Herpes simplex orofacial infection: Difference between revisions
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{{Herpes simplex}} | {{Herpes simplex}} | ||
{{CMG}}; '''Associate Editor-In-Chief:''' | {{CMG}}; '''Associate Editor-In-Chief:''' {{Anahita}} ; {{CZ}} | ||
==Overview== | ==Overview== | ||
[[Infection]] by [[HSV-1]] is the most common cause of [[Herpes simplex|herpes]] that affects the [[face]] and [[mouth]] ([[Herpes simplex orofacial infection|orofacial herpes]]), although within the recent years an increase in [[mouth|oral]] [[HSV-2]] [[infections]] has been reported. Studies demonstrated different rate of herpes simplex orofacial infection [[prevalence]] in different populations, nevertheless lifetime [[prevalence]]s of herpes simplex orofacial infection has been estimated 42.1% and 32.4%, in women and men, respectively. There are some evidences that report higher rate of herpes simplex orofacial infection in low socioeconomic status. A majority of primary [[HSV-1]] [[infections]] occur during childhood. Early [[herpes simplex|HSV]] [[infection]] could be [[asymptomatic]] without any obvious [[skin]] lesions. Transmission commonly occurs when [[infection]] source comes in contact with the [[mucosa]] or abraded [[skin]]. However there are other rout of transmission such as [[infant|infants]] born to [[infection|infected]] mothers who are also at risk of catching the [[herpes simplex|HSV-1]] during the [[childbirth|delivery]]. The estimated duration of [[Herpes simplex|primary HSV infection]] has been estimated between 2-20 days after contact with the source of [[infection]]. [[Skin]] involvement usually appear as grouped [[ulcer|ulcers]] or [[vesicle|vesicles]] on an [[erythema|erythematous base]]. Subsequently [[skin]] [[vesicle|vesicles]] may [[ulcer|ulcerate]] and then become crusted. [[Herpes simplex|Primary HSV infection]] in adolescents frequently manifests as severe [[pharyngitis]] with [[lesions]] developing on the [[cheek]] and [[Gingiva|gums]]. Some individuals develop difficulty in [[swallowing]]. Once a primary [[mouth|oral]] [[HSV-1]] [[infection]] has resolved, the [[Herpes simplex|HSV]] enters the [[nerves]] surrounding the primary [[lesion]], migrates to the [[cell body]] of the [[neuron]], and becomes latent in the [[trigeminal ganglion]]. In some [[patients]], the [[virus]] reactivates to cause recurrent [[infection]], which is more common with [[HSV-1]] than [[HSV-2]] [[mouth|oral]] [[infection]]. Even though [[trigeminal ganglion]] is the most common location for [[herpes simplex|HSV-1]] [[infection]], [[inferior cervical ganglia|inferior]] and [[superior cervical ganglia]] could also become [[infection|infected]] with this serotype of [[herpes simplex]]. [[Prodromal]] [[symptom|symptoms]] often precede a recurrence, which typically begins with [[erythema|reddening]] of the [[skin]] around the [[infection|infected site]]. [[Pain]], [[itch|itching]] and [[paresthesia]] are some of the other [[Prodrome|prodromal]] [[symptoms]] in [[herpes simplex]] [[infection]]. Duration of the [[Prodrome|prodromal]] [[symptoms]] can range between few hours to several days before lesions develop. Some factors such as concurrent [[virus|viral]] [[infection]], [[Physical trauma|trauma]], [[Menstrual cycle|menstural period]], [[fatigue]], [[Stress (medicine)|stress]] and [[Sunburn|sun exposure]] could trigger recurrent [[herpes simplex]] lesions. It has been estimated that [[patients]] with [[herpes simplex|HSV-1]] [[mouth|oro]][[face|facial]] [[infection]] could experience recurrent [[infections]] 1-6 times in a year. Each episode of [[mouth|oro]][[face|facial]] [[infection]] is less sever and shorter, compared to previous episodes of [[mouth|oro]][[face|facial]] [[infections]]. There are numerous [[differential diagnosis]] such as [[oral candidiasis]], [[Aphthous ulcer|aphthous ulcers]], [[squamous cell carcinoma]], [[leukoplakia]], [[Behçet's disease|behcet's disease]], [[crohn's disease]] and [[burning mouth syndrome]]. Some conditions such as [[Leukemia|leukemia]], [[bell's palsy]], [[Atopic dermatitis|chronic atopic dermatitis]] and [[Human Immunodeficiency Virus (HIV)|Human immunodeficiency virus]] [[infection]] have been known as associated conditions in [[Herpes simplex orofacial infection|orofacial herpes]]. [[mouth|Oro]][[face|facial]] [[herpes simplex]] [[infection]] is usually [[diagnosis|diagnosed]] clinically, nevertheless [[Polymerase chain reaction|PCR]] test, immunodot [[glycoprotein]] G-specific ([[Immunoglobulin G|IgG]]) test, [[skin]] [[biopsy]], [[virus]] [[Tissue culture|culture]] and [[direct fluorescent anti body]] ([[direct fluorescent anti body|DFA]]) studies are some of the available laboratory investigations to better [[diagnosis|diagnose]] [[mouth|oro]][[face|facial]] [[infection]] due to [[herpes simplex]]. Unfortunately there is no approved [[treatment]] to completely eradicate the [[herpes simplex]] [[virus]] from body. Nevertheless antiviral [[treatments]] have been successful in lowering the severity and duration of [[skin]] lesions. The available antiviral [[medication|drugs]] that can be used for [[herpes simplex]] [[infection]] include [[acyclovir]], [[valaciclovir]], [[famciclovir]] and [[penciclovir]]. [[Acyclovir]] is effective in decreasing the [[virus|viral]] shedding period in [[infection|infected]] [[patients]] (median of 2.5 days when [[patients]] received [[acyclovir]], compared to 17 days). It also has been reported to be efficient in augmenting [[pain]] resolution and healing of the [[skin]] lesions. | |||
==Epidemiology== | ==Epidemiology== | ||
*Based on a study, lifetime [[prevalence]]s of | |||
*Based on a study, lifetime [[prevalence]]s of herpes simplex orofacial infection are 42.1% and 32.4%, in women and men, respectively. Moreover [[herpes simplex|HSV1]] [[prevalence]] was estimated 50.3%.<ref name="pmid17958848">{{cite journal| author=Malvy D, Ezzedine K, Lançon F, Halioua B, Rezvani A, Bertrais S | display-authors=etal| title=Epidemiology of orofacial herpes simplex virus infections in the general population in France: results of the HERPIMAX study. | journal=J Eur Acad Dermatol Venereol | year= 2007 | volume= 21 | issue= 10 | pages= 1398-403 | pmid=17958848 | doi=10.1111/j.1468-3083.2007.02302.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17958848 }} </ref> | |||
*Another study reported [[herpes simplex]] [[infection]] rate approximately 70-80% in low socioeconomic status and 40%-60% in high socioeconomic status individuals. <ref name="pmid19339385">{{cite journal| author=Chayavichitsilp P, Buckwalter JV, Krakowski AC, Friedlander SF| title=Herpes simplex. | journal=Pediatr Rev | year= 2009 | volume= 30 | issue= 4 | pages= 119-29; quiz 130 | pmid=19339385 | doi=10.1542/pir.30-4-119 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19339385 }} </ref> | *Another study reported [[herpes simplex]] [[infection]] rate approximately 70-80% in low socioeconomic status and 40%-60% in high socioeconomic status individuals. <ref name="pmid19339385">{{cite journal| author=Chayavichitsilp P, Buckwalter JV, Krakowski AC, Friedlander SF| title=Herpes simplex. | journal=Pediatr Rev | year= 2009 | volume= 30 | issue= 4 | pages= 119-29; quiz 130 | pmid=19339385 | doi=10.1542/pir.30-4-119 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19339385 }} </ref> | ||
*[[Prevalence]] of [[herpes simplex|HSV-1]] estimated as 57.7% in US population. <ref name="pmid16926356">{{cite journal| author=Xu F, Sternberg MR, Kottiri BJ, McQuillan GM, Lee FK, Nahmias AJ | display-authors=etal| title=Trends in herpes simplex virus type 1 and type 2 seroprevalence in the United States. | journal=JAMA | year= 2006 | volume= 296 | issue= 8 | pages= 964-73 | pmid=16926356 | doi=10.1001/jama.296.8.964 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16926356 }} </ref> | *[[Prevalence]] of [[herpes simplex|HSV-1]] estimated as 57.7% in US population. <ref name="pmid16926356">{{cite journal| author=Xu F, Sternberg MR, Kottiri BJ, McQuillan GM, Lee FK, Nahmias AJ | display-authors=etal| title=Trends in herpes simplex virus type 1 and type 2 seroprevalence in the United States. | journal=JAMA | year= 2006 | volume= 296 | issue= 8 | pages= 964-73 | pmid=16926356 | doi=10.1001/jama.296.8.964 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16926356 }} </ref> | ||
*Based on a study done on college students demonstrated that 25.6 % of first year college students had history of [[Herpes labialis|recurrent orofacial HSV-1]] [[infection]] compared to 28 % in fourth-year students. | *Based on a study done on college students demonstrated that 25.6 % of first year college students had history of [[Herpes labialis|recurrent orofacial HSV-1]] [[infection]] compared to 28 % in fourth-year students. | ||
*A study done in France estimated annual [[prevalence]] of [[mouth|oro]][[face|facial]] [[herpes simplex]] [[infection]] as 14.8% (only 23% of these population were aware of their [[infection]]). Based on this study [[female]] population has higher chance of [[infection]], compared to [[male]] populations.<ref name="pmid16844503">{{cite journal| author=Lorette G, Crochard A, Mimaud V, Wolkenstein P, Stalder JF, El Hasnaoui A| title=A survey on the prevalence of orofacial herpes in France: the INSTANT Study. | journal=J Am Acad Dermatol | year= 2006 | volume= 55 | issue= 2 | pages= 225-32 | pmid=16844503 | doi=10.1016/j.jaad.2005.10.014 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16844503 }} </ref> | |||
==Clinical Presentations== | ==Clinical Presentations== | ||
*Early [[herpes simplex|HSV]] [[infection]] could be [[asymptomatic]] without any obvious [[symptoms]].<ref name="pmid6286797">{{cite journal| author=Stanberry LR, Kern ER, Richards JT, Abbott TM, Overall JC| title=Genital herpes in guinea pigs: pathogenesis of the primary infection and description of recurrent disease. | journal=J Infect Dis | year= 1982 | volume= 146 | issue= 3 | pages= 397-404 | pmid=6286797 | doi=10.1093/infdis/146.3.397 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6286797 }} </ref> | |||
*A majority of primary [[HSV-1]] [[infections]] occur during childhood and if the [[virus]] comes into contact with the [[mucosa]] or abraded [[skin]], it can cause acute [[herpetic]] [[gingivostomatitis]] ([[inflammation]] of the [[cheek]]'s [[mucosa]] and [[Gingiva|gums]]) within 5–10 days. Some other [[symptoms]] may also develop, including [[fever]] and [[sore throat]], refuse to eat or drink and [[pain|painful]] [[ulcer]]s may appear.<ref name="pmid15596324"/> | *Early [[herpes simplex|HSV]] [[infection]] could be [[asymptomatic]] without any obvious [[symptoms]] (Also called [[asymptomatic]] seroconversion).<ref name="pmid6286797">{{cite journal| author=Stanberry LR, Kern ER, Richards JT, Abbott TM, Overall JC| title=Genital herpes in guinea pigs: pathogenesis of the primary infection and description of recurrent disease. | journal=J Infect Dis | year= 1982 | volume= 146 | issue= 3 | pages= 397-404 | pmid=6286797 | doi=10.1093/infdis/146.3.397 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6286797 }} </ref> | ||
*[[Prodromal]] [[symptom|symptoms]] often precede a recurrence, which typically begins with [[erythema|reddening]] of the [[skin]] around the [[infection|infected site]], with eventual [[ulceration]] to form fluid-filled [[blister]]s that affect the [[lip]] ([[lip|labial]]) [[Tissue (biology)|tissue]] and the area between the [[lip]] and [[skin]] ([[vermillion border]]).<ref name="pmid15596324"/> <ref>[http://www.ashastd.org/pdfs/HELPER_SPRING_05.pdf Herpes Online: Exploring the "H" Community, pages 1-4 American Social Health Association 1996 Access date: 2007-03-29]</ref> | *A majority of primary [[HSV-1]] [[infections]] occur during childhood and if the [[virus]] comes into contact with the [[mucosa]] or abraded [[skin]], it can cause acute [[herpetic]] [[gingivostomatitis]] ([[inflammation]] of the [[cheek]]'s [[mucosa]] and [[Gingiva|gums]]) within 5–10 days. Some other [[symptoms]] may also develop, including [[fever]] and [[sore throat]], refuse to eat or drink and [[pain|painful]] [[ulcer]]s may appear.<ref name="pmid15596324">Bruce AJ, Rogers RS (2004) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15596324 Oral manifestations of sexually transmitted diseases.] ''Clin Dermatol'' 22 (6):520-7. [http://dx.doi.org/10.1016/j.clindermatol.2004.07.005 DOI:10.1016/j.clindermatol.2004.07.005] PMID: [http://pubmed.gov/15596324 15596324]</ref> | ||
*[[Prodromal]] [[symptom|symptoms]] often precede a recurrence, which typically begins with [[erythema|reddening]] of the [[skin]] around the [[infection|infected site]], with eventual [[ulceration]] to form fluid-filled [[blister]]s that affect the [[lip]] ([[lip|labial]]) [[Tissue (biology)|tissue]] and the area between the [[lip]] and [[skin]] ([[vermillion border]]).<ref name="pmid15596324" /> <ref>[http://www.ashastd.org/pdfs/HELPER_SPRING_05.pdf Herpes Online: Exploring the "H" Community, pages 1-4 American Social Health Association 1996 Access date: 2007-03-29]</ref> | |||
*The following list includes some of the [[Prodrome|prodromal]] [[symptoms]] in [[herpes simplex]] [[infection]]:<ref name="pmid18541820">{{cite journal| author=Cernik C, Gallina K, Brodell RT| title=The treatment of herpes simplex infections: an evidence-based review. | journal=Arch Intern Med | year= 2008 | volume= 168 | issue= 11 | pages= 1137-44 | pmid=18541820 | doi=10.1001/archinte.168.11.1137 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18541820 }} </ref> | *The following list includes some of the [[Prodrome|prodromal]] [[symptoms]] in [[herpes simplex]] [[infection]]:<ref name="pmid18541820">{{cite journal| author=Cernik C, Gallina K, Brodell RT| title=The treatment of herpes simplex infections: an evidence-based review. | journal=Arch Intern Med | year= 2008 | volume= 168 | issue= 11 | pages= 1137-44 | pmid=18541820 | doi=10.1001/archinte.168.11.1137 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18541820 }} </ref> | ||
**[[Itch|Itching]] | **[[Itch|Itching]] | ||
**[[Pain]] | **[[Pain]] | ||
**[[Paresthesia]] (may be described as [[paresthesia|tingling]]) | **[[Paresthesia]] (may be described as [[paresthesia|tingling]]) | ||
*Duration of the [[Prodrome|prodromal]] [[symptoms]] can range between few hours to several days before lesions develop. | *Duration of the [[Prodrome|prodromal]] [[symptoms]] can range between few hours to several days before lesions develop. | ||
*Most of the time [[mouth|oro]][[face|facial]] [[infection]] just involves [[lip|lips]] and [[mouth|oral]] [[Mucous membrane|mucosa]] and is often called ''[[Herpes labialis|herpes simplex labialis]]''. | *Most of the time [[mouth|oro]][[face|facial]] [[infection]] just involves [[lip|lips]] and [[mouth|oral]] [[Mucous membrane|mucosa]] and is often called ''[[Herpes labialis|herpes simplex labialis]]''. | ||
*[[Skin]] involvement usually appear as grouped [[ulcer|ulcers]] or [[vesicle|vesicles]] on an [[erythema|erythematous base]]. Subsequently [[skin]] [[vesicle|vesicles]] may [[ulcer|ulcerate]] (severely [[pain|painful]] at this stage) and then become crusted. | *[[Skin]] involvement usually appear as grouped [[ulcer|ulcers]] or [[vesicle|vesicles]] on an [[erythema|erythematous base]]. Subsequently [[skin]] [[vesicle|vesicles]] may [[ulcer|ulcerate]] (severely [[pain|painful]] at this stage) and then become crusted.<ref name="pmid17620742">{{cite journal| author=Patel AR, Romanelli P, Roberts B, Kirsner RS| title=Treatment of herpes simplex virus infection: rationale for occlusion. | journal=Adv Skin Wound Care | year= 2007 | volume= 20 | issue= 7 | pages= 408-12 | pmid=17620742 | doi=10.1097/01.ASW.0000280199.58260.62 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17620742 }} </ref> | ||
