Antiviral drugs. N Engl J Med. Fatahzadeh M, Schwartz RA. Human herpes simplex virus infections: epidemiology, pathogenesis, symptomatology, diagnosis, and management. J Am Acad Dermatol. Oral and perioral herpes simplex virus type 1 HSV-1 infection: review of its management. Oral Dis. Current management and recommendations for access to antiviral therapy of herpes labialis. J Clin Virol. Fatazadeh M, Schwartz RA. Human herpes simplex labialis. Clin Exp Dermatol.
Herpetic Eye Disease Study: a controlled trial of oral acyclovir for herpes simplex stromal keratitis. A controlled trial of oral acyclovir for the prevention of stromal keratitis or iritis in patients with herpes simplex virus epithelial keratitis: the epithelial keratitis trial.
Herpetic Eye Disease Study: a controlled trial of topical corticosteroids for herpes simplex stromal keratitis. Acyclovir for the prevention of recurrent herpes simplex virus eye disease. N Engl J Med. Long-term acyclovir suppression of frequently recurring genital herpes simplex virus infection: a multicenter double-blind trial. Double-blind, placebo-controlled trial comparing long-term suppressive with short-term oral acyclovir therapy for management of recurrent genital herpes.
Am J Med. Acyclovir prevents reactivation of herpes simplex labialis in skiers. Oral acyclovir to suppress frequently recurrent herpes labialis: a double-blind, placebo-controlled trial. Ann Intern Med. Sharma RA, Bobek M. Acetylenic nucleosides. J Org Chem. Demonstration of viral thymidine kinase inhibitor and its effect on deoxynucleotide metabolism in cells infected with herpes simplex virus.
Antimicrob Agents Chemother. Suppression of ocular herpes recurrences by a thymidine kinase inhibitor in squirrel monkeys. Rapid in vivo reactivation of herpes simplex virus in latently infected murine ganglionic neurons after transient hyperthermia. J Virol. Induction of ocular herpes simplex virus shedding by iontophoresis of epinephrine into rabbit cornea. Invest Ophthalmol Vis Sci. Kinetics of ocular herpes simplex virus shedding induced by epinephrine iontophoresis.
HSV-1 shedding by iontophoresis of 6-hydroxydopamine followed by topical epinephrine. Latanoprost and herpes simplex keratitis. Am J Ophthalmol. Latanoprost increases the severity and recurrence of herpetic keratitis in the rabbit. Effects of topical unoprostone and latanoprost on acute and recurrent herpetic keratitis in the rabbit.
Prostaglandins enhance spread of herpes simplex virus in cell cultures. J Gen Virol. Newton AA. Effect of cyclic nucleotides on the response of cells to infection by various herpesviruses. IARC Lyon. Inhibitors of prostaglandin synthesis as inhibitors of herpes simplex virus replication. Adv Ophthalmol. Inhibition by indomethacin of in vitro reactivation of latent herpes simplex virus type 1 in murine trigeminal ganglia. Reactivation of herpes simplex virus infection by ultraviolet light and possible involvement of prostaglandins.
An alternative theory of herpes-simplex recurrence and a possible role for prostaglandins. Biochem Biophys Res Commun. Gene expression analyzed by microarrays in HSV-1 latent mouse trigeminal ganglion following heat stress. Virus Genes. Biochemical and pharmacological profile of a tetrasubstituted furanone as a highly selective COX-2 inhibitor. Br J Pharmacol. Shenk T.
Use of microarrays to probe the replication and pathogenesis of human cytomegalovirus. Bazan NG. COX-2 as a multifunctional neuronal modulator. What causes recurrent cold sores? Medically reviewed by Alana Biggers, M. Recurrent cold sores Risk factors Treatments Prevention Summary Cold sores can occur when a person contracts the herpes simplex virus, which causes small, fluid-filled blisters around the lips and in the mouth.
Why do cold sores keep coming back? Risk factors. Share on Pinterest A person can take over-the-counter pain medication to reduce any cold sore-related pain. Share on Pinterest Stress management may help reduce the frequency of cold sores. Exposure to air pollutants may amplify risk for depression in healthy individuals.
