General Illness Information
Common Name: Cold Sores, Fever Blister
Description: A common, contagious virus (herpes simplex or HSV-1) infection. Usually involves the lips; gums and mouth area; cornea (rare); occasionally genitals.
Primary oral herpes infection (primary herpes gingivostomatitis) is an initial infection by the herpes simplex virus which causes very painful sores on the gums and in the other parts of the mouth. Secondary herpes (recurrent herpes labialis) is a local reactivation of the virus that produces a cold sore. Typically primary herpes is seen in an infant who got the virus from an adult with a cold sore.
First infection with HSV1 usually occurs in early childhood; incubation from 2-12 days, then fever, sore throat, small vesicles develop on pharyngeal and oral mucosa, rapidly ulcerate and increase in number to involve soft palate, buccal mucosa, tongue, floor of mouth, and often lips and cheeks; tender gums may bleed; fetid breath, swollen lymph nodes in the neck; fever, general toxicity, poor oral intake, and drooling contribute to dehydration; spread to other sites may occur; resolves in 10-14 days with slower resolution ofÂ the swollen lymph glands.
- It is a herpes virus , a DNA virus of two major types: HSV1 and HSV2; most often HSV1 is associated with oral lesions and HSV2 with genital lesions but reverse occurs also , often remaining dormant for months or years before causing active inflammation. Most persons develop antibodies that control the virus unless risk factors (below) develop;
- The virus is transmitted by person-to-person contact or by contact with saliva, stools, urine or discharge from an infected eye. The blisters and ulcers of herpes simplex are contagious until they heal, both in the first and in succeeding flare-ups;
- Usual course of primary disease is 2 weeks; duration of recurrences varies; viral shedding in recurrence is briefer than with primary disease. Newborns or individuals with immune compromise are at risk for complications such as encephalitis, pneumonia, or disseminated infection.
- Avoid physical contact with others who have active lesions;
- Wash your hands often during flare-ups to avoid spreading the virus.
Signs & Symptoms
- Small, painful blisters usually around the mouth, but sometimes on the genitals. Blisters are grouped together and each surrounded by a big red ring. They fill with fluid, then dry up and disappear;
- If the eye is infected: Eye pain and redness; feeling that something is in the eye; sensitivity to light; and tearing.
- Physical or emotional stress;
- Illness that has lowered resistance, including a cold, minor gastrointestinal upset or fever from any cause;
- Excess sun exposure;
- Dental treatment that stretches the mouth;
- Use of immunosuppressive drugs;
- Newborns; children who have eczema.
Diagnosis & Treatment
The appearance of the typical lesion is usually diagnostic, however, a laboratory study may be done of fluid from the sore for confirmation.
- Drink cool liquids or suck frozen juice bars to reduce discomfort;
- Apply an ice cube for 1 hour during the first 24 hours after lesion appears. This may make it heal more quickly;
- Intermittent cool moist dressings with Domeboro or Burrow’s solution;
- Don’t rub or scratch an infected eye;
- To prevent flare-ups, use zinc oxide or sun-screen preparations on your lips when you spend much time outdoors;
- Children with gingivostomatitis may require IV hydration;
- Extensive skin disease (as with neonates or with eczema herpeticum) may require vigorous volume replacement.
- Use acetaminophen to relieve minor pain. Don’t use aspirin. The use of aspirin during some viral illnesses may lead to Reye’s syndrome, a form of encephalitis;
- Don’t try to treat an infected eye especially with cortisone ointments or drops. Cortisone preparations promote growth of the herpes virus in the cornea;
- Antiviral topical (Zovirax) or oral medication (Acyclovir) may be prescribed. Antibiotic ointment if lesions become infected with bacteria may be prescribed;
- Oral medication may occasionally be recommended continuously to prevent frequent episodes. For chronic suppression in persons with frequent recurrences – 400 mg of acyclovir given twice daily.
No restrictions, except to avoid close contact especially kissing or oral sex until lesions heal. Avoid contact with newborns or patient who are taking immunosuppresant drugs (they are more susceptible to infection).
Avoid acidic foods if lesions in the mouth.
- Permanent vision impairment, if herpes eye infections are untreated;
- Severe, widespread infection in patient with eczema;
- Meningitis or encephalitis (rare).
Spontaneous recovery in a few days to a week, occasionally longer. Recurrence is common. The virus remains in the body for life, but it is usually dormant. Research continues in developing a vaccine.