*Presence of cervical or sub[[Mandible|mandibular]] [[lymphadenopathy]] is possible during the [[mouth|oro]][[face|facial]] [[herpes simplex|HSV-1]] [[infection]]. | *Presence of cervical or sub[[Mandible|mandibular]] [[lymphadenopathy]] is possible during the [[mouth|oro]][[face|facial]] [[herpes simplex|HSV-1]] [[infection]]. | ||
*The estimated duration of [[Herpes simplex|primary HSV infection]] has been estimated between 2-20 days after contact with the source of [[infection]]. | *The estimated duration of [[Herpes simplex|primary HSV infection]] has been estimated between 2-20 days after contact with the source of [[infection]]. | ||
*[[Herpes simplex|Primary HSV infection]] in adolescents frequently manifests as severe [[pharyngitis]] with [[lesions]] developing on the [[cheek]] and [[Gingiva|gums]]. Some individuals develop difficulty in [[swallowing]] ([[dysphagia]]) and swollen [[lymph node]]s ([[lymphadenopathy]]).<ref name="pmid15596324"/> Primary [[HSV]] infections in adults often presents as [[pharyngitis]] similar to that observed in glandular fever ([[infectious mononucleosis]]), but [[gingivostomatitis]] is less likely. The symptoms of primary [[HSV]] infection generally resolve within two weeks.<ref name="pmid15596324"/> | *[[Herpes simplex|Primary HSV infection]] in adolescents frequently manifests as severe [[pharyngitis]] with [[lesions]] developing on the [[cheek]] and [[Gingiva|gums]]. Some individuals develop difficulty in [[swallowing]] ([[dysphagia]]) and swollen [[lymph node]]s ([[lymphadenopathy]]).<ref name="pmid15596324" /> | ||
*[[Immunodeficiency|Immunodeficient]] [[patients]] can develop sever and atypical manifestations such as linear erosions in [[Wrinkle|skin creases]] which has a similar appearance to knife cuts(Knife-Cut Sign). <ref name="pmid26557219">{{cite journal| author=Cohen PR| title=The "Knife-Cut Sign" Revisited: A Distinctive Presentation of Linear Erosive Herpes Simplex Virus Infection in Immunocompromised Patients. | journal=J Clin Aesthet Dermatol | year= 2015 | volume= 8 | issue= 10 | pages= 38-42 | pmid=26557219 | doi= | pmc=4633212 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26557219 }} </ref> | *Primary [[HSV]] infections in adults often presents as [[pharyngitis]] similar to that observed in glandular fever ([[infectious mononucleosis]]), but [[gingivostomatitis]] is less likely. The symptoms of primary [[HSV]] infection generally resolve within two weeks.<ref name="pmid15596324" /> | ||
*[[Immunodeficiency|Immunodeficient]] [[patients]] can develop sever and atypical manifestations such as linear erosions in [[Wrinkle|skin creases]] which has a similar appearance to knife cuts (Knife-Cut Sign). <ref name="pmid26557219">{{cite journal| author=Cohen PR| title=The "Knife-Cut Sign" Revisited: A Distinctive Presentation of Linear Erosive Herpes Simplex Virus Infection in Immunocompromised Patients. | journal=J Clin Aesthet Dermatol | year= 2015 | volume= 8 | issue= 10 | pages= 38-42 | pmid=26557219 | doi= | pmc=4633212 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26557219 }} </ref> | |||
[[File:Knife-cut sign in a immunodeficient patient.jpg|frame|center|HSV-1 infection of external ear and adjacent periauricular area in an immunodeficient patient which resembles knife cuts.<ref name="pmid26557219">{{cite journal| author=Cohen PR| title=The "Knife-Cut Sign" Revisited: A Distinctive Presentation of Linear Erosive Herpes Simplex Virus Infection in Immunocompromised Patients. | journal=J Clin Aesthet Dermatol | year= 2015 | volume= 8 | issue= 10 | pages= 38-42 | pmid=26557219 | doi= | pmc=4633212 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26557219 }} </ref>]] | [[File:Knife-cut sign in a immunodeficient patient.jpg|frame|center|HSV-1 infection of external ear and adjacent periauricular area in an immunodeficient patient which resembles knife cuts.<ref name="pmid26557219">{{cite journal| author=Cohen PR| title=The "Knife-Cut Sign" Revisited: A Distinctive Presentation of Linear Erosive Herpes Simplex Virus Infection in Immunocompromised Patients. | journal=J Clin Aesthet Dermatol | year= 2015 | volume= 8 | issue= 10 | pages= 38-42 | pmid=26557219 | doi= | pmc=4633212 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26557219 }} </ref>]] | ||
*[[eye|Ocular]] [[infection]] due to [[herpes simplex|HSV-2]] can present as [[Acute retinal necrosis|acute retinal necrosis syndrome]]. | *[[eye|Ocular]] [[infection]] due to [[herpes simplex|HSV-2]] can present as [[Acute retinal necrosis|acute retinal necrosis syndrome]]. | ||
==Disease Progression And Recurrence== | ==Disease Progression And Recurrence== | ||
*Transmission of [[herpes simplex|HSV-1]] usually occurs via direct contact with [[skin|skin lesions]] or body fluids of the involved [[patient]] ([[aerosol]] and [[fomite]] spread are rare). In [[mouth|oro]][[face|facial]] [[infection]] the [[virus]] get inoculated onto [[oropharynx]] and [[conjunctiva]] or through small cracks in the [[skin]].<ref name="pmid17510153">{{cite journal| author=Sen P, Barton SE| title=Genital herpes and its management. | journal=BMJ | year= 2007 | volume= 334 | issue= 7602 | pages= 1048-52 | pmid=17510153 | doi=10.1136/bmj.39189.504306.55 | pmc=1871807 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17510153 }} </ref> <ref name="pmid1524332">{{cite journal| author=Perl TM, Haugen TH, Pfaller MA, Hollis R, Lakeman AD, Whitley RJ | display-authors=etal| title=Transmission of herpes simplex virus type 1 infection in an intensive care unit. | journal=Ann Intern Med | year= 1992 | volume= 117 | issue= 7 | pages= 584-6 | pmid=1524332 | doi=10.7326/0003-4819-117-7-584 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1524332 }} </ref> | *Transmission of [[herpes simplex|HSV-1]] usually occurs via direct contact with [[skin|skin lesions]] or body fluids of the involved [[patient]] ([[aerosol]] and [[fomite]] spread are rare). In [[mouth|oro]][[face|facial]] [[infection]] the [[virus]] get inoculated onto [[oropharynx]] and [[conjunctiva]] or through small cracks in the [[skin]].<ref name="pmid17510153">{{cite journal| author=Sen P, Barton SE| title=Genital herpes and its management. | journal=BMJ | year= 2007 | volume= 334 | issue= 7602 | pages= 1048-52 | pmid=17510153 | doi=10.1136/bmj.39189.504306.55 | pmc=1871807 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17510153 }} </ref> <ref name="pmid1524332">{{cite journal| author=Perl TM, Haugen TH, Pfaller MA, Hollis R, Lakeman AD, Whitley RJ | display-authors=etal| title=Transmission of herpes simplex virus type 1 infection in an intensive care unit. | journal=Ann Intern Med | year= 1992 | volume= 117 | issue= 7 | pages= 584-6 | pmid=1524332 | doi=10.7326/0003-4819-117-7-584 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1524332 }} </ref> | ||
*Some occupations such as [[Dentistry|dentists]], [[hospital]], [[nurse|nursery]] or [[Respiratory system|respiratory]] care unit personnel are at risk of [[herpes simplex|HSV-1]] spread via [[patient]]'s [[mouth|oral]] secretion. The aforementioned occupations are also at risk of [[herpes simplex]] [[infection]] due to [[hospital]] outbreaks. | *Some occupations such as [[Dentistry|dentists]], [[hospital]], [[nurse|nursery]] or [[Respiratory system|respiratory]] care unit personnel are at risk of [[herpes simplex|HSV-1]] spread via [[patient]]'s [[mouth|oral]] secretion. The aforementioned occupations are also at risk of [[herpes simplex]] [[infection]] due to [[hospital]] outbreaks. | ||
*Outbreaks are also reported in some [[Physical exercise|athletes]], such as wrestlers.<ref name="pmid1652687">{{cite journal| author=Belongia EA, Goodman JL, Holland EJ, Andres CW, Homann SR, Mahanti RL | display-authors=etal| title=An outbreak of herpes gladiatorum at a high-school wrestling camp. | journal=N Engl J Med | year= 1991 | volume= 325 | issue= 13 | pages= 906-10 | pmid=1652687 | doi=10.1056/NEJM199109263251302 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1652687 }} </ref> | *Outbreaks are also reported in some [[Physical exercise|athletes]], such as wrestlers.<ref name="pmid1652687">{{cite journal| author=Belongia EA, Goodman JL, Holland EJ, Andres CW, Homann SR, Mahanti RL | display-authors=etal| title=An outbreak of herpes gladiatorum at a high-school wrestling camp. | journal=N Engl J Med | year= 1991 | volume= 325 | issue= 13 | pages= 906-10 | pmid=1652687 | doi=10.1056/NEJM199109263251302 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1652687 }} </ref> | ||
*[[infant|Infants]] born to [[infection|infected]] mothers are also at risk of catching the [[herpes simplex|HSV-1]] during the [[childbirth|delivery]].<ref name="pmid9262493">{{cite journal| author=Brown ZA, Selke S, Zeh J, Kopelman J, Maslow A, Ashley RL | display-authors=etal| title=The acquisition of herpes simplex virus during pregnancy. | journal=N Engl J Med | year= 1997 | volume= 337 | issue= 8 | pages= 509-15 | pmid=9262493 | doi=10.1056/NEJM199708213370801 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9262493 }} </ref> | *[[infant|Infants]] born to [[infection|infected]] mothers are also at risk of catching the [[herpes simplex|HSV-1]] during the [[childbirth|delivery]].<ref name="pmid9262493">{{cite journal| author=Brown ZA, Selke S, Zeh J, Kopelman J, Maslow A, Ashley RL | display-authors=etal| title=The acquisition of herpes simplex virus during pregnancy. | journal=N Engl J Med | year= 1997 | volume= 337 | issue= 8 | pages= 509-15 | pmid=9262493 | doi=10.1056/NEJM199708213370801 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9262493 }} </ref> | ||
*[[herpes simplex|HSV-1]] [[infection]] can be transmitted through sexual activity especially in [[male|men]] who have sex with [[male|men]].<ref name="pmid7025620">{{cite journal| author=Quinn TC, Corey L, Chaffee RG, Schuffler MD, Brancato FP, Holmes KK| title=The etiology of anorectal infections in homosexual men. | journal=Am J Med | year= 1981 | volume= 71 | issue= 3 | pages= 395-406 | pmid=7025620 | doi=10.1016/0002-9343(81)90167-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7025620 }} </ref> | *[[herpes simplex|HSV-1]] [[infection]] can be transmitted through sexual activity especially in [[male|men]] who have sex with [[male|men]].<ref name="pmid7025620">{{cite journal| author=Quinn TC, Corey L, Chaffee RG, Schuffler MD, Brancato FP, Holmes KK| title=The etiology of anorectal infections in homosexual men. | journal=Am J Med | year= 1981 | volume= 71 | issue= 3 | pages= 395-406 | pmid=7025620 | doi=10.1016/0002-9343(81)90167-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7025620 }} </ref> | ||
*[[Incubation period]] of primary [[infection]] is very short, approximately 5 days. <ref name="pmid7025620">{{cite journal| author=Quinn TC, Corey L, Chaffee RG, Schuffler MD, Brancato FP, Holmes KK| title=The etiology of anorectal infections in homosexual men. | journal=Am J Med | year= 1981 | volume= 71 | issue= 3 | pages= 395-406 | pmid=7025620 | doi=10.1016/0002-9343(81)90167-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7025620 }} </ref> | *[[Incubation period]] of primary [[infection]] is very short, approximately 5 days. <ref name="pmid7025620">{{cite journal| author=Quinn TC, Corey L, Chaffee RG, Schuffler MD, Brancato FP, Holmes KK| title=The etiology of anorectal infections in homosexual men. | journal=Am J Med | year= 1981 | volume= 71 | issue= 3 | pages= 395-406 | pmid=7025620 | doi=10.1016/0002-9343(81)90167-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7025620 }} </ref> | ||
*Based on reports, [[virus|viral]] shedding last for 60 hours (when measured by [[Polymerase chain reaction|PCR]]) and 48 hours (when measured by [[tissue culture|culture]]).<ref name="pmid17046320">{{cite journal| author=Boivin G, Goyette N, Sergerie Y, Keays S, Booth T| title=Longitudinal evaluation of herpes simplex virus DNA load during episodes of herpes labialis. | journal=J Clin Virol | year= 2006 | volume= 37 | issue= 4 | pages= 248-51 | pmid=17046320 | doi=10.1016/j.jcv.2006.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17046320 }} </ref> | *Based on reports, [[virus|viral]] shedding last for 60 hours (when measured by [[Polymerase chain reaction|PCR]]) and 48 hours (when measured by [[tissue culture|culture]]).<ref name="pmid17046320">{{cite journal| author=Boivin G, Goyette N, Sergerie Y, Keays S, Booth T| title=Longitudinal evaluation of herpes simplex virus DNA load during episodes of herpes labialis. | journal=J Clin Virol | year= 2006 | volume= 37 | issue= 4 | pages= 248-51 | pmid=17046320 | doi=10.1016/j.jcv.2006.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17046320 }} </ref> | ||
*Once a primary [[mouth|oral]] [[HSV-1]] [[infection]] has resolved, the [[Herpes simplex|HSV]] enters the [[nerves]] surrounding the primary [[lesion]], migrates to the [[cell body]] of the [[neuron]], and becomes latent in the [[trigeminal ganglion]]. In some [[patients]], the [[virus]] reactivates to cause recurrent [[infection]]; which is more common with [[HSV-1]] than [[HSV-2]] [[mouth|oral]] [[infection]].<ref name="pmid15596324"/> <ref>[http://www.ashastd.org/pdfs/HELPER_SPRING_05.pdf Herpes Online: Exploring the "H" Community, pages 1-4 American Social Health Association 1996 Access date: 2007-03-29]</ref> | *Once a primary [[mouth|oral]] [[HSV-1]] [[infection]] has resolved, the [[Herpes simplex|HSV]] enters the [[nerves]] surrounding the primary [[lesion]], migrates to the [[cell body]] of the [[neuron]], and becomes latent in the [[trigeminal ganglion]]. In some [[patients]], the [[virus]] reactivates to cause recurrent [[infection]]; which is more common with [[HSV-1]] than [[HSV-2]] [[mouth|oral]] [[infection]].<ref name="pmid15596324" /> <ref>[http://www.ashastd.org/pdfs/HELPER_SPRING_05.pdf Herpes Online: Exploring the "H" Community, pages 1-4 American Social Health Association 1996 Access date: 2007-03-29]</ref> | ||
*Even though [[trigeminal ganglion]] is the most common location for [[herpes simplex|HSV-1]] [[infection]], [[inferior cervical ganglia|inferior]] and [[superior cervical ganglia]] could also become [[infection|infected]] with this serotype of [[herpes simplex]].<ref name="pmid6345823">{{cite journal| author=Cushing H| title=Landmark article April 28, 1900: A method of total extirpation of the Gasserian ganglion for trigeminal neuralgia. By a route through the temporal fossa and beneath the middle meningeal artery. By Harvey Cushing. | journal=JAMA | year= 1983 | volume= 250 | issue= 4 | pages= 519-28 | pmid=6345823 | doi=10.1001/jama.250.4.519 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6345823 }} </ref> | *Even though [[trigeminal ganglion]] is the most common location for [[herpes simplex|HSV-1]] [[infection]], [[inferior cervical ganglia|inferior]] and [[superior cervical ganglia]] could also become [[infection|infected]] with this serotype of [[herpes simplex]].<ref name="pmid6345823">{{cite journal| author=Cushing H| title=Landmark article April 28, 1900: A method of total extirpation of the Gasserian ganglion for trigeminal neuralgia. By a route through the temporal fossa and beneath the middle meningeal artery. By Harvey Cushing. | journal=JAMA | year= 1983 | volume= 250 | issue= 4 | pages= 519-28 | pmid=6345823 | doi=10.1001/jama.250.4.519 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6345823 }} </ref> | ||
