Herpetic Oral Lesions: Herpes Simplex Infection

Herpetic Oral Lesions: Herpes Simplex Infection

Viral infection, caused by 1st type of herpes simplex virus (HSV-1) is the most common viral disease in humans. By sensitive laboratory tests herpes simplex persistency is detected among 90% of adult population.

Infants in the age range from 6 month to 3 years are grossly susceptible to this infection. Large outbreaks of acute herpetic stomatitis emerge in child care settings.

The main clinical presentations of infection are acute (primary) herpetic gingivostomatitis and chronic herpes labialis (or cold sores) with its recurrent exacerbations.

Herpetic Oral Lesions: Herpes Simplex Infection

Acute herpetic gingivostomatitis occurs as initial (primary) herpetic infection. It is caused by HSV-1 and in rare cases by HSV-2 that is common for genital infection.

The incubation period lasts for 4-5 days. It is followed by fever and appearance of characteristic lesions – pin-head vesicles, localized on lips, tongue and gingival or buccal mucosa. Soon the vesicles become eroded forming painful ulcerations.

Usually, isolated viral lesions heal spontaneously in several days without scarring. Clinical recovery occurs in 1-3 weeks.

Nonetheless, in course of primary infection, the virus invades local nerve endings and moves by retrograde axonal flow to dorsal root ganglia, where the latency is established.

Chronic herpes labialis (or cold sores) results from repetitive exacerbations of latent HSV-1 infection. In most cases, various exogenous stimuli (fever, UV irradiation, physical or emotional stress, axonal injury, etc.) activate viral replication. The virus moves along axons back to the peripheral site, and replication proceeds at the skin or mucous membranes. The vesicles commonly affect the perioral area, lip vermilions and their borders, sometimes – soft and hard palate, tongue or buccal epithelium. Many recurrences are asymptomatic.

Clinical diagnosis of herpetic infection is confirmed with laboratory testing of specimens taken from herpetic lesions. Immunofluorescence analysis and PCR are the standard reactions in this condition. Serological testing states the elevated levels of specific antiviral antibodies of IgM class.

In mild or moderate cases acute herpetic gingivostomatitis doesn’t require treatment. Severe or complicated manifestations can be treated with topical applications of acyclovir on the background of adequate oral hygiene.