Recurrent Herpes Simplex: What Are the Possible Interventions?
This short consult is presented by Dr. Eric Stoopler, DMD; Dr. Arthur Kuperstein, DDS; and Dr. Thomas Sollecito, DMD
Peer-reviewed content that appeared in the JCDA OASIS “point of care” searchable database at www.jcdaoasis.ca and in the sixth edition of the print JCDA.
Primary and recurrent infection with herpes simplex virus (HSV-1 and HSV-2) can cause oral and/or genital lesions, although the majority of oral infections are caused by HSV-1. Symptomatic vesicles/ulcers of the oral mucosal tissues generally follow the onset of systemic symptoms and are often accompanied by significant erythema of the gingival tissues (i.e., “primary herpetic gingivostomatitis”). Treatment of primary HSV infections is usually palliative, while the majority of infections resolve within 2 weeks of symptom onset.
When a diagnosis of recurrent herpes simplex labialis (RHL) is determined, you have a range of interventions at your fingertips that are based on frequency and severity of lesions:
- Abortive Therapy: Valacyclovir 2000 mg twice a day for one day or famciclovir 500 mg 2-3 times a day when the patient experiences prodromal symptoms.
- Active Therapy: Acyclovir 400 mg 3 times a day for 5 to 7 days.
- Prophylaxis Therapy: Sunscreen alone (SPF 15 or higher) or acyclovir 400 mg 2-3 times a day or valacyclovir 500 to 2000 mg twice a day.
- Suppressive Therapy: This may be considered for patients with frequent, severe, and disfiguring RHL episodes. Patients should be referred to the appropriate dental or medical specialist for this type of management.
- RIH: Immunocompromised patients with this condition may require extended courses of systemic antivirals and should be referred to the appropriate dental or medical specialist for this type of management.
- It is unusual for lesions to not respond to typical antiviral agents. However, some lesions may be resistant to typical medications.
- If lesion does not resolve with application of usual medications, further investigation is warranted.
- Elective dental treatment should be deferred for patients with active lesions as aerosolization of the virus may occur during dental procedures, placing both the patient and oral health care provider at risk for possible infection or re-infection.
JCDA-OASIS supports clinical decisions. However, it does not provide medical advice, diagnosis or treatment details. JCDA-OASIS is a rapidly accessible, initial clinical resource—not a complete reference.
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