*After initial [[infection]] with one type of [[herpes simplex]] [[virus]] [[antibody]] development occurs which prevent another form of [[infection]] with the same type. Based on this, a [[patient]] with history of [[mouth|oro]][[face|facial]] [[herpes simplex|HSV-1]] [[infection]] is immune against [[herpetic whitlow]], [[eye|ocular]] [[infection]] or [[Sex organ|genital]] [[herpes simplex]] caused by [[herpes simplex|HSV-1]]. [[Antibody]] production occurs 6 months after the initial [[infection]] with [[herpes simplex|HSV-1]].<ref name="pmid12805441">{{cite journal| author=Reuven NB, Staire AE, Myers RS, Weller SK| title=The herpes simplex virus type 1 alkaline nuclease and single-stranded DNA binding protein mediate strand exchange in vitro. | journal=J Virol | year= 2003 | volume= 77 | issue= 13 | pages= 7425-33 | pmid=12805441 | doi=10.1128/jvi.77.13.7425-7433.2003 | pmc=164775 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12805441 }} </ref> | *After initial [[infection]] with one type of [[herpes simplex]] [[virus]] [[antibody]] development occurs which prevent another form of [[infection]] with the same type. Based on this, a [[patient]] with history of [[mouth|oro]][[face|facial]] [[herpes simplex|HSV-1]] [[infection]] is immune against [[herpetic whitlow]], [[eye|ocular]] [[infection]] or [[Sex organ|genital]] [[herpes simplex]] caused by [[herpes simplex|HSV-1]]. [[Antibody]] production occurs 6 months after the initial [[infection]] with [[herpes simplex|HSV-1]].<ref name="pmid12805441">{{cite journal| author=Reuven NB, Staire AE, Myers RS, Weller SK| title=The herpes simplex virus type 1 alkaline nuclease and single-stranded DNA binding protein mediate strand exchange in vitro. | journal=J Virol | year= 2003 | volume= 77 | issue= 13 | pages= 7425-33 | pmid=12805441 | doi=10.1128/jvi.77.13.7425-7433.2003 | pmc=164775 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12805441 }} </ref> | ||
*Even though [[infection]] with [[herpes simplex|HSV-1]] will not protect [[patients]] from [[herpes simplex|HSV-2]] [[infection]], it will decrease the severity of [[herpes simplex|HSV-2]] [[infection]].<ref name="pmid11095834">{{cite journal| author=Handsfield HH| title=Public Health Strategies to Prevent Genital Herpes: Where Do We Stand? | journal=Curr Infect Dis Rep | year= 2000 | volume= 2 | issue= 1 | pages= 25-30 | pmid=11095834 | doi=10.1007/s11908-000-0084-y | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11095834 }} </ref> | *Even though [[infection]] with [[herpes simplex|HSV-1]] will not protect [[patients]] from [[herpes simplex|HSV-2]] [[infection]], it will decrease the severity of [[herpes simplex|HSV-2]] [[infection]].<ref name="pmid11095834">{{cite journal| author=Handsfield HH| title=Public Health Strategies to Prevent Genital Herpes: Where Do We Stand? | journal=Curr Infect Dis Rep | year= 2000 | volume= 2 | issue= 1 | pages= 25-30 | pmid=11095834 | doi=10.1007/s11908-000-0084-y | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11095834 }} </ref> | ||
*Most of the time recurrent episodes of [[herpes simplex|HSV-1]] [[mouth|oro]][[face|facial]] [[infection]] just involves [[lip|lips]] and [[mouth|oral]] [[Mucous membrane|mucosa]] which is called ''[[Herpes labialis|herpes simplex labialis]]''. Rare occasions of [[infection|reinfections]] occur inside the [[mouth]] (''[[Herpes simplex|intraoral HSV stomatitis]]''), affecting the [[gums]], [[alveolar ridge]], [[hard palate]], and the back of the [[tongue]]. This may be accompanied ''by [[herpes labialis]]''.<ref name="pmid15596324"/> <ref>[http://www.ashastd.org/pdfs/HELPER_SPRING_05.pdf Herpes Online: Exploring the "H" Community, pages 1-4 American Social Health Association 1996 Access date: 2007-03-29]</ref><ref name="pmid17877887">{{cite journal| author=Gilbert S, Corey L, Cunningham A, Malkin JE, Stanberry L, Whitley R | display-authors=etal| title=An update on short-course intermittent and prevention therapies for herpes labialis. | journal=Herpes | year= 2007 | volume= 14 Suppl 1 | issue= | pages= 13A-18A | pmid=17877887 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17877887 }} </ref> | *Most of the time recurrent episodes of [[herpes simplex|HSV-1]] [[mouth|oro]][[face|facial]] [[infection]] just involves [[lip|lips]] and [[mouth|oral]] [[Mucous membrane|mucosa]] which is called ''[[Herpes labialis|herpes simplex labialis]]''. Rare occasions of [[infection|reinfections]] occur inside the [[mouth]] (''[[Herpes simplex|intraoral HSV stomatitis]]''), affecting the [[gums]], [[alveolar ridge]], [[hard palate]], and the back of the [[tongue]]. This may be accompanied ''by [[herpes labialis]]''.<ref name="pmid15596324" /> <ref>[http://www.ashastd.org/pdfs/HELPER_SPRING_05.pdf Herpes Online: Exploring the "H" Community, pages 1-4 American Social Health Association 1996 Access date: 2007-03-29]</ref><ref name="pmid17877887">{{cite journal| author=Gilbert S, Corey L, Cunningham A, Malkin JE, Stanberry L, Whitley R | display-authors=etal| title=An update on short-course intermittent and prevention therapies for herpes labialis. | journal=Herpes | year= 2007 | volume= 14 Suppl 1 | issue= | pages= 13A-18A | pmid=17877887 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17877887 }} </ref> | ||
*It seems that some factors are responsible for recurrent [[herpes simplex]] [[infection]] due to decreasing the [[Cell-mediated immunity|cell mediated immunity]] (either [[antigen]] dependent or no [[antigen]] dependent). the following list contains some of these factors:<ref name="pmid2553308">{{cite journal| author=Vestey JP, Norval M, Howie S, Maingay J, Neill WA| title=Variation in lymphoproliferative responses during recrudescent orofacial herpes simplex virus infections. | journal=Clin Exp Immunol | year= 1989 | volume= 77 | issue= 3 | pages= 384-90 | pmid=2553308 | doi= | pmc=1542042 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2553308 }} </ref><ref name="pmid9377190">{{cite journal| author=Oakley C, Epstein JB, Sherlock CH| title=Reactivation of oral herpes simplex virus: implications for clinical management of herpes simplex virus recurrence during radiotherapy. | journal=Oral Surg Oral Med Oral Pathol Oral Radiol Endod | year= 1997 | volume= 84 | issue= 3 | pages= 272-8 | pmid=9377190 | doi=10.1016/s1079-2104(97)90342-5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9377190 }} </ref><ref name="pmid11022124">{{cite journal| author=Myśliwska J, Trzonkowski P, Bryl E, Lukaszuk K, Myśliwski A| title=Lower interleukin-2 and higher serum tumor necrosis factor-a levels are associated with perimenstrual, recurrent, facial Herpes simplex infection in young women. | journal=Eur Cytokine Netw | year= 2000 | volume= 11 | issue= 3 | pages= 397-406 | pmid=11022124 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11022124 }} </ref><ref name="pmid19064573">{{cite journal| author=Flores R, Lu B, Beibei L, Nielson C, Abrahamsen M, Wolf K | display-authors=etal| title=Correlates of human papillomavirus viral load with infection site in asymptomatic men. | journal=Cancer Epidemiol Biomarkers Prev | year= 2008 | volume= 17 | issue= 12 | pages= 3573-6 | pmid=19064573 | doi=10.1158/1055-9965.EPI-08-0467 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19064573 }} </ref><ref name="pmid2821086">{{cite journal| author=Perna JJ, Mannix ML, Rooney JF, Notkins AL, Straus SE| title=Reactivation of latent herpes simplex virus infection by ultraviolet light: a human model. | journal=J Am Acad Dermatol | year= 1987 | volume= 17 | issue= 3 | pages= 473-8 | pmid=2821086 | doi=10.1016/s0190-9622(87)70232-1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2821086 }} </ref> | *It seems that some factors are responsible for recurrent [[herpes simplex]] [[infection]] due to decreasing the [[Cell-mediated immunity|cell mediated immunity]] (either [[antigen]] dependent or no [[antigen]] dependent). the following list contains some of these factors:<ref name="pmid2553308">{{cite journal| author=Vestey JP, Norval M, Howie S, Maingay J, Neill WA| title=Variation in lymphoproliferative responses during recrudescent orofacial herpes simplex virus infections. | journal=Clin Exp Immunol | year= 1989 | volume= 77 | issue= 3 | pages= 384-90 | pmid=2553308 | doi= | pmc=1542042 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2553308 }} </ref><ref name="pmid9377190">{{cite journal| author=Oakley C, Epstein JB, Sherlock CH| title=Reactivation of oral herpes simplex virus: implications for clinical management of herpes simplex virus recurrence during radiotherapy. | journal=Oral Surg Oral Med Oral Pathol Oral Radiol Endod | year= 1997 | volume= 84 | issue= 3 | pages= 272-8 | pmid=9377190 | doi=10.1016/s1079-2104(97)90342-5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9377190 }} </ref><ref name="pmid11022124">{{cite journal| author=Myśliwska J, Trzonkowski P, Bryl E, Lukaszuk K, Myśliwski A| title=Lower interleukin-2 and higher serum tumor necrosis factor-a levels are associated with perimenstrual, recurrent, facial Herpes simplex infection in young women. | journal=Eur Cytokine Netw | year= 2000 | volume= 11 | issue= 3 | pages= 397-406 | pmid=11022124 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11022124 }} </ref><ref name="pmid19064573">{{cite journal| author=Flores R, Lu B, Beibei L, Nielson C, Abrahamsen M, Wolf K | display-authors=etal| title=Correlates of human papillomavirus viral load with infection site in asymptomatic men. | journal=Cancer Epidemiol Biomarkers Prev | year= 2008 | volume= 17 | issue= 12 | pages= 3573-6 | pmid=19064573 | doi=10.1158/1055-9965.EPI-08-0467 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19064573 }} </ref><ref name="pmid2821086">{{cite journal| author=Perna JJ, Mannix ML, Rooney JF, Notkins AL, Straus SE| title=Reactivation of latent herpes simplex virus infection by ultraviolet light: a human model. | journal=J Am Acad Dermatol | year= 1987 | volume= 17 | issue= 3 | pages= 473-8 | pmid=2821086 | doi=10.1016/s0190-9622(87)70232-1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2821086 }} </ref><ref name="pmid16844503">{{cite journal| author=Lorette G, Crochard A, Mimaud V, Wolkenstein P, Stalder JF, El Hasnaoui A| title=A survey on the prevalence of orofacial herpes in France: the INSTANT Study. | journal=J Am Acad Dermatol | year= 2006 | volume= 55 | issue= 2 | pages= 225-32 | pmid=16844503 | doi=10.1016/j.jaad.2005.10.014 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16844503 }} </ref> | ||
**Other [[virus|viral]] [[infections]] with [[fever]] | **Other [[virus|viral]] [[infections]] with [[fever]] | ||
**[[Fatigue]] | **[[Fatigue]] | ||
**[[Menstrual cycle|Menstural period]] | **[[Menstrual cycle|Menstural period]] | ||
**[[Stress (medicine)|Stress]] | **[[Stress (medicine)|Stress]] | ||
**Local [[Physical trauma|trauma]] | **Local [[Physical trauma|trauma]] | ||
**[[Ultraviolet|Ultraviolet light]] | **[[Ultraviolet|Ultraviolet light]] | ||
**Local [[injury]] due to high temprature or [[frostbite]] | **Local [[injury]] due to high temprature or [[frostbite]] | ||
**[[Sunburn|Sun exposure]] | **[[Sunburn|Sun exposure]] | ||
*A study reported a protein named protein VP16 as an involved factor in [[infection]] recurrency. | *A study reported a protein named protein VP16 as an involved factor in [[infection]] recurrency. | ||
*It has been estimated that [[patients]] with [[herpes simplex|HSV-1]] [[mouth|oro]][[face|facial]] [[infection]] could experience recurrent [[infections]] 1-6 times in a year. Each episode of [[mouth|oro]][[face|facial]] [[infection]] is less sever and shorter, compared to previous episodes of [[mouth|oro]][[face|facial]] [[infections]]. <ref name="pmid18541820">{{cite journal| author=Cernik C, Gallina K, Brodell RT| title=The treatment of herpes simplex infections: an evidence-based review. | journal=Arch Intern Med | year= 2008 | volume= 168 | issue= 11 | pages= 1137-44 | pmid=18541820 | doi=10.1001/archinte.168.11.1137 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18541820 }} </ref> | *It has been estimated that [[patients]] with [[herpes simplex|HSV-1]] [[mouth|oro]][[face|facial]] [[infection]] could experience recurrent [[infections]] 1-6 times in a year. Each episode of [[mouth|oro]][[face|facial]] [[infection]] is less sever and shorter, compared to previous episodes of [[mouth|oro]][[face|facial]] [[infections]]. <ref name="pmid18541820">{{cite journal| author=Cernik C, Gallina K, Brodell RT| title=The treatment of herpes simplex infections: an evidence-based review. | journal=Arch Intern Med | year= 2008 | volume= 168 | issue= 11 | pages= 1137-44 | pmid=18541820 | doi=10.1001/archinte.168.11.1137 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18541820 }} </ref> | ||
*Chance of recurrent [[mouth|oro]][[face|facial]] involvement has been estimated 0.12 monthly.<ref name="pmid3033506">{{cite journal| author=Lafferty WE, Coombs RW, Benedetti J, Critchlow C, Corey L| title=Recurrences after oral and genital herpes simplex virus infection. Influence of site of infection and viral type. | journal=N Engl J Med | year= 1987 | volume= 316 | issue= 23 | pages= 1444-9 | pmid=3033506 | doi=10.1056/NEJM198706043162304 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3033506 }} </ref> | *Chance of recurrent [[mouth|oro]][[face|facial]] involvement has been estimated 0.12 monthly.<ref name="pmid3033506">{{cite journal| author=Lafferty WE, Coombs RW, Benedetti J, Critchlow C, Corey L| title=Recurrences after oral and genital herpes simplex virus infection. Influence of site of infection and viral type. | journal=N Engl J Med | year= 1987 | volume= 316 | issue= 23 | pages= 1444-9 | pmid=3033506 | doi=10.1056/NEJM198706043162304 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3033506 }} </ref> | ||
*[[mouth|Oral]] [[Herpes simplex|herpes]] is spread by direct contact with an active [[sore]] in an [[infection|infected]] person, for instance, by kissing. However, the [[virus]] can be transmitted through the [[skin]] in the absence of a [[lesion]]. | *[[mouth|Oral]] [[Herpes simplex|herpes]] is spread by direct contact with an active [[sore]] in an [[infection|infected]] person, for instance, by kissing. However, the [[virus]] can be transmitted through the [[skin]] in the absence of a [[lesion]]. | ||
*[[mouth|Oral]] [[Herpes simplex|herpes]] and [[Oral ulcer|cold sores]] can sometimes be confused with [[canker sores]]. | *[[mouth|Oral]] [[Herpes simplex|herpes]] and [[Oral ulcer|cold sores]] can sometimes be confused with [[canker sores]]. | ||
*Healing time has been estimated 10 to 14 days, based on a study done on [[herpes simplex]] [[infections]].<ref name="pmid18541820">{{cite journal| author=Cernik C, Gallina K, Brodell RT| title=The treatment of herpes simplex infections: an evidence-based review. | journal=Arch Intern Med | year= 2008 | volume= 168 | issue= 11 | pages= 1137-44 | pmid=18541820 | doi=10.1001/archinte.168.11.1137 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18541820 }} </ref> | *Healing time has been estimated 10 to 14 days, based on a study done on [[herpes simplex]] [[infections]].<ref name="pmid18541820">{{cite journal| author=Cernik C, Gallina K, Brodell RT| title=The treatment of herpes simplex infections: an evidence-based review. | journal=Arch Intern Med | year= 2008 | volume= 168 | issue= 11 | pages= 1137-44 | pmid=18541820 | doi=10.1001/archinte.168.11.1137 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18541820 }} </ref> | ||
Line 86: | Line 94: | ||
|[[Oral candidiasis|Oral Candidiasis]] | |[[Oral candidiasis|Oral Candidiasis]] | ||
| | | | ||
* [[Dysphagia]] or [[odynophagia]] | *[[Dysphagia]] or [[odynophagia]] | ||
* White patches on the [[mouth]] and [[tongue]] | *White patches on the [[mouth]] and [[tongue]] | ||
| | | | ||
*[[Infant|Newborn babies]] | *[[Infant|Newborn babies]] | ||
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*[[Organ transplantation]] [[patients]] | *[[Organ transplantation]] [[patients]] | ||
| | | | ||
* Clinical [[diagnosis]] | *Clinical [[diagnosis]] | ||
* Confirmatory tests rarely needed | *Confirmatory tests rarely needed | ||
|'''Localized candidiasis''' | |'''Localized candidiasis''' | ||
* [[Oral candidiasis|Oral]] and [[Esophageal candidiasis|esophageal candidasis]] | *[[Oral candidiasis|Oral]] and [[Esophageal candidiasis|esophageal candidasis]] | ||
* [[Candida vulvovaginitis]] | *[[Candida vulvovaginitis]] | ||
* [[Chronic mucocutaneous candidiasis]] | *[[Chronic mucocutaneous candidiasis]] | ||
'''Invasive candidasis''' | '''Invasive candidasis''' | ||
