HERPES SIMPLEX - LIPS & GENITALS

The common presentations of a herpes simplex virus infection are the
"cold sores" or "fever blisters" on the lip (herpes labialis) and the genital
herpes infection. After a few days of prodromal burning sensation, a
group of blisters appear, which quickly break down to form superficial
ulcers. The primary infection may be accompanied by constitutional
symptoms such as fever, malaise and anorexia and take up to 3 weeks to
heal. If recurrences occur symptoms are less severe, usually without constitutional
symptoms and they heal within 7 to 10 days. In most people
they too are preceded by a burning sensation for a few days. Recurrences
are triggered by:
- exposure to sunlight (herpes labialis)
- trauma (e.g. fighting-lip; sexual intercourse-genitals)
- fever
People with immunodeficiency as in HIV infection may have more severe
infections and more frequent recurrences. Genital herpes may become
chronic, persisting for months, ulcerating and may cover large parts of
the genitals and surrounding skin, causing severe pain and disability.
Herpes simplex infection is spread by direct contact. It is highly contagious
when lesions are visible and it has been shown that people shed
virus even when there are no symptoms.
Management of herpes simplex infections
- Primary infections are very painful: analgesia is indicated.
- Lips: zinc oxide ointment or zinc oxide and castor oil; soothes and protects from
sunlight.
Antiseptic mouthwash e.g. chlorhexidine mouthwash 3-4 times daily and topical
antiseptic or antibiotic e.g. betadine ointment or oxytetracycline ointment 3 times
daily for bacterial superinfection.
Use a lip cream / stick with a sunblocker daily to prevent recurrences.
- Genital herpes: Betadine or potassium permanganate solution sit baths 3 times
daily. Zinc oxide and castor oil to soothe, or sulphur 5% in zinc oxide. Alternatively
betadine ointment or oxytetracycline ointment 3 times daily.
- Severe infections or infections in immunodeficient patients: if available give
acyclovir 200-400 mg 5 times daily for 5-10 days.