HSV-1 Infection

Herpetic Stomatitis
Herpes Simplex Virus
Herpes viruses are DNA viruses that are
mostly :
Contracted in early life
Transmitted in saliva
Characterized by latency
Cause more severe in patient with compromised immunity
Herpes viruses can sometimes cause malignant
tumors (oncogenic)
Include herpes virus :
Herpes simplex type 1 (HSV-1)
Herpes simplex type 2 (HSV-2)
Herpes varicella zoster (VZV)
Epstein Barr virus (EBV)
Cytomegalovirus (CMV)
Human herpes virus type 6,7,8 (HHV-6, HHV-&, HHV-8)
HSV-1
Infection above the waist (below waist
caused by HSV-2) although with changing
sexual practices, its uncommon to culture
HSV-2 from oral lesion and vise versa
Infection :
Primary infection : 80% subclinical
Secondary infection
HSV-1

Herpetic stomatitis Recurrent herpetic

Primary herpetic stomatitis
stomatitis Recrudescent oral
Primary HSV infection
gingivostomatitis Herpes Labialis

Primary Secondary
Herpetic stomatitis : Primary
Etiology : mostly HSV-1
Incidence:
Common, esp. in lower socio-economic conditions
Age : children and adolescents
Sex : both sexes are affected
Geographic : developing world

Incubation time : up to 2 weeks

1 to 3 day viral prodrome
Fever
Lost appetite
Malaise
Headache
Nausea
Herpetic stomatitis : Primary
Self-limiting , resolves within 10 to 14 days
Clinical findings:
Erythema and clusters of vesicles and / or ulcers
appear on :
the keratinized mucosa of the hard palate, attached gingiva,
and dorsum of the tongue
the non keratinized mucosa of the buccal and labial
mucosa, ventral tongue, and soft palate.
Vesicles ulcers (1 to 5 mm) larger ulcers,
scalloped borders and marked surrounding
erythema
Gingiva : fiery red
Mouth is extremely painful eating difficulty
hospitalization for hydration
Herpetic stomatitis : Primary
Herpetic stomatitis : Primary
Herpetic stomatitis : Primary
Cervical lymph nodes : may be enlarged
and tender
No hepatosplenomegaly unless there are
systemic complications and lesions
elsewhere
There is sometimes fever and/ or malaise
Herpetic stomatitis : Primary
Diagnosis :
Patient history
Clinical findings
Lab :
Cytology : multinucleate virus-infected giant cell
Biopsy : intraepithelial vesicles
Viral culture / PCR
Differential diagnosis :
Herpangina
Hand-foot-and-mouth disease
Varicella
Shingles (herpes zoster)
Herpetic stomatitis : Primary
Treatment :
Antipyretics / analgesik
Local antiseptics : 2.0% aqueous chlorhexidine
Acyclovir
Adult : 200mg five times daily for 5 days
Children : 15mg/kg five times daily
Valacyclovir tablets 500mg or famciclovir 250mg
twice daily for 5 days
Adequate fluid intake, esp. in children
Soft bland diet
Bed rest for 4-6days
Herpetic stomatitis : Primary
Prognosis :
Excellent in immunocompetent host
Latent phase in nearly all those affected who have
adequate antibody titers
Herpetic stomatitis : Secondary
Latency:
Neural latency :
virus travelled along the sensory nerve axons and establishes chronic,
latent infection in the sensory ganglion
Extraneural latency :
virus remaining latent in cells such as at the epithelium
virus travelled centripetally to the mucosa or the skin
Triggers :
Fever
Ultraviolet radiation
Trauma
Stress
Menstruation
Sites :
Intraoral : recurrent herpetic stomatitis (recurrent intraoral
herpes / RIH)
Extraoral : herpes labialis (HL)
Herpetic stomatitis : Secondary
Etiology : reactivation HSV-1
Incidence:
Up to 15% population
Age : young adult, mainly in adult
Sex : both sexes are affected
Geographic : herpes labialis most common in sunny climes

Prodrome
Itching
Tingling
Burning
Pain in the gingiva (RIH)
Herpetic stomatitis : Secondary
Self-limiting disease
Clinical findings:
Herpes Labialis
Lip lesion
Papules vesicle ulcer crusting resolution
Pain present in the first 2 days
Recurrent Intraoral Herpes
Chiefly on the keratinized mucosa : hard palate, attached
gingiva, dorsum of tongue
1 to 5 mm single or clustered painful ulcers with a bright
erythematous border
Herpes Labialis
Recurrent Intraoral Herpes
Herpetic stomatitis : Secondary
Diagnosis :
Patient history
Clinical findings
Lab :
Cytology : multinucleate virus-infected giant cell
Biopsy : intraepithelial vesicles
Viral culture / PCR
Differential diagnosis :
Herpangina
Hand-foot-and-mouth disease
Shingles (herpes zoster)
Herpetic stomatitis : Secondary
Treatment :
Reduction triggering factors
Sunscreen
Antiviral after dental prosedure
Herpes Labialis
Topical antiviral : acyclovir cream 5%, penciclovir cream 3%
RIH :
Local antiseptics : 2.0% aqueous chlorhexidine
Soft bland diet
Acyclovir
Adult : 200mg five times daily for 5 days
Children : 15mg/kg five times daily
Valacyclovir tablets 500mg or famciclovir 250mg twice
daily for 5 days
Adequate fluid intake
Bed rest
 HSV

Primary Subclinical
Infection Infection

Antibody
Primary
Self limiting
Herpetic
stomatitis Latent
Reactivated

Secondary
Infection

Recurrent Herpes
intraoral Labialis
herpes