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Signs herpes outbreak is coming

Outbreaks of genital herpes vary depending on the individual and the virus type that causes it. Step 1See a doctor as soon as you can if you suspect an initial outbreak of genital herpes.
Step 2Consider episodic use of oral antiviral medications if you're not sexually active and have few outbreaks or if both you and your partner have genital herpes.
Step 3Take oral antivirals daily if herpes outbreaks are frequent and severe, if you have sexual partners that aren't infected with HSV, or if you have genital herpes caused by HSV-2 and your partner has oral herpes caused by HSV-1.
ASHA states that the frequency of herpes outbreaks may be reduced by avoiding stress, getting enough rest, good nutrition, and exercise.
Transmission is by direct contact of lesions or oral secretions.  Most common in 1-3 year olds. Recurrent disease: after primary infection, HSV migrates to trigeminal ganglion where it becomes latent.
Supportive treatment with the use of analgesics, popsicles, avoidance of citrus or spicy foods, and glyoxide rinse for oral hygiene.
One-half mixture of Maalox and Diphenylhydramine applied to ulcers may help alleviate symptoms.
Use of oral acyclovir- if used within 48-72 hours, may shorten duration of symptoms and shedding.
Usually occur in the summer and fall and caused by infections with enteroviruses, Coxsackie A16, the most common. Transmission is fecal-oral and less commonly oral-oral.  Virus may be shed for months after infection.

Principally caused by group A Coxsackie viruses, but also by group B Coxsackie viruses and Echoviruses. The infection is self-limited, symptoms are generally mild, and lesions resolve within 3-5 days.  Decreased PO intake may lead to dehydration. Chickenpox may have vesicles inside the mouth but the diffuse skin findings and crusting of vesicles helps differentiate it from other infections.
Acute pseudomembranous candidiasis, or thrush, is a common local infection secondary to overgrowth of the fungus Candida Albicans. Occurs in children after exposure in vaginal tract, children on antibiotics, chemotherapy, radiation, inhaled glucocorticoids, and the immunosuppressed.
The pseudomembranous form is most common, and is characterized by white plaques on buccal mucosa, tongue, palate, and oropharynx.
Recurrence is common in patients with unmodifiable risk factors.  For those with persistent thrush, fluconazole 100mg daily can be used prophylactically. Etiology unclear although associated with many underlying conditions.  Not secondary to HSV infections.
Associated with arthritis, inflammatory bowel disease, CNS abnormalities, and skin manifestations.
The American Social Health Association notes that those with genital herpes caused by herpes simplex virus type 2 tend to experience around four or five outbreaks per year, while genital herpes outbreaks caused by the herpes simplex virus type 1 occur less frequently–usually less than once a year. The American Academy of Family Physicians notes that the sooner you are diagnosed with herpes, the sooner you can begin treatment. Episodic therapy entails taking oral antiviral medications only when you feel an outbreak coming on.

According to Mayo Clinic experts, suppressive therapy cuts down the frequency of herpes outbreaks by 70 to 80 percent in those who have six or more outbreaks yearly, and some patients report no herpes symptoms at all.
ASHA states that the best way to help herpes sores heal is to keep the genital area clean and dry. Both ASHA and the Mayo Clinic indicate that studies have shown conflicting results as to the efficacy of lysine in preventing or shortening herpes outbreaks. The ulcers are much less painful than the primary disease and most often found on the lips. However, there are different ways your health care professional may choose to administer these medications, based on your symptoms and level of sexual activity. ASHA notes that these are generally most successful when started at the onset of prodrome (tingling or pain in the area of the genitals one or two days before an outbreak), but may not make a difference if herpes sores have already erupted.
Additionally, ASHA notes that daily use of antivirals can curb asymptomatic shedding of the herpes virus by as much as 94 percent in both men and women. Creams and ointments may slow the healing process and cause herpes outbreaks to last even longer. Does oral aciclovir improve clinical outcome in immunocompetent children with primary herpes simplex gingivostomatitis? ASHA states that outbreaks may be reduced by around one or two days when episodic therapy is used.

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