* [[Candidiasis|Candidaemia]] | |||
* [[Endocarditis|Candida endocarditis]] | *[[Candidiasis|Candidaemia]] | ||
* [[Osteoarthritis|Candida osteoarticular disease]] | *[[Endocarditis|Candida endocarditis]] | ||
*[[Osteoarthritis|Candida osteoarticular disease]] | |||
| | | | ||
*[[Osteoarthritis|Oral candidiaisis]] is a [[benign]] self limiting [[disease]] unless accompanied by [[immunosuppression]]. | *[[Osteoarthritis|Oral candidiaisis]] is a [[benign]] self limiting [[disease]] unless accompanied by [[immunosuppression]]. | ||
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|[[Herpes simplex|Herpes simplex oral lesions]] | |[[Herpes simplex|Herpes simplex oral lesions]] | ||
| | | | ||
* [[Fever]] | *[[Fever]] | ||
* [[Sore throat]] | *[[Sore throat]] | ||
* [[pain|Painful]] [[ulcer]]s | *[[pain|Painful]] [[ulcer]]s | ||
| | | | ||
* [[Stress (medicine)|Stress]] | *[[Stress (medicine)|Stress]] | ||
* Recent [[Upper respiratory tract infection|URTI]] | *Recent [[Upper respiratory tract infection|URTI]] | ||
* [[Female]] gender | *[[Female]] gender | ||
| | | | ||
* [[Physical examination]] | *[[Physical examination]] | ||
* [[Viral culture]] | *[[Viral culture]] | ||
* [[Tzanck smear]] | *[[Tzanck smear]] | ||
| | | | ||
* [[mouth|Oro]][[face|facial]] [[infection]] | *[[mouth|Oro]][[face|facial]] [[infection]] | ||
* [[Herpes simplex anogenital infection|Anogenital infection]] | *[[Herpes simplex anogenital infection|Anogenital infection]] | ||
* [[Herpes simplex ocular infection|Ocular infection]] | *[[Herpes simplex ocular infection|Ocular infection]] | ||
* [[Herpes simplex encephalitis|Herpes encephalitis]] | *[[Herpes simplex encephalitis|Herpes encephalitis]] | ||
* [[Herpes simplex neonatorum|Neonatal herpes]] | *[[Herpes simplex neonatorum|Neonatal herpes]] | ||
* [[Herpetic whitlow|Herpetic whitlow]] | *[[Herpetic whitlow|Herpetic whitlow]] | ||
* [[Herpes gladiatorum|Herpes gladiatorum]] | *[[Herpes gladiatorum|Herpes gladiatorum]] | ||
| | | | ||
* The [[symptom|symptoms]] of primary [[Herpes simplex virus|HSV]] [[infection]] generally resolve within two weeks | *The [[symptom|symptoms]] of primary [[Herpes simplex virus|HSV]] [[infection]] generally resolve within two weeks | ||
|[[File:Herpesinfection - By James Heilman, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=19051042.jpg|thumb|Oral herpes simplex infection - By James Heilman, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=19051042.jpg|400x400px]] | |[[File:Herpesinfection - By James Heilman, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=19051042.jpg|thumb|Oral herpes simplex infection - By James Heilman, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=19051042.jpg|400x400px]] | ||
|- | |- | ||
|[[Aphthous ulcer|Aphthous ulcers]] | |[[Aphthous ulcer|Aphthous ulcers]] | ||
| | | | ||
* [[pain|Painful]], [[erythema|red]] spot or bump that develops into an open [[ulcer]] | *[[pain|Painful]], [[erythema|red]] spot or bump that develops into an open [[ulcer]] | ||
| | | | ||
* [[female|Female gender]] | *[[female|Female gender]] | ||
* Between the ages of 10-40 | *Between the ages of 10-40 | ||
* [[Family history]] of [[Aphthous ulcer|aphthous ulcers]] | *[[Family history]] of [[Aphthous ulcer|aphthous ulcers]] | ||
| | | | ||
* [[Physical examination]] | *[[Physical examination]] | ||
* [[Diagnosis]] of exclusion | *[[Diagnosis]] of exclusion | ||
| | | | ||
* [[mouth|Oral cavity]] | *[[mouth|Oral cavity]] | ||
| | | | ||
* It is elf-limiting and [[pain]] usually decreases in 7 to 10 days, with | *It is elf-limiting and [[pain]] usually decreases in 7 to 10 days, with complete healing in 1 to 3 weeks | ||
|[[File:Afta foto - By Ebarruda - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=7903358.jpg|thumb|Apthous ulcer on the | |[[File:Afta foto - By Ebarruda - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=7903358.jpg|thumb|Apthous ulcer on the undersurface of the tongue|By Ebarruda - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=7903358|400x400px]] | ||
|- | |- | ||
|[[Squamous cell carcinoma]] | |[[Squamous cell carcinoma]] | ||
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*May involve [[skin]], [[lips]], inside the [[mouth]], [[throat]] or [[esophagus]] | *May involve [[skin]], [[lips]], inside the [[mouth]], [[throat]] or [[esophagus]] | ||
| | | | ||
* Chronic sun or [[Ultraviolet|UV exposure]] | *Chronic sun or [[Ultraviolet|UV exposure]] | ||
* Fair [[skin]] | *Fair [[skin]] | ||
* [[old age|Elderly]] [[aging|age]] (>45 yrs) | *[[old age|Elderly]] [[aging|age]] (>45 yrs) | ||
* [[Male sex]] | *[[Male sex]] | ||
* [[Smoking]] | *[[Smoking]] | ||
| | | | ||
*[[Physical exam]] | *[[Physical exam]] | ||
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*Can spread to [[Temporomandibular joint disorder|TMJ]] | *Can spread to [[Temporomandibular joint disorder|TMJ]] | ||
*Some times associated with [[leukoplakia]] | *Some times associated with [[leukoplakia]] | ||
|[[File:PLoS oral cancer.png|thumb|400x400px | |[[File:PLoS oral cancer.png|thumb|400x400px|Squamous cell carcinoma - By Luca Pastore, Maria Luisa Fiorella, Raffaele Fiorella, Lorenzo Lo Muzio - http://www.plosmedicine.org/article/showImageLarge.action?uri=info%3Adoi%2F10.1371%2Fjournal.pmed.0050212.g001, CC BY 2.5, https://commons.wikimedia.org/w/index.php?curid=15252632]] | ||
|- | |- | ||
|[[Leukoplakia]] | |[[Leukoplakia]] | ||
Line 259: | Line 268: | ||
*Some [[Rheumatic|rheumatic disorders]] | *Some [[Rheumatic|rheumatic disorders]] | ||
*[[Hereditary nonpolyposis colorectal cancer]] | *[[Hereditary nonpolyposis colorectal cancer]] | ||
**Lower [[gingiva]] ([[gingiva|gums]]) | **Lower [[gingiva]] ([[gingiva|gums]]) | ||
**[[Vestibular system|Vestibular mucosa]] | **[[Vestibular system|Vestibular mucosa]] | ||
| | | | ||
Line 312: | Line 321: | ||
**[[Torus palatinus|Flat tori]] | **[[Torus palatinus|Flat tori]] | ||
**[[Torus palatinus|Spindle tori]] | **[[Torus palatinus|Spindle tori]] | ||
**[[Torus palatinus|Nodular tori]] | **[[Torus palatinus|Nodular tori]] | ||
**[[Torus palatinus|Lobular tori]] | **[[Torus palatinus|Lobular tori]] | ||
| | | | ||
*[[Hard palate]] | *[[Hard palate]] | ||
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| | | | ||
*[[Dark field microscopy]] | *[[Dark field microscopy]] | ||
*Non [[Treponema|treponemal]] tests like [[Venereal disease research laboratory (VDRL) test|VDRL]] and [[Rapid plasma reagent|RPR test]]) | *Non [[Treponema|treponemal]] tests like [[Venereal disease research laboratory (VDRL) test|VDRL]] and [[Rapid plasma reagent|RPR test]]) | ||
*[[Treponema|Treponemal]] tests, such as [[Fluorescent treponemal antibody absorbtion (FTA-ABS) test|FTA-ABS tests]], [[Bejel laboratory findings|TPPA assay]], [[Enzyme linked immunosorbent assay (ELISA)|enzyme immunoassays]], and [[Chemiluminescence|chemiluminescence immunoassays]]) | *[[Treponema|Treponemal]] tests, such as [[Fluorescent treponemal antibody absorbtion (FTA-ABS) test|FTA-ABS tests]], [[Bejel laboratory findings|TPPA assay]], [[Enzyme linked immunosorbent assay (ELISA)|enzyme immunoassays]], and [[Chemiluminescence|chemiluminescence immunoassays]]) | ||
| | | | ||
Line 458: | Line 467: | ||
|[[Coxsackie virus]] | |[[Coxsackie virus]] | ||
| | | | ||
*[[Fever]] | *[[Fever]] | ||
*[[Sores]] in the [[mouth]] | *[[Sores]] in the [[mouth]] | ||
*[[Rash]] with [[blisters]] | *[[Rash]] with [[blisters]] | ||
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*History and [[physical examination]] | *History and [[physical examination]] | ||
*[[Cotton swab|Throat swabs]] | *[[Cotton swab|Throat swabs]] | ||
*[[Cotton swab|Swabs]] from the lesion | *[[Cotton swab|Swabs]] from the lesion | ||
*[[Tzanck test]] | *[[Tzanck test]] | ||
| | | | ||
Line 480: | Line 489: | ||
| | | | ||
*[[Conjunctival]] [[symptoms]] | *[[Conjunctival]] [[symptoms]] | ||
*[[Rhinitis|Catarrhal]] [[symptoms]] | *[[Rhinitis|Catarrhal]] [[symptoms]] | ||
*Characteristic [[spots]] on the trunk appearing in two or three waves | *Characteristic [[spots]] on the trunk appearing in two or three waves | ||
*[[Itching]] | *[[Itching]] | ||
Line 535: | Line 544: | ||
</div> | </div> | ||
==Associated Conditions== | ==Associated Conditions== | ||
*[[Leukemia|Leukemia]]:<ref name="pmid3515270">{{cite journal| author=Barrett AP| title=A long-term prospective clinical study of orofacial herpes simplex virus infection in acute leukemia. | journal=Oral Surg Oral Med Oral Pathol | year= 1986 | volume= 61 | issue= 2 | pages= 149-52 | pmid=3515270 | doi=10.1016/0030-4220(86)90177-5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3515270 }} </ref><ref name="pmid3050711">{{cite journal| author=Barrett AP| title=Chronic indolent orofacial herpes simplex virus infection in chronic leukemia: a report of three cases. | journal=Oral Surg Oral Med Oral Pathol | year= 1988 | volume= 66 | issue= 3 | pages= 387-90 | pmid=3050711 | doi=10.1016/0030-4220(88)90251-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3050711 }} </ref> | *[[Leukemia|Leukemia]]:<ref name="pmid3515270">{{cite journal| author=Barrett AP| title=A long-term prospective clinical study of orofacial herpes simplex virus infection in acute leukemia. | journal=Oral Surg Oral Med Oral Pathol | year= 1986 | volume= 61 | issue= 2 | pages= 149-52 | pmid=3515270 | doi=10.1016/0030-4220(86)90177-5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3515270 }} </ref><ref name="pmid3050711">{{cite journal| author=Barrett AP| title=Chronic indolent orofacial herpes simplex virus infection in chronic leukemia: a report of three cases. | journal=Oral Surg Oral Med Oral Pathol | year= 1988 | volume= 66 | issue= 3 | pages= 387-90 | pmid=3050711 | doi=10.1016/0030-4220(88)90251-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3050711 }} </ref> | ||
**[[Herpes simplex orofacial infection]] has been reported in 40% of [[patients]] with [[Leukemia|acute leukemia]]. | **[[Herpes simplex orofacial infection]] has been reported in 40% of [[patients]] with [[Leukemia|acute leukemia]]. | ||
Line 546: | Line 556: | ||
==Prognosis== | ==Prognosis== | ||
*Many [[patients]] with [[herpes simplex]] [[infection]] experience recurrent lesions within the first year after [[infection]].<ref name="pmid16199646">{{cite journal| author=Brown ZA, Gardella C, Wald A, Morrow RA, Corey L| title=Genital herpes complicating pregnancy. | journal=Obstet Gynecol | year= 2005 | volume= 106 | issue= 4 | pages= 845-56 | pmid=16199646 | doi=10.1097/01.AOG.0000180779.35572.3a | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16199646 }} </ref> | *Many [[patients]] with [[herpes simplex]] [[infection]] experience recurrent lesions within the first year after [[infection]].<ref name="pmid16199646">{{cite journal| author=Brown ZA, Gardella C, Wald A, Morrow RA, Corey L| title=Genital herpes complicating pregnancy. | journal=Obstet Gynecol | year= 2005 | volume= 106 | issue= 4 | pages= 845-56 | pmid=16199646 | doi=10.1097/01.AOG.0000180779.35572.3a | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16199646 }} </ref> | ||
*[[Symptoms]] in recurrent [[infection]] can range from minor burning or just an [[itch]] to [[pain|painful]] [[face|facial]] lesions that may cause debilitation. | *[[Symptoms]] in recurrent [[infection]] can range from minor burning or just an [[itch]] to [[pain|painful]] [[face|facial]] lesions that may cause debilitation. | ||
*Based on some reports [[Genetics|genetical factors]] may play a role in [[prognosis]] of [[mouth|oro]][[face|facial]] [[herpes simplex]] [[infection]]. | *Based on some reports [[Genetics|genetical factors]] may play a role in [[prognosis]] of [[mouth|oro]][[face|facial]] [[herpes simplex]] [[infection]]. | ||
==Diagnosis== | ==Diagnosis== | ||
*[[mouth|Oro]][[face|facial]] [[herpes simplex]] [[infection]] is usually [[diagnosis|diagnosed]] clinically. [[Skin]] and [[mouth|oral]] involvement usually present as multiple superficial round [[ulcers]] on [[face]] or [[mouth]] with or without acute [[gingivitis]].<ref name="pmid17939933">{{cite journal| author=Fatahzadeh M, Schwartz RA| title=Human herpes simplex virus infections: epidemiology, pathogenesis, symptomatology, diagnosis, and management. | journal=J Am Acad Dermatol | year= 2007 | volume= 57 | issue= 5 | pages= 737-63; quiz 764-6 | pmid=17939933 | doi=10.1016/j.jaad.2007.06.027 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17939933 }} </ref> | *[[mouth|Oro]][[face|facial]] [[herpes simplex]] [[infection]] is usually [[diagnosis|diagnosed]] clinically. [[Skin]] and [[mouth|oral]] involvement usually present as multiple superficial round [[ulcers]] on [[face]] or [[mouth]] with or without acute [[gingivitis]].<ref name="pmid17939933">{{cite journal| author=Fatahzadeh M, Schwartz RA| title=Human herpes simplex virus infections: epidemiology, pathogenesis, symptomatology, diagnosis, and management. | journal=J Am Acad Dermatol | year= 2007 | volume= 57 | issue= 5 | pages= 737-63; quiz 764-6 | pmid=17939933 | doi=10.1016/j.jaad.2007.06.027 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17939933 }} </ref> | ||
*Although most [[mouth|oro]][[face|facial]] [[infections]] of [[herpes simplex]] is due to [[herpes simplex|HSV-1]], nevertheless [[herpes simplex|HSV-2]] could be also responsible in some cases. Hence differentiating the two serotypes could be necessary in some occasions. | *Although most [[mouth|oro]][[face|facial]] [[infections]] of [[herpes simplex]] is due to [[herpes simplex|HSV-1]], nevertheless [[herpes simplex|HSV-2]] could be also responsible in some cases. Hence differentiating the two serotypes could be necessary in some occasions. | ||
*[[Polymerase chain reaction|PCR]] test which detects [[herpes simplex]] [[antibody|antibodies]] and immunodot [[glycoprotein]] G-specific ([[Immunoglobulin G|IgG]]) test are two specific tests (more than 98%) to differentiate these two different serotypes. <ref name="pmid2835389">{{cite journal| author=Ashley RL, Militoni J, Lee F, Nahmias A, Corey L| title=Comparison of Western blot (immunoblot) and glycoprotein G-specific immunodot enzyme assay for detecting antibodies to herpes simplex virus types 1 and 2 in human sera. | journal=J Clin Microbiol | year= 1988 | volume= 26 | issue= 4 | pages= 662-7 | pmid=2835389 | doi=10.1128/JCM.26.4.662-667.1988 | pmc=266403 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2835389 }} </ref><ref name="pmid17046320">{{cite journal| author=Boivin G, Goyette N, Sergerie Y, Keays S, Booth T| title=Longitudinal evaluation of herpes simplex virus DNA load during episodes of herpes labialis. | journal=J Clin Virol | year= 2006 | volume= 37 | issue= 4 | pages= 248-51 | pmid=17046320 | doi=10.1016/j.jcv.2006.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17046320 }} </ref> | *[[Polymerase chain reaction|PCR]] test which detects [[herpes simplex]] [[antibody|antibodies]] and immunodot [[glycoprotein]] G-specific ([[Immunoglobulin G|IgG]]) test are two specific tests (more than 98%) to differentiate these two different serotypes. <ref name="pmid2835389">{{cite journal| author=Ashley RL, Militoni J, Lee F, Nahmias A, Corey L| title=Comparison of Western blot (immunoblot) and glycoprotein G-specific immunodot enzyme assay for detecting antibodies to herpes simplex virus types 1 and 2 in human sera. | journal=J Clin Microbiol | year= 1988 | volume= 26 | issue= 4 | pages= 662-7 | pmid=2835389 | doi=10.1128/JCM.26.4.662-667.1988 | pmc=266403 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2835389 }} </ref><ref name="pmid17046320">{{cite journal| author=Boivin G, Goyette N, Sergerie Y, Keays S, Booth T| title=Longitudinal evaluation of herpes simplex virus DNA load during episodes of herpes labialis. | journal=J Clin Virol | year= 2006 | volume= 37 | issue= 4 | pages= 248-51 | pmid=17046320 | doi=10.1016/j.jcv.2006.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17046320 }} </ref> | ||
