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16.5 Viral Infections

Table of Contents

Herpes Simplex Virus

This is a viral infection commonly affecting the lips and perioral soft tissues presenting as papulovesicular lesions which ultimately ulcerate. The condition is recurrent following a primary herpes infection which occurs during childhood leaving herpes simplex viruses latent in the trigeminal ganglia. The primary infection affects mainly the gingiva and palate.

Diagnostic Criteria

  • A prodrome of tingling, warmth or itching at the site usually precedes the recurrence
  • About 12 hours later, redness appears followed by papules and then vesicles
  • These vesicles then burst, weep, dry, scab and then heal
  • The length of the cycle is variable (5–12 days mean time being 7 days)

There are no investigations required unless patient has systemic diseases

Non-Pharmacological Treatment

  • Adequate hydration
  • Avoid salty and acidic drinks
  • Cover lesions on the lips with Petroleum jelly and control any underlying cause

Pharmacological Treatment

This is an otherwise self-limiting condition but if persistent for 10 days or recurrent infection use medication:

For Herpes Labials

B: Acyclovir cream apply 4 hourly for 5 days

For Herpes Stomatitis

B: Acyclovir (PO) 200mg 6 hourly for 5 days

AND

B: Acyclovir cream 12 houlry for 5 days

In immunocompromised patients
B: Acyclovir (PO) 400mg 5 times in 24 hours for 5 days

For oral facial lesions of herpes zoster treat with
B: Acyclovir (PO) 400–800mg 5 times a day for 5 days.

Pain control by analgesics
A: Paracetamol (PO) 1gm 8 hourly for 3 days

OR

C: Diclofenac (PO) 50mg 8 hourly for 3 days

OR

A: Ibuprofen (PO) 400 mg 8 hourly for 3 days

The codes will be shown below

Seconds
First: 170598
Seconds
Second: 180198

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