HERPES SIMPLEX 1

Question 1

resulting in a rash of the skin and mucous membranes
(usually lips).
Primary outbreaks manifest as herpetic gingivostomatitis, while recurrent
episodes usually affect the vermillion border of lips or the mucosa of the
hard palate.
can be transmitted via mucous membranes/secretions and open or
abraded skin by kissing and by sharing utensils or towels.

Answer 1

herpes

simplex virus type 1 (HSV-1)

Question 2

Orolabial Herpes Presentation

Primary infection:

Answer 2

(a) Defined as an initial exposure to virus in nonimmune person.
(b) Can be asymptomatic or cause self-limiting gingivostomatitis in
immunocompetent hosts
(c) Can affect all of oral mucosa, including inner surface of lips, buccal
mucosa, ventral surface of tongue, and floor of mouth
(d) More severe and lasts longer than recurrence

Question 3

Orolabial Herpes Presentation

Recurrent Infection

Answer 3

(a) AKA herpes labialis, non-primary disease, or relapsing disease
(b) Usually affects vermillion border of lips or mucosa of hard palate
and is less severe than primary infection.
(c) Recurrent infection rare with herpes simplex virus type 2 (HSV-2)
(d) Recurrences may be precipitated by stress, sun, illness, fatigue,
dental work, local trauma, menstruation, pregnancy, and
immunodeficiency.

Question 4

Diagnosis

Answer 4

(a) Based on clinically on history and appearance of typical

papulovesicular lesions

Question 5

Laboratory testing not typically performed unless

Answer 5

not typically performed unless:

(a) Atypical presentation or immunosuppressed patients

Question 6

HSV-1 Treatment

Answer 6

(1) Pt education:
(a) Handwashing, avoidance of kissing during episodes, avoidance of
shared utensils, contagious nature of virus and modes of
transmission, potential reactivation triggers, appropriate use of
sunscreen.
(2) Symptomatic treatment includes analgesics and adequate hydration.
(3) Antiviral treatment is typically not required by many patients due to selflimited nature of disease.
(4) Oral antiviral therapy may indicated for:
(a) Healthy persons with frequent outbreaks
(b) Moderate to severe cases of primary infection in healthy persons
(5) Antiviral medications reduce duration by about 1 day (range 0.5 days-2
days) but cannot cure infection (lifelong latency).
(a) Acyclovir 400 mg PO 5x / day for 5 days

Question 7

Differential Diagnosis

Answer 7

(1) HSV1 (Orolabial)
(a) Aphthous Stomatitis
(b) Impetigo
(c) Herpes Zoster

Question 8

Disposition

Answer 8

Full duty

Question 9

Complications

Answer 9

(1) Pyoderma
(2) Eczema Herpeticum
(3) Herpetic Whitlow
(4) Ocular Keratitis

Question 10

Diffuse pox-like eruption complicating atopic dermatitis; sudden
appearance of lesions in typical atopic areas (upper trunk, neck, head);
high fever, localized edema, adenopathy

Answer 10

Eczema herpeticum

Question 11

Localized infection of affected finger with intense itching and pain,
followed by vesicles that may coalesce with swelling and erythema.
Mimics pyogenic paronychia; neuralgia and axillary adenopathy are
possible; heals in 2 to 3 weeks

Answer 11

Herpetic whitlow