*Beside [[Polymerase chain reaction|PCR]] test there are some other laboratory tests include [[skin]] [[biopsy]], [[virus]] [[Tissue culture|culture]] and [[direct fluorescent anti body]] ([[direct fluorescent anti body|DFA]]) studies.<ref name="pmid17939933">{{cite journal| author=Fatahzadeh M, Schwartz RA| title=Human herpes simplex virus infections: epidemiology, pathogenesis, symptomatology, diagnosis, and management. | journal=J Am Acad Dermatol | year= 2007 | volume= 57 | issue= 5 | pages= 737-63; quiz 764-6 | pmid=17939933 | doi=10.1016/j.jaad.2007.06.027 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17939933 }} </ref> | *Beside [[Polymerase chain reaction|PCR]] test there are some other laboratory tests include [[skin]] [[biopsy]], [[virus]] [[Tissue culture|culture]] and [[direct fluorescent anti body]] ([[direct fluorescent anti body|DFA]]) studies.<ref name="pmid17939933">{{cite journal| author=Fatahzadeh M, Schwartz RA| title=Human herpes simplex virus infections: epidemiology, pathogenesis, symptomatology, diagnosis, and management. | journal=J Am Acad Dermatol | year= 2007 | volume= 57 | issue= 5 | pages= 737-63; quiz 764-6 | pmid=17939933 | doi=10.1016/j.jaad.2007.06.027 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17939933 }} </ref> | ||
*If it is possible [[tissue culture]] for [[diagnosis]] should be taken from [[vesicles]]. Highest measure of [[herpes simplex]] [[virus]] has been found in the first 24 to 48 hours of [[vesicles]] appearance. <ref name="pmid194157">{{cite journal| author=Spruance SL, Overall JC, Kern ER, Krueger GG, Pliam V, Miller W| title=The natural history of recurrent herpes simplex labialis: implications for antiviral therapy. | journal=N Engl J Med | year= 1977 | volume= 297 | issue= 2 | pages= 69-75 | pmid=194157 | doi=10.1056/NEJM197707142970201 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=194157 }} </ref> | *If it is possible [[tissue culture]] for [[diagnosis]] should be taken from [[vesicles]]. Highest measure of [[herpes simplex]] [[virus]] has been found in the first 24 to 48 hours of [[vesicles]] appearance. <ref name="pmid194157">{{cite journal| author=Spruance SL, Overall JC, Kern ER, Krueger GG, Pliam V, Miller W| title=The natural history of recurrent herpes simplex labialis: implications for antiviral therapy. | journal=N Engl J Med | year= 1977 | volume= 297 | issue= 2 | pages= 69-75 | pmid=194157 | doi=10.1056/NEJM197707142970201 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=194157 }} </ref> | ||
*Compared to [[tissue culture]], [[Direct fluorescent antibody|direct fluorescent antibody testing]] is capable of detecting 80 % of [[herpes simplex|HSV]] [[infections]].<ref name="pmid11527802">{{cite journal| author=Chan EL, Brandt K, Horsman GB| title=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 varicella-zoster virus. | journal=Clin Diagn Lab Immunol | year= 2001 | volume= 8 | issue= 5 | pages= 909-12 | pmid=11527802 | doi=10.1128/CDLI.8.5.909-912.2001 | pmc=96170 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11527802 }} </ref> | *Compared to [[tissue culture]], [[Direct fluorescent antibody|direct fluorescent antibody testing]] is capable of detecting 80 % of [[herpes simplex|HSV]] [[infections]].<ref name="pmid11527802">{{cite journal| author=Chan EL, Brandt K, Horsman GB| title=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 varicella-zoster virus. | journal=Clin Diagn Lab Immunol | year= 2001 | volume= 8 | issue= 5 | pages= 909-12 | pmid=11527802 | doi=10.1128/CDLI.8.5.909-912.2001 | pmc=96170 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11527802 }} </ref> | ||
*[[Tzanck test]] require expert personnel to perform the test. It is reported positive if [[Large cell|multinucleated giant cells]] are seen. [[Tzanck test]] could not be used to differente [[herpes simplex|HSV-1]] from [[herpes simplex|HSV-2]], nevertheless it's sensitivity has been estimated 40-77 % for [[herpetic gingivostomatitis]].<ref name="pmid12626280">{{cite journal| author=Chauvin PJ, Ajar AH| title=Acute herpetic gingivostomatitis in adults: a review of 13 cases, including diagnosis and management. | journal=J Can Dent Assoc | year= 2002 | volume= 68 | issue= 4 | pages= 247-51 | pmid=12626280 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12626280 }} </ref> | *[[Tzanck test]] require expert personnel to perform the test. It is reported positive if [[Large cell|multinucleated giant cells]] are seen. [[Tzanck test]] could not be used to differente [[herpes simplex|HSV-1]] from [[herpes simplex|HSV-2]], nevertheless it's [[Sensitivity (tests)|sensitivity]] has been estimated 40-77 % for [[herpetic gingivostomatitis]].<ref name="pmid12626280">{{cite journal| author=Chauvin PJ, Ajar AH| title=Acute herpetic gingivostomatitis in adults: a review of 13 cases, including diagnosis and management. | journal=J Can Dent Assoc | year= 2002 | volume= 68 | issue= 4 | pages= 247-51 | pmid=12626280 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12626280 }} </ref> | ||
==Treatment== | ==Treatment== | ||
Unfortunately there is no approved [[treatment]] to completely eradicate the [[herpes simplex]] [[virus]] from body. Nevertheless antiviral [[treatments]] have been successful in lowering the severity and duration of [[skin]] lesions. | Unfortunately, there is no approved [[treatment]] to completely eradicate the [[herpes simplex]] [[virus]] from the body. Nevertheless, antiviral [[treatments]] have been successful in lowering the severity and duration of [[skin]] lesions. Soft, smooth, and cold foods are helpful in lowering the [[symptoms]] severity during meals. | ||
===Antiviral drugs=== | ===Antiviral drugs=== | ||
*The available antiviral [[medication|drugs]] that can be used for [[herpes simplex]] [[infection]] include [[acyclovir]], [[valaciclovir]], [[famciclovir]] and [[penciclovir]].<ref name="pmid18621575">{{cite journal| author=Bartlett BL, Tyring SK, Fife K, Gnann JW, Hadala JT, Kianifard F | display-authors=etal| title=Famciclovir treatment options for patients with frequent outbreaks of recurrent genital herpes: the RELIEF trial. | journal=J Clin Virol | year= 2008 | volume= 43 | issue= 2 | pages= 190-5 | pmid=18621575 | doi=10.1016/j.jcv.2008.06.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18621575 }} </ref><ref name="pmid19160295">{{cite journal| author=Glenny AM, Fernandez Mauleffinch LM, Pavitt S, Walsh T| title=Interventions for the prevention and treatment of herpes simplex virus in patients being treated for cancer. | journal=Cochrane Database Syst Rev | year= 2009 | volume= | issue= 1 | pages= CD006706 | pmid=19160295 | doi=10.1002/14651858.CD006706.pub2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19160295 }} </ref><ref name="pmid8380540">{{cite journal| author=Rooney JF, Straus SE, Mannix ML, Wohlenberg CR, Alling DW, Dumois JA | display-authors=etal| title=Oral acyclovir to suppress frequently recurrent herpes labialis. A double-blind, placebo-controlled trial. | journal=Ann Intern Med | year= 1993 | volume= 118 | issue= 4 | pages= 268-72 | pmid=8380540 | doi=10.7326/0003-4819-118-4-199302150-00004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8380540 }} </ref> | *The available antiviral [[medication|drugs]] that can be used for [[herpes simplex]] [[infection]] include [[acyclovir]], [[valaciclovir]], [[famciclovir]] and [[penciclovir]].<ref name="pmid18621575">{{cite journal| author=Bartlett BL, Tyring SK, Fife K, Gnann JW, Hadala JT, Kianifard F | display-authors=etal| title=Famciclovir treatment options for patients with frequent outbreaks of recurrent genital herpes: the RELIEF trial. | journal=J Clin Virol | year= 2008 | volume= 43 | issue= 2 | pages= 190-5 | pmid=18621575 | doi=10.1016/j.jcv.2008.06.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18621575 }} </ref><ref name="pmid19160295">{{cite journal| author=Glenny AM, Fernandez Mauleffinch LM, Pavitt S, Walsh T| title=Interventions for the prevention and treatment of herpes simplex virus in patients being treated for cancer. | journal=Cochrane Database Syst Rev | year= 2009 | volume= | issue= 1 | pages= CD006706 | pmid=19160295 | doi=10.1002/14651858.CD006706.pub2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19160295 }} </ref><ref name="pmid8380540">{{cite journal| author=Rooney JF, Straus SE, Mannix ML, Wohlenberg CR, Alling DW, Dumois JA | display-authors=etal| title=Oral acyclovir to suppress frequently recurrent herpes labialis. A double-blind, placebo-controlled trial. | journal=Ann Intern Med | year= 1993 | volume= 118 | issue= 4 | pages= 268-72 | pmid=8380540 | doi=10.7326/0003-4819-118-4-199302150-00004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8380540 }} </ref> | ||
*Based on a [[Blind experiment|double-blind]], [[Placebo-controlled studies|placebo controlled]], [[Randomized controlled trial|randomized trial]] done on [[patients]] with recurrent [[herpes simplex orofacial infection]] showed efficacy of 5% [[Acyclovir (ointment)|acyclovir cream]] containing propylene glycol in reducing the period of [[vesicle|vesiculation]] (P = 0.016), healing time (P = 0.022) and [[itch|itching]] duration.<ref name="pmid6355055">{{cite journal| author=Van Vloten WA, Swart RN, Pot F| title=Topical acyclovir therapy in patients with recurrent orofacial herpes simplex infections. | journal=J Antimicrob Chemother | year= 1983 | volume= 12 Suppl B | issue= | pages= 89-93 | pmid=6355055 | doi=10.1093/jac/12.suppl_b.89 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6355055 }} </ref> <ref name="pmid3515270">{{cite journal| author=Barrett AP| title=A long-term prospective clinical study of orofacial herpes simplex virus infection in acute leukemia. | journal=Oral Surg Oral Med Oral Pathol | year= 1986 | volume= 61 | issue= 2 | pages= 149-52 | pmid=3515270 | doi=10.1016/0030-4220(86)90177-5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3515270 }} </ref> | *Based on a [[Blind experiment|double-blind]], [[Placebo-controlled studies|placebo controlled]], [[Randomized controlled trial|randomized trial]] done on [[patients]] with recurrent [[herpes simplex orofacial infection]] showed efficacy of 5% [[Acyclovir (ointment)|acyclovir cream]] containing propylene glycol in reducing the period of [[vesicle|vesiculation]] (P = 0.016), healing time (P = 0.022) and [[itch|itching]] duration.<ref name="pmid6355055">{{cite journal| author=Van Vloten WA, Swart RN, Pot F| title=Topical acyclovir therapy in patients with recurrent orofacial herpes simplex infections. | journal=J Antimicrob Chemother | year= 1983 | volume= 12 Suppl B | issue= | pages= 89-93 | pmid=6355055 | doi=10.1093/jac/12.suppl_b.89 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6355055 }} </ref> <ref name="pmid3515270">{{cite journal| author=Barrett AP| title=A long-term prospective clinical study of orofacial herpes simplex virus infection in acute leukemia. | journal=Oral Surg Oral Med Oral Pathol | year= 1986 | volume= 61 | issue= 2 | pages= 149-52 | pmid=3515270 | doi=10.1016/0030-4220(86)90177-5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3515270 }} </ref> | ||
*Another study done on 703 [[patients]] with [[Herpes Simplex Keratitis|herpes simplex keratitis]] demonstrated the effectiveness of [[acyclovir]] [[therapy]] for 12 months in lowering the chance of recurrent [[herpes simplex orofacial infection]], including the [[eye|ocular]] [[infection]]. <ref name="pmid9696640">{{cite journal| author=| title=Acyclovir for the prevention of recurrent herpes simplex virus eye disease. Herpetic Eye Disease Study Group. | journal=N Engl J Med | year= 1998 | volume= 339 | issue= 5 | pages= 300-6 | pmid=9696640 | doi=10.1056/NEJM199807303390503 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9696640 }} </ref> | *Another study done on 703 [[patients]] with [[Herpes Simplex Keratitis|herpes simplex keratitis]] demonstrated the effectiveness of [[acyclovir]] [[therapy]] for 12 months in lowering the chance of recurrent [[herpes simplex orofacial infection]], including the [[eye|ocular]] [[infection]]. <ref name="pmid9696640">{{cite journal| author=| title=Acyclovir for the prevention of recurrent herpes simplex virus eye disease. Herpetic Eye Disease Study Group. | journal=N Engl J Med | year= 1998 | volume= 339 | issue= 5 | pages= 300-6 | pmid=9696640 | doi=10.1056/NEJM199807303390503 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9696640 }} </ref> | ||
*Data from different studies suggest the use of [[acyclovir]] and [[valaciclovir]] in [[herpes labialis]]. These two [[medications]] are also effective in [[cancer]] [[patients]] who are [[infection|infected]] with [[herpes simplex]] [[infection]].<ref name="pmid19160295">{{cite journal| author=Glenny AM, Fernandez Mauleffinch LM, Pavitt S, Walsh T| title=Interventions for the prevention and treatment of herpes simplex virus in patients being treated for cancer. | journal=Cochrane Database Syst Rev | year= 2009 | volume= | issue= 1 | pages= CD006706 | pmid=19160295 | doi=10.1002/14651858.CD006706.pub2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19160295 }} </ref><ref name="pmid17605952">{{cite journal| author=Chon T, Nguyen L, Elliott TC| title=Clinical inquiries. What are the best treatments for herpes labialis? | journal=J Fam Pract | year= 2007 | volume= 56 | issue= 7 | pages= 576-8 | pmid=17605952 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17605952 }} </ref><ref name="pmid11880960">{{cite journal| author=Wald A, Carrell D, Remington M, Kexel E, Zeh J, Corey L| title=Two-day regimen of acyclovir for treatment of recurrent genital herpes simplex virus type 2 infection. | journal=Clin Infect Dis | year= 2002 | volume= 34 | issue= 7 | pages= 944-8 | pmid=11880960 | doi=10.1086/339325 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11880960 }} </ref> | *Data from different studies suggest the use of [[acyclovir]] and [[valaciclovir]] in [[herpes labialis]]. These two [[medications]] are also effective in [[cancer]] [[patients]] who are [[infection|infected]] with [[herpes simplex]] [[infection]].<ref name="pmid19160295">{{cite journal| author=Glenny AM, Fernandez Mauleffinch LM, Pavitt S, Walsh T| title=Interventions for the prevention and treatment of herpes simplex virus in patients being treated for cancer. | journal=Cochrane Database Syst Rev | year= 2009 | volume= | issue= 1 | pages= CD006706 | pmid=19160295 | doi=10.1002/14651858.CD006706.pub2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19160295 }} </ref><ref name="pmid17605952">{{cite journal| author=Chon T, Nguyen L, Elliott TC| title=Clinical inquiries. What are the best treatments for herpes labialis? | journal=J Fam Pract | year= 2007 | volume= 56 | issue= 7 | pages= 576-8 | pmid=17605952 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17605952 }} </ref><ref name="pmid11880960">{{cite journal| author=Wald A, Carrell D, Remington M, Kexel E, Zeh J, Corey L| title=Two-day regimen of acyclovir for treatment of recurrent genital herpes simplex virus type 2 infection. | journal=Clin Infect Dis | year= 2002 | volume= 34 | issue= 7 | pages= 944-8 | pmid=11880960 | doi=10.1086/339325 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11880960 }} </ref><ref name="pmid19160295">{{cite journal| author=Glenny AM, Fernandez Mauleffinch LM, Pavitt S, Walsh T| title=Interventions for the prevention and treatment of herpes simplex virus in patients being treated for cancer. | journal=Cochrane Database Syst Rev | year= 2009 | volume= | issue= 1 | pages= CD006706 | pmid=19160295 | doi=10.1002/14651858.CD006706.pub2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19160295 }} </ref> | ||
