topical acyclovir, penciclovir, and docosanol are optional treatments for recurrent herpes labialis, but they are less effective than oral treatment.


Resolution of symptoms occurred more rapidly in the penciclovir group regardless of whether the medication was applied in the early or late stage. The French RGHQoL was then used with 150 herpes patients obtained from a general population sample. A majority of the respondents completed all questions, indicating a high level of acceptability. Quality of life was found to be lowest in the under 25-year-olds and in those respondents who were most psychologically and sexually disturbed by their outbreaks and found it difficult to discuss the problem with their partner. It is concluded that the French version of the RGHQoL is an acceptable, reliable and valid instrument and that the measure provides valuable information about the impact of the disease. Usatine, MDFigure 3.(A) Ulcers that form after the vesicles break, as shown in an adult women with herpes labialis. The effect of suppressive oral acyclovir on the psychological mor-bidity associated with recurrent genital herpes. Common symptoms are eye pain, light sensitivity, and discharge with gritty sensation in the eye.
Fluorescein stain with a ultraviolet light may show a classic dendritic ulcer on the cornea (Figure 47). Does psychiatric illness affect the recurrence rate of genital herpes?British Journal of Veneral Disease, 54 40–43.Hamilton, R. The adaptation of health status measures: methodological aspects of the translation procedure. In: Shumaker S, Berzon R, eds, Interna-tional Use and Performance of Health-Related Quality of Life Instruments. Usatine, MDHerpetic whitlow is a vesicular lesion found on the hands or digits (Figures 68 and 7).
It occurs in children who suck their thumbs or medical and dental workers exposed to HSV-1 while not wearing gloves. Herpes gladiatorum is often seen in athletes who wrestle, which may put them in close physical contact with an infected person. Vesicular eruptions are often seen on the torso, but can occur in any location where skin-to-skin contact has occurred. Herpetic sycosis is a follicular infection with HSV that causes vesiculopapular lesions in the beard area. I think I may have herpes — What should I do?Occupational Health and Safety, 52(4), 15–42.McDowell, M.
Usatine, MDHSV infection is one of the most common causes of erythema multiforme (Figure 8), which some patients have with a recurrent HSV infection. Usatine, MDFigure 9.Vesicles on a red base of the wrist in a woman with herpes gestationis after the loss of a pregnancy. The psychological and behavioral effects of genital herpes in women.Dissertation Abstracts International, 2529B–2530B.




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