Management

Treatment

• in healthy patients, the infection is self limited even without treatment (1)
• treatment in immunocompetent patients is often symptomatic.Topical acyclovir may be indicated.(1)
• oral anti-viral medications include:
  • acyclovir, famciclovir, valacyclovir
  • indications for systemic use are:
    • if lesions are noticed within 72 hrs (1)
    • to treat an outbreak
    • to suppress herpes recurrences
      • suppressive therapy may be indicated for patients having > 6 recurrences per year (1)
    • to reduce outbreaks
    • to reduce spreading by viral shedding.(2)
    • in severe infections
    • in the immunocompromised
      • tend to have chronic disease
      • require anti-viral therapy (1)
• oral therapy will reduce pain, viral shedding and time to healing (1)
• if secondary infection occurs then treat with antibiotics
• recurrent herpetic infections should not be treated with corticosteroids.(3)

Prevention

• there is no vaccine that prevents the disease (2)
• the area of the body where there is a herpes infection should be kept away from other people.
• with oral herpes, kissing, sharing cups, or lip balms should be avoided
• persons with genital herpes should avoid sexual relations, including oral/genital contact during active lesions
  • condoms should always be used
    • condoms helps prevent transmission of genital herpes

Note:

• more detailed information regarding management is found on sections relating to specific infections e.g. cold sores, genital herpes.

Reference:

• (1) David A, et al.Viral Infections - Verrucae, Herpes Simplex, and Herpes Zoster. American Academy of Dermatology.2007
• (2) Herpes simplex. American Academy of Dermatology.2007
• (3) Wanda C. Gonsalves .Common Oral Lesions: Part I. Superficial Mucosal Lesions. Am Fam Physician 2007;75:501-7.