*Based on a study done on 701 randomly selected [[patients]], 1500 mg single [[dose]] of [[famciclovir]] reduce healing period by 2 days, compared to placebo.<ref name="pmid16781291">{{cite journal| author=Spruance SL, Bodsworth N, Resnick H, Conant M, Oeuvray C, Gao J | display-authors=etal| title=Single-dose, patient-initiated famciclovir: a randomized, double-blind, placebo-controlled trial for episodic treatment of herpes labialis. | journal=J Am Acad Dermatol | year= 2006 | volume= 55 | issue= 1 | pages= 47-53 | pmid=16781291 | doi=10.1016/j.jaad.2006.02.031 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16781291 }} </ref> | *Based on a study done on 701 randomly selected [[patients]], 1500 mg single [[dose]] of [[famciclovir]] reduce healing period by 2 days, compared to [[placebo]]. The following table is a summary of [[median]] healing time in 3 different [[treatments]] that have been studied.<ref name="pmid16781291">{{cite journal| author=Spruance SL, Bodsworth N, Resnick H, Conant M, Oeuvray C, Gao J | display-authors=etal| title=Single-dose, patient-initiated famciclovir: a randomized, double-blind, placebo-controlled trial for episodic treatment of herpes labialis. | journal=J Am Acad Dermatol | year= 2006 | volume= 55 | issue= 1 | pages= 47-53 | pmid=16781291 | doi=10.1016/j.jaad.2006.02.031 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16781291 }} </ref> | ||
*[[Acyclovir]] [[treatment]] shows less effectiveness in [[treatment]] of [[Herpetic gingivostomatitis|primary herpetic gingivostomatitis]] in adults. <ref name="pmid18843726">{{cite journal| author=Nasser M, Fedorowicz Z, Khoshnevisan MH, Shahiri Tabarestani M| title=Acyclovir for treating primary herpetic gingivostomatitis. | journal=Cochrane Database Syst Rev | year= 2008 | volume= | issue= 4 | pages= CD006700 | pmid=18843726 | doi=10.1002/14651858.CD006700.pub2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18843726 }} </ref> | |||
*[[Topical]] use of [[acyclovir]], [[docosanol]] and [[penciclovir]] has been reported as an effective [[treatment]] in [[herpes labialis]].<ref name="pmid17605952">{{cite journal| author=Chon T, Nguyen L, Elliott TC| title=Clinical inquiries. What are the best treatments for herpes labialis? | journal=J Fam Pract | year= 2007 | volume= 56 | issue= 7 | pages= 576-8 | pmid=17605952 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17605952 }} </ref><ref name="pmid9134943">{{cite journal| author=Spruance SL, Rea TL, Thoming C, Tucker R, Saltzman R, Boon R| title=Penciclovir cream for the treatment of herpes simplex labialis. A randomized, multicenter, double-blind, placebo-controlled trial. Topical Penciclovir Collaborative Study Group. | journal=JAMA | year= 1997 | volume= 277 | issue= 17 | pages= 1374-9 | pmid=9134943 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9134943 }} </ref><ref name="pmid11464183">{{cite journal| author=Sacks SL, Thisted RA, Jones TM, Barbarash RA, Mikolich DJ, Ruoff GE | display-authors=etal| title=Clinical efficacy of topical docosanol 10% cream for herpes simplex labialis: A multicenter, randomized, placebo-controlled trial. | journal=J Am Acad Dermatol | year= 2001 | volume= 45 | issue= 2 | pages= 222-30 | pmid=11464183 | doi=10.1067/mjd.2001.116215 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11464183 }} </ref><ref name="pmid12069980">{{cite journal| author=Spruance SL, Nett R, Marbury T, Wolff R, Johnson J, Spaulding T| title=Acyclovir cream for treatment of herpes simplex labialis: results of two randomized, double-blind, vehicle-controlled, multicenter clinical trials. | journal=Antimicrob Agents Chemother | year= 2002 | volume= 46 | issue= 7 | pages= 2238-43 | pmid=12069980 | doi=10.1128/AAC.46.7.2238-2243.2002 | pmc=127288 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12069980 }} </ref> | <br> | ||
*An effective [[treatment]] for [[Herpetic gingivostomatitis|primary herpetic gingivostomatitis]] in [[Child|children]] is [[mouth|oral]] suspension of [[acyclovir]]. It will shorten the duration of [[infection]] significantly, if started within the first 3 days.<ref name="pmid9224082">{{cite journal| author=Amir J, Harel L, Smetana Z, Varsano I| title=Treatment of herpes simplex gingivostomatitis with aciclovir in children: a randomised double blind placebo controlled study. | journal=BMJ | year= 1997 | volume= 314 | issue= 7097 | pages= 1800-3 | pmid=9224082 | doi=10.1136/bmj.314.7097.1800 | pmc=2126953 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9224082 }} </ref> | {| border="1" | ||
! !![[Famciclovir]] - Single [[dose]]!![[Famciclovir]] - Single day!![[Placebo]] | |||
|- | |||
![[Median]] Healing Time (days) | |||
|4.4||4||6.2 | |||
|} | |||
<sub>There is no significant difference in [[famciclovir]] single [[dose]] or [[famciclovir]] single day [[treatement]], based on the mentioned study. | |||
</sub> | |||
<br> | |||
*[[Acyclovir]] is effective in decreasing the [[virus|viral]] shedding period in [[infection|infected]] [[patients]] (median of 2.5 days when [[patients]] recieved [[acyclovir]], compared to 17 days). It also has been reported to be efficient in augmenting [[pain]] resolution and healing of the [[skin]] lesions. | |||
*In another study total daily [[dose]] of 800 mg [[acyclovir]] was able to lower the recurrent [[skin]] lesions by 53%. Moreover the investigations showed that this [[dose]] of [[acyclovir]] is related to 71% reduction in [[tissue culture]]-positive recurrences, compared to control groups.<ref name="pmid8380540">{{cite journal| author=Rooney JF, Straus SE, Mannix ML, Wohlenberg CR, Alling DW, Dumois JA | display-authors=etal| title=Oral acyclovir to suppress frequently recurrent herpes labialis. A double-blind, placebo-controlled trial. | journal=Ann Intern Med | year= 1993 | volume= 118 | issue= 4 | pages= 268-72 | pmid=8380540 | doi=10.7326/0003-4819-118-4-199302150-00004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8380540 }} </ref> | |||
*[[Acyclovir]] [[treatment]] shows less effectiveness in [[treatment]] of [[Herpetic gingivostomatitis|primary herpetic gingivostomatitis]] in adults. <ref name="pmid18843726">{{cite journal| author=Nasser M, Fedorowicz Z, Khoshnevisan MH, Shahiri Tabarestani M| title=Acyclovir for treating primary herpetic gingivostomatitis. | journal=Cochrane Database Syst Rev | year= 2008 | volume= | issue= 4 | pages= CD006700 | pmid=18843726 | doi=10.1002/14651858.CD006700.pub2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18843726 }} </ref><ref name="pmid19160295">{{cite journal| author=Glenny AM, Fernandez Mauleffinch LM, Pavitt S, Walsh T| title=Interventions for the prevention and treatment of herpes simplex virus in patients being treated for cancer. | journal=Cochrane Database Syst Rev | year= 2009 | volume= | issue= 1 | pages= CD006706 | pmid=19160295 | doi=10.1002/14651858.CD006706.pub2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19160295 }} </ref> | |||
*[[Topical]] use of [[acyclovir]], [[docosanol]] and [[penciclovir]] has been reported as an effective [[treatment]] in [[herpes labialis]]. However their efficacy is less than [[mouth|oral]] anti[[virus|viral]] [[medications]].<ref name="pmid17605952">{{cite journal| author=Chon T, Nguyen L, Elliott TC| title=Clinical inquiries. What are the best treatments for herpes labialis? | journal=J Fam Pract | year= 2007 | volume= 56 | issue= 7 | pages= 576-8 | pmid=17605952 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17605952 }} </ref><ref name="pmid9134943">{{cite journal| author=Spruance SL, Rea TL, Thoming C, Tucker R, Saltzman R, Boon R| title=Penciclovir cream for the treatment of herpes simplex labialis. A randomized, multicenter, double-blind, placebo-controlled trial. Topical Penciclovir Collaborative Study Group. | journal=JAMA | year= 1997 | volume= 277 | issue= 17 | pages= 1374-9 | pmid=9134943 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9134943 }} </ref><ref name="pmid11464183">{{cite journal| author=Sacks SL, Thisted RA, Jones TM, Barbarash RA, Mikolich DJ, Ruoff GE | display-authors=etal| title=Clinical efficacy of topical docosanol 10% cream for herpes simplex labialis: A multicenter, randomized, placebo-controlled trial. | journal=J Am Acad Dermatol | year= 2001 | volume= 45 | issue= 2 | pages= 222-30 | pmid=11464183 | doi=10.1067/mjd.2001.116215 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11464183 }} </ref><ref name="pmid12069980">{{cite journal| author=Spruance SL, Nett R, Marbury T, Wolff R, Johnson J, Spaulding T| title=Acyclovir cream for treatment of herpes simplex labialis: results of two randomized, double-blind, vehicle-controlled, multicenter clinical trials. | journal=Antimicrob Agents Chemother | year= 2002 | volume= 46 | issue= 7 | pages= 2238-43 | pmid=12069980 | doi=10.1128/AAC.46.7.2238-2243.2002 | pmc=127288 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12069980 }} </ref> | |||
*An effective [[treatment]] for [[Herpetic gingivostomatitis|primary herpetic gingivostomatitis]] in [[Child|children]] is [[mouth|oral]] suspension of [[acyclovir]]. It will shorten the duration of [[infection]] significantly, if started within the first 3 days.<ref name="pmid9224082">{{cite journal| author=Amir J, Harel L, Smetana Z, Varsano I| title=Treatment of herpes simplex gingivostomatitis with aciclovir in children: a randomised double blind placebo controlled study. | journal=BMJ | year= 1997 | volume= 314 | issue= 7097 | pages= 1800-3 | pmid=9224082 | doi=10.1136/bmj.314.7097.1800 | pmc=2126953 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9224082 }} </ref> | |||
*[[mouth|Oral]] [[treatment]] with [[acyclovir]] has been related with shorter duration of [[virus|viral]] shedding in [[child|children]] which can decrease the chance of transmission. The aforementioned [[treatment]] has been effective in lowering the severity of [[mouth|oral]][[face|facial]] lesions and improving eating and drinking difficulties.<ref name="pmid9224082">{{cite journal| author=Amir J, Harel L, Smetana Z, Varsano I| title=Treatment of herpes simplex gingivostomatitis with aciclovir in children: a randomised double blind placebo controlled study. | journal=BMJ | year= 1997 | volume= 314 | issue= 7097 | pages= 1800-3 | pmid=9224082 | doi=10.1136/bmj.314.7097.1800 | pmc=2126953 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9224082 }} </ref> | *[[mouth|Oral]] [[treatment]] with [[acyclovir]] has been related with shorter duration of [[virus|viral]] shedding in [[child|children]] which can decrease the chance of transmission. The aforementioned [[treatment]] has been effective in lowering the severity of [[mouth|oral]][[face|facial]] lesions and improving eating and drinking difficulties.<ref name="pmid9224082">{{cite journal| author=Amir J, Harel L, Smetana Z, Varsano I| title=Treatment of herpes simplex gingivostomatitis with aciclovir in children: a randomised double blind placebo controlled study. | journal=BMJ | year= 1997 | volume= 314 | issue= 7097 | pages= 1800-3 | pmid=9224082 | doi=10.1136/bmj.314.7097.1800 | pmc=2126953 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9224082 }} </ref> | ||
===Analgesics=== | ===Analgesics=== | ||
*[[Analgesics]] such as [[Acetaminophen|paracetamol]] ([[acetaminophen]]) or [[ibuprofen]] can be used in order to control [[pain]] and [[fever]] (if present). | *[[Analgesics]] such as [[Acetaminophen|paracetamol]] ([[acetaminophen]]) or [[ibuprofen]] can be used in order to control [[pain]] and [[fever]] (if present). | ||
*[[Mouth|Oral]] [[analgesics]] is recommended in [[child|children]] who are experiencing [[pain]] and discomfort. | *[[Mouth|Oral]] [[analgesics]] is recommended in [[child|children]] who are experiencing [[pain]] and discomfort. | ||
===Topical Anesthetics=== | ===Topical Anesthetics=== | ||
*[[Medications]] such as [[lidocaine]], [[prilocaine]], [[tetracaine]] and [[benzocaine]] can be prescribe in order to reduce some [[symptoms]] such as [[pain]] and [[itch|itching]].<ref name="pmid3147021">{{cite journal| author=| title=Local anesthetic creams. | journal=BMJ | year= 1988 | volume= 297 | issue= 6661 | pages= 1468 | pmid=3147021 | doi= | pmc=1835116 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3147021 }} </ref> | *[[Medications]] such as [[lidocaine]], [[prilocaine]], [[tetracaine]] and [[benzocaine]] can be prescribe in order to reduce some [[symptoms]] such as [[pain]] and [[itch|itching]].<ref name="pmid3147021">{{cite journal| author=| title=Local anesthetic creams. | journal=BMJ | year= 1988 | volume= 297 | issue= 6661 | pages= 1468 | pmid=3147021 | doi= | pmc=1835116 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3147021 }} </ref> | ||
*[[Topical]] [[anesthetics]] are able to decrease [[symptoms]] in [[child|children]] in order to improve eating and drinking difficulties due to [[mouth|oral]] lesions. | |||
===Topical Corticosteroids=== | |||
*[[Topical]] [[corticosteroids]] (such as [[corticosteroid|clobetasol]] 0.05% [[gel]]) combined with anti[[virus|viral]] [[medications]] has been reported to be effective in improving the healing process of [[skin]] lesions. <ref name="pmid19143902">{{cite journal| author=Hull C, McKeough M, Sebastian K, Kriesel J, Spruance S| title=Valacyclovir and topical clobetasol gel for the episodic treatment of herpes labialis: a patient-initiated, double-blind, placebo-controlled pilot trial. | journal=J Eur Acad Dermatol Venereol | year= 2009 | volume= 23 | issue= 3 | pages= 263-7 | pmid=19143902 | doi=10.1111/j.1468-3083.2008.03047.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19143902 }} </ref> | |||
===Future or Investigational Therapies=== | ===Future or Investigational Therapies=== | ||
*There have been some investigations of a [[vaccine]] to prevent [[mouth|oro]][[face|facial]] [[herpes simplex]] [[infection]]. Attacking [[messenger RNA]] ([[messengerRNA|mRNA]]) of essential [[herpes simplex|HSV-1]] [[genes]] (such as UL20 [[genes|gene]]) is how one of the investigated [[vaccines]] works. The aforementioned [[vaccine]] has been studied on rabbits and showed lower risk of [[eye|ocular]] [[infection]] due to [[herpes simplex|HSV-1]] in them. <ref name="pmid9188579">{{cite journal| author=Miyatake S, Iyer A, Martuza RL, Rabkin SD| title=Transcriptional targeting of herpes simplex virus for cell-specific replication. | journal=J Virol | year= 1997 | volume= 71 | issue= 7 | pages= 5124-32 | pmid=9188579 | doi=10.1128/JVI.71.7.5124-5132.1997 | pmc=191747 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9188579 }} </ref> | *There have been some investigations of a [[vaccine]] to prevent [[mouth|oro]][[face|facial]] [[herpes simplex]] [[infection]]. Attacking [[messenger RNA]] ([[messengerRNA|mRNA]]) of essential [[herpes simplex|HSV-1]] [[genes]] (such as UL20 [[genes|gene]]) is how one of the investigated [[vaccines]] works. The aforementioned [[vaccine]] has been studied on rabbits and showed lower risk of [[eye|ocular]] [[infection]] due to [[herpes simplex|HSV-1]] in them. <ref name="pmid9188579">{{cite journal| author=Miyatake S, Iyer A, Martuza RL, Rabkin SD| title=Transcriptional targeting of herpes simplex virus for cell-specific replication. | journal=J Virol | year= 1997 | volume= 71 | issue= 7 | pages= 5124-32 | pmid=9188579 | doi=10.1128/JVI.71.7.5124-5132.1997 | pmc=191747 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9188579 }} </ref> | ||
*Another idea which requires more study to be approved suggests a [[medication]] (such as antagomir) to force all copies of [[herpes simplex|HSV-1]] [[virus]] to become active at a same time (from the latent status). Since there would be no latent [[virus]] in body, antiviral [[treatments]] could be successful in destroying the whole [[virus]] population. | *Another idea which requires more study to be approved suggests a [[medication]] (such as antagomir) to force all copies of [[herpes simplex|HSV-1]] [[virus]] to become active at a same time (from the latent status). Since there would be no latent [[virus]] in body, antiviral [[treatments]] could be successful in destroying the whole [[virus]] population. | ||
