DENTAL ENCYLOPEDIA

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Herpes Simplex Virus Infections:

Herpes simplex virus infections are common vesicular eruptions of the skin and mucosa. They occur in two forms: systemic or primary disease and localized or secondary disease. Both forms are self-limited, but exacerbations of the primary form are common, because the virus can sequester itself in ganglionic tissue. Control rather than cure is the usual treatment scenario.

During the primary infection, only a small percentage of individuals show clinical signs and symptoms of infectious systemic disease while a vast majority experience only subclinical disease.

The incubation period after exposure ranges from several days to two weeks. In primary herpes disease, a vesiculo-ulcerative eruption typically occurs in the oral and peri-oral tissues. This stage of the disease is called primary gingivostomititis.

After resolution of primary herpetic gingivostomititis, the virus is believed to migrate, through an unknown mechanism, along the trigeminal nerve to the trigeminal ganglion, where it is capable of remaining in a latent state. Reactivation of the virus may follow exposure to sunlight also known as fever blisters, exposure to cold, or cold sores, trauma, stress, and immunosuppression causing a secondary or recurrent infection.

The reactivated virus travels by way of the trigeminal nerve to the originally infected surface where replication occurs, resulting in an outbreak of lesions. As the secondary infection resolves the virus returns to the trigeminal ganglion and the area of outbreak completely resolves. Recurrent herpetic gingivostomititis affects from one third to one half of the United States population. It is believed that nearly all secondary herpes lesions develop from reactivated latent virus.

Most oral-facial herpetic lesions are due to HSV-I, although a small percentage may be caused by HSV-II secondary to oral-genital contact. Lesions caused by either virus are clinically indistinguishable.

Clinical Features of Herpes Simplex Virus:

Primary herpetic gingivostomatitis is usually seen in children although adults who have not been previously exposed to HSV or who fail to mount an appropriate response to a previous infection may be affected. The vesicular eruptions may appear on the skin, lips, or oral mucus membranes. Intraorally, lesions may appear on any mucous membrane. The primary herpes lesions are accompanied by fever, arthralgia, malaise, headache, and enlarged cervical lymph nodes. The systemic primary infection runs its course in about 1 week to ten days and the lesions heal without scar.

Secondary or recurrent herpes simplex virus infection is caused by the reactivation of latent virus. Virus is usually reactivated when the host is immunocompromised or when an alteration in local inflammatory mediators occurs.

Patients usually have prodromal symptoms of tingling, burning or pain in the site in which lesions will appear. Within a few hours, multiple, short-lived vesicles appear. In recurrent herpes simplex lesions are found on the hard palate and gingival. The lesions heal without scarring in one to two weeks.

Both conditions are self-limiting. There are antiviral medications on the market such as Acyclovir, known more commonly as Zovirax, and Valacyclovir or Valtrex. These medications reduce the strength of herpes outbreaks and can help you heal from outbreaks faster. If you decide not to take any medications the healing time may be prolonged. If you choose to take the medicine you should take it at the initial onset of symptoms. Usually that is when you first start to feel the tingling sensation.

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References:

Regezi JA, Sciubba JJ. Common Skin Lesions. Oral Pathology: Clinical Pathologic Correlations 3rd ed 1:1-4, 1999.

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