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A cross-sectional study of herpes simplex virus types 1 and 2 in college students: occurrence and determinants of infection. Longitudinal evaluation of herpes simplex virus DNA load during episodes of herpes labialis.
The natural history of recurrent herpes simplex labialis: implications for antiviral therapy. 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 varicellazoster virus.
Acute herpetic gingivostomatitis in adults: a review of 13 cases, including diagnosis and management. Treatment of herpes simplex gingivostomatitis with aciclovir in children: a randomised double blind placebo controlled study.
Interventions for the prevention and treatment of herpes simplex virus in patients being treated for cancer.
Single-dose, patient-initiated famciclovir: a randomized, double-blind, placebo-controlled trial for episodic treatment of herpes labialis. Valacyclovir and topical clobetasol gel for the episodic treatment of herpes labialis: a patient-initiated, double-blind, placebo-controlled pilot trial.
Clinical efficacy of topical docosanol 10% cream for herpes simplex labialis: a multi-center, randomized, placebo-controlled trial. Acyclovir cream for treatment of herpes simplex labialis: results of two randomized, double-blind, vehicle-controlled, multicenter clinical trials.
A systematic review of the effectiveness of antifungal drugs for the prevention and treatment of oropharyngeal candidiasis in HIV-positive patients. High-dose, short-duration, early valacyclovir therapy for episodic treatment of cold sores: results of two randomized, placebo-controlled, multicenter studies. Effective treatment of herpes simplex labialis with penciclovir cream: combined results of two trials.


A double-blind study of topically applied 5% amlexanox in the treatment of aphthous ulcers. Comparison of fluconazole and nystatin oral suspensions for treatments of oral candidiasis in infants. Treatment of oropharyngeal candidiasis and candidal diaper dermatitis in neonates and infants: review and reappraisal. A controlled clinical trial of the efficacy of topically applied fluocinonide in the treatment of recurrent aphthous ulceration.
The diagnosis of an infection with herpes simplex virus type 1 is usually made by the appearance of the lesions (grouped vesicles or ulcers on an erythematous base) and patient history. Oral HSV-1 infections reactivate from the trigeminal sensory ganglia, affecting the facial, oral, labial, oropharyngeal, and ocular mucosa.Primary infection appears two to 20 days after contact with an infected person. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. However, if uncertain, the diagnosis of herpes labialis can be made by viral culture, polymerase chain reaction, serology, direct fluorescent antibody testing, or Tzanck test. Other nonoral herpes simplex virus type 1 infections include herpetic keratitis, herpetic whitlow, herpes gladiatorum, and herpetic sycosis of the beard area. The differential diagnosis of nongenital herpes simplex virus infection includes aphthous ulcers, acute paronychia, varicellazoster virus infection, herpangina, herpes gestationis (pemphigoid gestationis), pemphigus vulgaris, and Behcet syndrome. Oral acyclovir suspension is an effective treatment for children with primary herpetic gingivostomatitis. Usatine, MDFigure 2.Primary herpetic gingivostomatitis caused by herpes simplex virus type 1 shown in (A) a four-year-old girl with lower lip ulcers and crusting on the upper lip, and (B) a two-year-old girl with ulcers on the lower lip and tongue. However, most individuals are asymptomatic and do not require treatment for this benign condition. Oral acyclovir, valacyclovir, and famciclovir are effective in treating acute recurrence of herpes labialis (cold sores).


A Tzanck test is difficult to perform correctly without specific training in its use, but it may be done in the office setting by scraping the floor of the herpetic vesicle, staining the specimen, and looking for multinucleated giant cells. For symptomatic cases, several treatments have been proposed, including topical steroids, zinc supplements, and topical anesthetic rinses. Recurrences of herpes labialis may be diminished with daily oral acyclovir or valacyclovir.
Usatine, MDIn recurrent herpes labialis, symptoms of tingling, pain, paresthesias, itching, and burning precede the lesions in 60 percent of persons.5 The lesions then appear as clusters of vesicles on the lip or vermilion border (Figure 1).
Topical acyclovir, penciclovir, and docosanol are optional treatments for recurrent herpes labialis, but they are less effective than oral treatment. Nongenital herpes simplex virus type 1 (HSV-1) is a common infection that most often involves the oral mucosa or lips (herpes labialis). Use of systemic antivirals for herpes labialis generally should be reserved for immunocompromised patients. Usatine, MDFigure 3.(A) Ulcers that form after the vesicles break, as shown in an adult women with herpes labialis. Herpes gladiatorum is often seen in athletes who wrestle, which may put them in close physical contact with an infected person. Herpetic sycosis is a follicular infection with HSV that causes vesiculopapular lesions in the beard area. Usatine, MDFigure 9.Vesicles on a red base of the wrist in a woman with herpes gestationis after the loss of a pregnancy.



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