*Another possible [[treatment]] try to target [[microRNA]] in order to prevent [[virus|viruses]] from become latent. | *Another possible [[treatment]] try to target [[microRNA]] in order to prevent [[virus|viruses]] from become latent. | ||
*A study done on mice reported the possible effectiveness of phosphonoacetic acid in preventing [[skin]] lesion development. Based on this study phosphonoacetic acid prevented [[viruses]] from become latent when this ointment has been applied three times a day [[topical|topically]]. | *A study done on mice reported the possible effectiveness of phosphonoacetic acid in preventing [[skin]] lesion development. Based on this study phosphonoacetic acid prevented [[viruses]] from become latent when this ointment has been applied three times a day [[topical|topically]]. | ||
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==Prevention== | ==Prevention== | ||
*Antiviral [[treatment]] lower the risk of [[symptom]] development in a [[Seropositivity|seropositive]] [[patient]] by 50%, based on a study. | *Antiviral [[treatment]] lower the risk of [[symptom]] development in a [[Seropositivity|seropositive]] [[patient]] by 50%, based on a study. | ||
*A 4 month period of 500mg per day [[valacyclovir]] [[mouth|oral]] intake has been reported to be effective in [[Prevention (medical)|prevention]] of [[Herpes labialis|recurrent herpes labialis]] in a [[Blind experiment|double-blind]], [[Placebo-controlled studies|placebo-controlled study]].<ref name="pmid12661753">{{cite journal| author=Baker D, Eisen D| title=Valacyclovir for prevention of recurrent herpes labialis: 2 double-blind, placebo-controlled studies. | journal=Cutis | year= 2003 | volume= 71 | issue= 3 | pages= 239-42 | pmid=12661753 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12661753 }} </ref> | *A 4 month period of 500mg per day [[valacyclovir]] [[mouth|oral]] intake has been reported to be effective in [[Prevention (medical)|prevention]] of [[Herpes labialis|recurrent herpes labialis]] in a [[Blind experiment|double-blind]], [[Placebo-controlled studies|placebo-controlled study]].<ref name="pmid12661753">{{cite journal| author=Baker D, Eisen D| title=Valacyclovir for prevention of recurrent herpes labialis: 2 double-blind, placebo-controlled studies. | journal=Cutis | year= 2003 | volume= 71 | issue= 3 | pages= 239-42 | pmid=12661753 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12661753 }} </ref> | ||
*Use of [[condom]] is also effective in [[Prevention (medical)|prevention]] of [[herpes simplex|HSV-1]] [[infection]].<ref name="pmid16287791">{{cite journal| author=Wald A, Langenberg AG, Krantz E, Douglas JM, Handsfield HH, DiCarlo RP | display-authors=etal| title=The relationship between condom use and herpes simplex virus acquisition. | journal=Ann Intern Med | year= 2005 | volume= 143 | issue= 10 | pages= 707-13 | pmid=16287791 | doi=10.7326/0003-4819-143-10-200511150-00007 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16287791 }} </ref> | *Use of [[condom]] is also effective in [[Prevention (medical)|prevention]] of [[herpes simplex|HSV-1]] [[infection]].<ref name="pmid16287791">{{cite journal| author=Wald A, Langenberg AG, Krantz E, Douglas JM, Handsfield HH, DiCarlo RP | display-authors=etal| title=The relationship between condom use and herpes simplex virus acquisition. | journal=Ann Intern Med | year= 2005 | volume= 143 | issue= 10 | pages= 707-13 | pmid=16287791 | doi=10.7326/0003-4819-143-10-200511150-00007 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16287791 }} </ref> | ||
*Combination of antiviral [[treatment]] and [[condom]] use can reduce the chance of [[Transmission (medicine)|transmission]] by 75% annually. | *Combination of antiviral [[treatment]] and [[condom]] use can reduce the chance of [[Transmission (medicine)|transmission]] by 75% annually. | ||
*Risk of [[Transmission (medicine)|transmission]] from mother to [[infant]] is between 30% to 60% when mother become [[infection|infected]] around [[Childbirth|delivery]]. Conversly [[Transmission (medicine)|transmission]] risk decreases to 3% if mother has recurrent [[infections]].<ref name="pmid9262493">{{cite journal| author=Brown ZA, Selke S, Zeh J, Kopelman J, Maslow A, Ashley RL | display-authors=etal| title=The acquisition of herpes simplex virus during pregnancy. | journal=N Engl J Med | year= 1997 | volume= 337 | issue= 8 | pages= 509-15 | pmid=9262493 | doi=10.1056/NEJM199708213370801 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9262493 }} </ref> <ref name="pmid1849612">{{cite journal| author=Brown ZA, Benedetti J, Ashley R, Burchett S, Selke S, Berry S | display-authors=etal| title=Neonatal herpes simplex virus infection in relation to asymptomatic maternal infection at the time of labor. | journal=N Engl J Med | year= 1991 | volume= 324 | issue= 18 | pages= 1247-52 | pmid=1849612 | doi=10.1056/NEJM199105023241804 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1849612 }} </ref> | *Risk of [[Transmission (medicine)|transmission]] from mother to [[infant]] is between 30% to 60% when mother become [[infection|infected]] around [[Childbirth|delivery]]. Conversly [[Transmission (medicine)|transmission]] risk decreases to 3% if mother has recurrent [[infections]].<ref name="pmid9262493">{{cite journal| author=Brown ZA, Selke S, Zeh J, Kopelman J, Maslow A, Ashley RL | display-authors=etal| title=The acquisition of herpes simplex virus during pregnancy. | journal=N Engl J Med | year= 1997 | volume= 337 | issue= 8 | pages= 509-15 | pmid=9262493 | doi=10.1056/NEJM199708213370801 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9262493 }} </ref> <ref name="pmid1849612">{{cite journal| author=Brown ZA, Benedetti J, Ashley R, Burchett S, Selke S, Berry S | display-authors=etal| title=Neonatal herpes simplex virus infection in relation to asymptomatic maternal infection at the time of labor. | journal=N Engl J Med | year= 1991 | volume= 324 | issue= 18 | pages= 1247-52 | pmid=1849612 | doi=10.1056/NEJM199105023241804 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1849612 }} </ref> | ||
*Suppressive [[treatment]] with [[acyclovir]] is safe during [[pregnancy]] and has been recommended in last months of [[pregnancy]]. In contrast [[valaciclovir]] and [[famciclovir]] use has not been proved to be safe during [[pregnancy]].<ref name="pmid30580877">{{cite journal| author=Parra-Sánchez M| title=Genital ulcers caused by herpes simplex virus. | journal=Enferm Infecc Microbiol Clin (Engl Ed) | year= 2019 | volume= 37 | issue= 4 | pages= 260-264 | pmid=30580877 | doi=10.1016/j.eimc.2018.10.020 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30580877 }} </ref> | *Suppressive [[treatment]] with [[acyclovir]] is safe during [[pregnancy]] and has been recommended in last months of [[pregnancy]]. In contrast [[valaciclovir]] and [[famciclovir]] use has not been proved to be safe during [[pregnancy]].<ref name="pmid30580877">{{cite journal| author=Parra-Sánchez M| title=Genital ulcers caused by herpes simplex virus. | journal=Enferm Infecc Microbiol Clin (Engl Ed) | year= 2019 | volume= 37 | issue= 4 | pages= 260-264 | pmid=30580877 | doi=10.1016/j.eimc.2018.10.020 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30580877 }} </ref> | ||
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==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
[[Category:Sexually transmitted diseases]] | [[Category:Sexually transmitted diseases]] | ||
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[[Category:Needs overview]] | [[Category:Needs overview]] | ||
[[Category:Emergency mdicine]] | [[Category:Emergency mdicine]] | ||
[[Category:Infectious disease]] | [[Category:Infectious disease]] | ||
[[Category:Otolaryngology]] | [[Category:Otolaryngology]] | ||
[[Category:Urology]] | [[Category:Urology]] | ||
[[Category:Up-to-date]] |
Latest revision as of 19:11, 4 October 2021
Herpesviral vesicular dermatitis | |
Herpes lesion on upper lip and face |
Herpes simplex Microchapters |
Patient Information |
Classification |
Herpes simplex orofacial infection On the Web |
Risk calculators and risk factors for Herpes simplex orofacial infection |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Anahita Deylamsalehi, M.D.[2] ; Cafer Zorkun, M.D., Ph.D. [3]
Overview
Infection by HSV-1 is the most common cause of herpes that affects the face and mouth (orofacial herpes), although within the recent years an increase in oral HSV-2 infections has been reported. Studies demonstrated different rate of herpes simplex orofacial infection prevalence in different populations, nevertheless lifetime prevalences of herpes simplex orofacial infection has been estimated 42.1% and 32.4%, in women and men, respectively. There are some evidences that report higher rate of herpes simplex orofacial infection in low socioeconomic status. A majority of primary HSV-1 infections occur during childhood. Early HSV infection could be asymptomatic without any obvious skin lesions. Transmission commonly occurs when infection source comes in contact with the mucosa or abraded skin. However there are other rout of transmission such as infants born to infected mothers who are also at risk of catching the HSV-1 during the delivery. The estimated duration of primary HSV infection has been estimated between 2-20 days after contact with the source of infection. Skin involvement usually appear as grouped ulcers or vesicles on an erythematous base. Subsequently skin vesicles may ulcerate and then become crusted. Primary HSV infection in adolescents frequently manifests as severe pharyngitis with lesions developing on the cheek and gums. Some individuals develop difficulty in swallowing. Once a primary oral HSV-1 infection has resolved, the HSV enters the nerves surrounding the primary lesion, migrates to the cell body of the neuron, and becomes latent in the trigeminal ganglion. In some patients, the virus reactivates to cause recurrent infection, which is more common with HSV-1 than HSV-2 oral infection. Even though trigeminal ganglion is the most common location for HSV-1 infection, inferior and superior cervical ganglia could also become infected with this serotype of herpes simplex. Prodromal symptoms often precede a recurrence, which typically begins with reddening of the skin around the infected site. Pain, itching and paresthesia are some of the other prodromal symptoms in herpes simplex infection. Duration of the prodromal symptoms can range between few hours to several days before lesions develop. Some factors such as concurrent viral infection, trauma, menstural period, fatigue, stress and sun exposure could trigger recurrent herpes simplex lesions. It has been estimated that patients with HSV-1 orofacial infection could experience recurrent infections 1-6 times in a year. Each episode of orofacial infection is less sever and shorter, compared to previous episodes of orofacial infections. There are numerous differential diagnosis such as oral candidiasis, aphthous ulcers, squamous cell carcinoma, leukoplakia, behcet's disease, crohn's disease and burning mouth syndrome. Some conditions such as leukemia, bell's palsy, chronic atopic dermatitis and Human immunodeficiency virus infection have been known as associated conditions in orofacial herpes. Orofacial herpes simplex infection is usually diagnosed clinically, nevertheless PCR test, immunodot glycoprotein G-specific (IgG) test, skin biopsy, virus culture and direct fluorescent anti body (DFA) studies are some of the available laboratory investigations to better diagnose orofacial infection due to herpes simplex. Unfortunately there is no approved treatment to completely eradicate the herpes simplex virus from body. Nevertheless antiviral treatments have been successful in lowering the severity and duration of skin lesions. The available antiviral drugs that can be used for herpes simplex infection include acyclovir, valaciclovir, famciclovir and penciclovir. Acyclovir is effective in decreasing the viral shedding period in infected patients (median of 2.5 days when patients received acyclovir, compared to 17 days). It also has been reported to be efficient in augmenting pain resolution and healing of the skin lesions.
Epidemiology
- Based on a study, lifetime prevalences of herpes simplex orofacial infection are 42.1% and 32.4%, in women and men, respectively. Moreover HSV1 prevalence was estimated 50.3%.[1]
- Another study reported herpes simplex infection rate approximately 70-80% in low socioeconomic status and 40%-60% in high socioeconomic status individuals. [2]
- Prevalence of HSV-1 estimated as 57.7% in US population. [3]
- Based on a study done on college students demonstrated that 25.6 % of first year college students had history of recurrent orofacial HSV-1 infection compared to 28 % in fourth-year students.
- A study done in France estimated annual prevalence of orofacial herpes simplex infection as 14.8% (only 23% of these population were aware of their infection). Based on this study female population has higher chance of infection, compared to male populations.[4]
Clinical Presentations
- Early HSV infection could be asymptomatic without any obvious symptoms (Also called asymptomatic seroconversion).[5]
- A majority of primary HSV-1 infections occur during childhood and if the virus comes into contact with the mucosa or abraded skin, it can cause acute herpetic gingivostomatitis (inflammation of the cheek's mucosa and gums) within 5–10 days. Some other symptoms may also develop, including fever and sore throat, refuse to eat or drink and painful ulcers may appear.[6]
- Prodromal symptoms often precede a recurrence, which typically begins with reddening of the skin around the infected site, with eventual ulceration to form fluid-filled blisters that affect the lip (labial) tissue and the area between the lip and skin (vermillion border).[6] [7]
- The following list includes some of the prodromal symptoms in herpes simplex infection:[8]
- Itching
- Pain
- Paresthesia (may be described as tingling)
- Duration of the prodromal symptoms can range between few hours to several days before lesions develop.
- Most of the time orofacial infection just involves lips and oral mucosa and is often called herpes simplex labialis.
- Skin involvement usually appear as grouped ulcers or vesicles on an erythematous base. Subsequently skin vesicles may ulcerate (severely painful at this stage) and then become crusted.[9]
- Presence of cervical or submandibular lymphadenopathy is possible during the orofacial HSV-1 infection.
- The estimated duration of primary HSV infection has been estimated between 2-20 days after contact with the source of infection.
- Primary HSV infection in adolescents frequently manifests as severe pharyngitis with lesions developing on the cheek and gums. Some individuals develop difficulty in swallowing (dysphagia) and swollen lymph nodes (lymphadenopathy).[6]
- Primary HSV infections in adults often presents as pharyngitis similar to that observed in glandular fever (infectious mononucleosis), but gingivostomatitis is less likely. The symptoms of primary HSV infection generally resolve within two weeks.[6]
- Immunodeficient patients can develop sever and atypical manifestations such as linear erosions in skin creases which has a similar appearance to knife cuts (Knife-Cut Sign). [10]
- Ocular infection due to HSV-2 can present as acute retinal necrosis syndrome.
Disease Progression And Recurrence
- Transmission of HSV-1 usually occurs via direct contact with skin lesions or body fluids of the involved patient (aerosol and fomite spread are rare). In orofacial infection the virus get inoculated onto oropharynx and conjunctiva or through small cracks in the skin.[11] [12]
- Some occupations such as dentists, hospital, nursery or respiratory care unit personnel are at risk of HSV-1 spread via patient's oral secretion. The aforementioned occupations are also at risk of herpes simplex infection due to hospital outbreaks.
- Outbreaks are also reported in some athletes, such as wrestlers.[13]
- Infants born to infected mothers are also at risk of catching the HSV-1 during the delivery.[14]
- HSV-1 infection can be transmitted through sexual activity especially in men who have sex with men.[15]
- Incubation period of primary infection is very short, approximately 5 days. [15]
- Based on reports, viral shedding last for 60 hours (when measured by PCR) and 48 hours (when measured by culture).[16]
- Once a primary oral HSV-1 infection has resolved, the HSV enters the nerves surrounding the primary lesion, migrates to the cell body of the neuron, and becomes latent in the trigeminal ganglion. In some patients, the virus reactivates to cause recurrent infection; which is more common with HSV-1 than HSV-2 oral infection.[6] [17]
- Even though trigeminal ganglion is the most common location for HSV-1 infection, inferior and superior cervical ganglia could also become infected with this serotype of herpes simplex.[18]
- After initial infection with one type of herpes simplex virus antibody development occurs which prevent another form of infection with the same type. Based on this, a patient with history of orofacial HSV-1 infection is immune against herpetic whitlow, ocular infection or genital herpes simplex caused by HSV-1. Antibody production occurs 6 months after the initial infection with HSV-1.[19]
- Even though infection with HSV-1 will not protect patients from HSV-2 infection, it will decrease the severity of HSV-2 infection.[20]
- Most of the time recurrent episodes of HSV-1 orofacial infection just involves lips and oral mucosa which is called herpes simplex labialis. Rare occasions of reinfections occur inside the mouth (intraoral HSV stomatitis), affecting the gums, alveolar ridge, hard palate, and the back of the tongue. This may be accompanied by herpes labialis.[6] [21][22]
- It seems that some factors are responsible for recurrent herpes simplex infection due to decreasing the cell mediated immunity (either antigen dependent or no antigen dependent). the following list contains some of these factors:[23][24][25][26][27][4]
- Other viral infections with fever
- Fatigue
- Menstural period
- Stress
- Local trauma
- Ultraviolet light
- Local injury due to high temprature or frostbite
- Sun exposure
- A study reported a protein named protein VP16 as an involved factor in infection recurrency.
- It has been estimated that patients with HSV-1 orofacial infection could experience recurrent infections 1-6 times in a year. Each episode of orofacial infection is less sever and shorter, compared to previous episodes of orofacial infections. [8]
- Chance of recurrent orofacial involvement has been estimated 0.12 monthly.[28]
- Oral herpes is spread by direct contact with an active sore in an infected person, for instance, by kissing. However, the virus can be transmitted through the skin in the absence of a lesion.
- Oral herpes and cold sores can sometimes be confused with canker sores.
- Healing time has been estimated 10 to 14 days, based on a study done on herpes simplex infections.[8]
Differential diagnosis
Herpes simplex orofacial infection must be differentiated from other diseases causing oral lesions such as leukoplakia and herpes simplex virus infection.[29]
Disease | Presentation | Risk Factors | Diagnosis | Affected Organ Systems | Important features | Picture |
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Diseases predominantly affecting the oral cavity | ||||||
Oral Candidiasis |
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Localized candidiasis
Invasive candidasis |
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Herpes simplex oral lesions | ||||||
Aphthous ulcers |
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Squamous cell carcinoma |
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Leukoplakia |
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Melanoma |
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Fordyce spots |
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Burning mouth syndrome |
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Torus palatinus |
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Diseases involving oral cavity and other organ systems | ||||||
Behcet's disease |
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Crohn's disease |
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Agranulocytosis |
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Syphilis[32] |
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Coxsackie virus |
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Chicken pox |
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Measles |
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Associated Conditions
- Leukemia:[35][36]
- Herpes simplex orofacial infection has been reported in 40% of patients with acute leukemia.
- Chronic atopic dermatitis:
- Chronic atopic dermatitis is associated with a form of herpes simplex infection in the eczematous areas (eczema herpeticum).
- It seems that atopic dermatitis in this patients further augments the herpes simplex infection spread within the eczematous skin.
- Bell's palsy:[37]
- Although the explicit cause of bell's palsy is not fully understood, but it could be related to reactivation of HSV-1 infection.
- Human immunodeficiency virus (HIV) infection
Prognosis
- Many patients with herpes simplex infection experience recurrent lesions within the first year after infection.[38]
- Symptoms in recurrent infection can range from minor burning or just an itch to painful facial lesions that may cause debilitation.
- Based on some reports genetical factors may play a role in prognosis of orofacial herpes simplex infection.
Diagnosis
- Orofacial herpes simplex infection is usually diagnosed clinically. Skin and oral involvement usually present as multiple superficial round ulcers on face or mouth with or without acute gingivitis.[39]
- Although most orofacial infections of herpes simplex is due to HSV-1, nevertheless HSV-2 could be also responsible in some cases. Hence differentiating the two serotypes could be necessary in some occasions.
- PCR test which detects herpes simplex antibodies and immunodot glycoprotein G-specific (IgG) test are two specific tests (more than 98%) to differentiate these two different serotypes. [40][16]
- Beside PCR test there are some other laboratory tests include skin biopsy, virus culture and direct fluorescent anti body (DFA) studies.[39]
- If it is possible tissue culture for diagnosis should be taken from vesicles. Highest measure of herpes simplex virus has been found in the first 24 to 48 hours of vesicles appearance. [41]
- Compared to tissue culture, direct fluorescent antibody testing is capable of detecting 80 % of HSV infections.[42]
- Tzanck test require expert personnel to perform the test. It is reported positive if multinucleated giant cells are seen. Tzanck test could not be used to differente HSV-1 from HSV-2, nevertheless it's sensitivity has been estimated 40-77 % for herpetic gingivostomatitis.[43]
Treatment
Unfortunately, there is no approved treatment to completely eradicate the herpes simplex virus from the body. Nevertheless, antiviral treatments have been successful in lowering the severity and duration of skin lesions. Soft, smooth, and cold foods are helpful in lowering the symptoms severity during meals.
Antiviral drugs
- The available antiviral drugs that can be used for herpes simplex infection include acyclovir, valaciclovir, famciclovir and penciclovir.[44][45][46]
- Based on a double-blind, placebo controlled, randomized trial done on patients with recurrent herpes simplex orofacial infection showed efficacy of 5% acyclovir cream containing propylene glycol in reducing the period of vesiculation (P = 0.016), healing time (P = 0.022) and itching duration.[47] [35]
- Another study done on 703 patients with herpes simplex keratitis demonstrated the effectiveness of acyclovir therapy for 12 months in lowering the chance of recurrent herpes simplex orofacial infection, including the ocular infection. [48]
- Data from different studies suggest the use of acyclovir and valaciclovir in herpes labialis. These two medications are also effective in cancer patients who are infected with herpes simplex infection.[45][49][50][45]
- Based on a study done on 701 randomly selected patients, 1500 mg single dose of famciclovir reduce healing period by 2 days, compared to placebo. The following table is a summary of median healing time in 3 different treatments that have been studied.[51]
Famciclovir - Single dose | Famciclovir - Single day | Placebo | |
---|---|---|---|
Median Healing Time (days) | 4.4 | 4 | 6.2 |
There is no significant difference in famciclovir single dose or famciclovir single day treatement, based on the mentioned study.
- Acyclovir is effective in decreasing the viral shedding period in infected patients (median of 2.5 days when patients recieved acyclovir, compared to 17 days). It also has been reported to be efficient in augmenting pain resolution and healing of the skin lesions.
- In another study total daily dose of 800 mg acyclovir was able to lower the recurrent skin lesions by 53%. Moreover the investigations showed that this dose of acyclovir is related to 71% reduction in tissue culture-positive recurrences, compared to control groups.[46]
- Acyclovir treatment shows less effectiveness in treatment of primary herpetic gingivostomatitis in adults. [52][45]
- Topical use of acyclovir, docosanol and penciclovir has been reported as an effective treatment in herpes labialis. However their efficacy is less than oral antiviral medications.[49][53][54][55]
- An effective treatment for primary herpetic gingivostomatitis in children is oral suspension of acyclovir. It will shorten the duration of infection significantly, if started within the first 3 days.[56]
- Oral treatment with acyclovir has been related with shorter duration of viral shedding in children which can decrease the chance of transmission. The aforementioned treatment has been effective in lowering the severity of oralfacial lesions and improving eating and drinking difficulties.[56]
Analgesics
- Analgesics such as paracetamol (acetaminophen) or ibuprofen can be used in order to control pain and fever (if present).
- Oral analgesics is recommended in children who are experiencing pain and discomfort.
Topical Anesthetics
- Medications such as lidocaine, prilocaine, tetracaine and benzocaine can be prescribe in order to reduce some symptoms such as pain and itching.[57]
- Topical anesthetics are able to decrease symptoms in children in order to improve eating and drinking difficulties due to oral lesions.
Topical Corticosteroids
- Topical corticosteroids (such as clobetasol 0.05% gel) combined with antiviral medications has been reported to be effective in improving the healing process of skin lesions. [58]
Future or Investigational Therapies
- There have been some investigations of a vaccine to prevent orofacial herpes simplex infection. Attacking messenger RNA (mRNA) of essential HSV-1 genes (such as UL20 gene) is how one of the investigated vaccines works. The aforementioned vaccine has been studied on rabbits and showed lower risk of ocular infection due to HSV-1 in them. [59]
- Another idea which requires more study to be approved suggests a medication (such as antagomir) to force all copies of HSV-1 virus to become active at a same time (from the latent status). Since there would be no latent virus in body, antiviral treatments could be successful in destroying the whole virus population.
- Another possible treatment try to target microRNA in order to prevent viruses from become latent.
- A study done on mice reported the possible effectiveness of phosphonoacetic acid in preventing skin lesion development. Based on this study phosphonoacetic acid prevented viruses from become latent when this ointment has been applied three times a day topically.
- Oral or topical use of a new antiviral agent named 2'-Nor-2'-deoxyguanosine (2'NDG) on mice demonstrated reduced severity in orofacial lesions. Minimum effective dose has been estimated as 0.2 mg/kg per day in one study. [60]
Prevention
- Antiviral treatment lower the risk of symptom development in a seropositive patient by 50%, based on a study.
- A 4 month period of 500mg per day valacyclovir oral intake has been reported to be effective in prevention of recurrent herpes labialis in a double-blind, placebo-controlled study.[61]
- Use of condom is also effective in prevention of HSV-1 infection.[62]
- Combination of antiviral treatment and condom use can reduce the chance of transmission by 75% annually.
- Risk of transmission from mother to infant is between 30% to 60% when mother become infected around delivery. Conversly transmission risk decreases to 3% if mother has recurrent infections.[14] [63]
- Suppressive treatment with acyclovir is safe during pregnancy and has been recommended in last months of pregnancy. In contrast valaciclovir and famciclovir use has not been proved to be safe during pregnancy.[64]
References
- ↑ Malvy D, Ezzedine K, Lançon F, Halioua B, Rezvani A, Bertrais S; et al. (2007). "Epidemiology of orofacial herpes simplex virus infections in the general population in France: results of the HERPIMAX study". J Eur Acad Dermatol Venereol. 21 (10): 1398–403. doi:10.1111/j.1468-3083.2007.02302.x. PMID 17958848.
- ↑ Chayavichitsilp P, Buckwalter JV, Krakowski AC, Friedlander SF (2009). "Herpes simplex". Pediatr Rev. 30 (4): 119–29, quiz 130. doi:10.1542/pir.30-4-119. PMID 19339385.
- ↑ Xu F, Sternberg MR, Kottiri BJ, McQuillan GM, Lee FK, Nahmias AJ; et al. (2006). "Trends in herpes simplex virus type 1 and type 2 seroprevalence in the United States". JAMA. 296 (8): 964–73. doi:10.1001/jama.296.8.964. PMID 16926356.
- ↑ 4.0 4.1 Lorette G, Crochard A, Mimaud V, Wolkenstein P, Stalder JF, El Hasnaoui A (2006). "A survey on the prevalence of orofacial herpes in France: the INSTANT Study". J Am Acad Dermatol. 55 (2): 225–32. doi:10.1016/j.jaad.2005.10.014. PMID 16844503.
- ↑ Stanberry LR, Kern ER, Richards JT, Abbott TM, Overall JC (1982). "Genital herpes in guinea pigs: pathogenesis of the primary infection and description of recurrent disease". J Infect Dis. 146 (3): 397–404. doi:10.1093/infdis/146.3.397. PMID 6286797.
- ↑ 6.0 6.1 6.2 6.3 6.4 6.5 Bruce AJ, Rogers RS (2004) Oral manifestations of sexually transmitted diseases. Clin Dermatol 22 (6):520-7. DOI:10.1016/j.clindermatol.2004.07.005 PMID: 15596324
- ↑ Herpes Online: Exploring the "H" Community, pages 1-4 American Social Health Association 1996 Access date: 2007-03-29
- ↑ 8.0 8.1 8.2 Cernik C, Gallina K, Brodell RT (2008). "The treatment of herpes simplex infections: an evidence-based review". Arch Intern Med. 168 (11): 1137–44. doi:10.1001/archinte.168.11.1137. PMID 18541820.
- ↑ Patel AR, Romanelli P, Roberts B, Kirsner RS (2007). "Treatment of herpes simplex virus infection: rationale for occlusion". Adv Skin Wound Care. 20 (7): 408–12. doi:10.1097/01.ASW.0000280199.58260.62. PMID 17620742.
- ↑ 10.0 10.1 Cohen PR (2015). "The "Knife-Cut Sign" Revisited: A Distinctive Presentation of Linear Erosive Herpes Simplex Virus Infection in Immunocompromised Patients". J Clin Aesthet Dermatol. 8 (10): 38–42. PMC 4633212. PMID 26557219.
- ↑ Sen P, Barton SE (2007). "Genital herpes and its management". BMJ. 334 (7602): 1048–52. doi:10.1136/bmj.39189.504306.55. PMC 1871807. PMID 17510153.
- ↑ Perl TM, Haugen TH, Pfaller MA, Hollis R, Lakeman AD, Whitley RJ; et al. (1992). "Transmission of herpes simplex virus type 1 infection in an intensive care unit". Ann Intern Med. 117 (7): 584–6. doi:10.7326/0003-4819-117-7-584. PMID 1524332.
- ↑ Belongia EA, Goodman JL, Holland EJ, Andres CW, Homann SR, Mahanti RL; et al. (1991). "An outbreak of herpes gladiatorum at a high-school wrestling camp". N Engl J Med. 325 (13): 906–10. doi:10.1056/NEJM199109263251302. PMID 1652687.
- ↑ 14.0 14.1 Brown ZA, Selke S, Zeh J, Kopelman J, Maslow A, Ashley RL; et al. (1997). "The acquisition of herpes simplex virus during pregnancy". N Engl J Med. 337 (8): 509–15. doi:10.1056/NEJM199708213370801. PMID 9262493.
- ↑ 15.0 15.1 Quinn TC, Corey L, Chaffee RG, Schuffler MD, Brancato FP, Holmes KK (1981). "The etiology of anorectal infections in homosexual men". Am J Med. 71 (3): 395–406. doi:10.1016/0002-9343(81)90167-4. PMID 7025620.
- ↑ 16.0 16.1 Boivin G, Goyette N, Sergerie Y, Keays S, Booth T (2006). "Longitudinal evaluation of herpes simplex virus DNA load during episodes of herpes labialis". J Clin Virol. 37 (4): 248–51. doi:10.1016/j.jcv.2006.09.006. PMID 17046320.
- ↑ Herpes Online: Exploring the "H" Community, pages 1-4 American Social Health Association 1996 Access date: 2007-03-29
- ↑ Cushing H (1983). "Landmark article April 28, 1900: A method of total extirpation of the Gasserian ganglion for trigeminal neuralgia. By a route through the temporal fossa and beneath the middle meningeal artery. By Harvey Cushing". JAMA. 250 (4): 519–28. doi:10.1001/jama.250.4.519. PMID 6345823.
- ↑ Reuven NB, Staire AE, Myers RS, Weller SK (2003). "The herpes simplex virus type 1 alkaline nuclease and single-stranded DNA binding protein mediate strand exchange in vitro". J Virol. 77 (13): 7425–33. doi:10.1128/jvi.77.13.7425-7433.2003. PMC 164775. PMID 12805441.
- ↑ Handsfield HH (2000). "Public Health Strategies to Prevent Genital Herpes: Where Do We Stand?". Curr Infect Dis Rep. 2 (1): 25–30. doi:10.1007/s11908-000-0084-y. PMID 11095834.
- ↑ Herpes Online: Exploring the "H" Community, pages 1-4 American Social Health Association 1996 Access date: 2007-03-29
- ↑ Gilbert S, Corey L, Cunningham A, Malkin JE, Stanberry L, Whitley R; et al. (2007). "An update on short-course intermittent and prevention therapies for herpes labialis". Herpes. 14 Suppl 1: 13A–18A. PMID 17877887.
- ↑ Vestey JP, Norval M, Howie S, Maingay J, Neill WA (1989). "Variation in lymphoproliferative responses during recrudescent orofacial herpes simplex virus infections". Clin Exp Immunol. 77 (3): 384–90. PMC 1542042. PMID 2553308.
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|month=
ignored (help) - ↑ Andrès E, Zimmer J, Affenberger S, Federici L, Alt M, Maloisel F. (2006). "Idiosyncratic drug-induced agranulocytosis: Update of an old disorder". Eur J Intern Med. 17 (8): 529–35. Text "pmid 17142169" ignored (help)
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