Costs associated with obesity may account for 3. Related Coverage. Lysine for cold sores: Does it work? Medically reviewed by Dena Westphalen, Pharm. Everything you need to know about cold sores.
Medically reviewed by Debra Sullivan, Ph. A Tzanck test is difficult to perform correctly without specific training in its use, but it may be done in the office setting by scraping the floor of the herpetic vesicle, staining the specimen, and looking for multinucleated giant cells. Its results do not specify the type of HSV infection, but if done correctly, its sensitivity is 40 to 77 percent for acute herpetic gingivostomatitis. Oral acyclovir suspension Zovirax; 15 mg per kg five times per day for seven days can be used to treat herpetic gingivostomatitis in young children.
In one randomized controlled trial RCT , children receiving acyclovir had oral lesions for a shorter time than children receiving placebo median of four versus 10 days.
The treatment group also had earlier resolution of the following signs and symptoms: fever one versus three days ; eating difficulties four versus seven days ; and drinking difficulties three versus six days. Various concoctions of topical anesthetics and other medications have been used to numb the painful ulcers so that children can be kept well hydrated. In a Cochrane review on the treatment of herpes labialis in patients receiving cancer treatment, acyclovir was found to be effective with regard to viral shedding median of 2.
In one RCT, patients self-initiated therapy with famciclovir Famvir; 1, mg once [single dose] or mg twice per day for one day [single day] or placebo within one hour of prodromal symptoms onset. In one RCT of recurrent herpes labialis, treatment with oral valacyclovir Valtrex plus topical clobetasol Temovate was compared with placebo. There were more aborted lesions in the valacyclovirclobetasol group compared with the placebo-placebo group 50 versus Combination therapy reduced the mean maximum lesion size 9.
Topical treatment for herpes labialis is less effective than oral treatment. They applied penciclovir cream or placebo within one hour of the first sign or symptom of a recurrence, and then every two hours while awake for four days. Resolution of symptoms occurred more rapidly in the penciclovir group regardless of whether the medication was applied in the early or late stage. Penciclovir cream applied every two hours while awake reduced median duration of pain from 4.
Docosanol cream Abreva is a saturated, carbon, aliphatic alcohol with antiviral activity. It is available without prescription. In study 1, the mean duration of episodes was 4. Oral acyclovir is effective in suppressing herpes labialis in immunocompetent adults with frequent recurrences. In one RCT, treatment with oral acyclovir mg twice per day resulted in a 53 percent reduction in the number of clinical recurrences and a 71 percent reduction in virus culture-positive recurrences compared with placebo.
Treatment with oral valacyclovir mg per day for 16 weeks was compared with placebo in the suppression of herpes labialis in patients with a history of four or more recurrent lesions in the previous year. The mean time to first recurrence was longer with valacyclovir In another study, daily valacyclovir mg per day and acyclovir mg twice per day were equally effective in the prevention of recurrent HSV eye disease.
An overview of treatments for herpes labialis is provided in Table 2. Generic price listed first; brand price listed in parentheses. Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. Address correspondence to Richard P. Reprints are not available from the authors. Trends in herpes simplex virus type 1 and type 2 seroprevalence in the United States.
A cross-sectional study of herpes simplex virus types 1 and 2 in college students: occurrence and determinants of infection. J Infect Dis.
An update on short-course intermittent and prevention therapies for herpes labialis. Longitudinal evaluation of herpes simplex virus DNA load during episodes of herpes labialis. J Clin Virol. The treatment of herpes simplex infections: an evidence-based review.
Arch Intern Med. Recurrences after oral and genital herpes simplex virus infection. Influence of site of infection and viral type. N Engl J Med. Chumley H. Mayeaux EJ Jr. The natural history of recurrent herpes simplex labialis: implications for antiviral therapy.
Comparison of Chemicon SimulFluor direct fluorescent antibody staining with cell culture and shell vial direct immunoperoxidase staining for detection of herpes simplex virus and with cytospin direct immunofluorescence staining for detection of varicellazoster virus.
Clin Diagn Lab Immunol. Acute herpetic gingivostomatitis in adults: a review of 13 cases, including diagnosis and management. J Can Dent Assoc. Treatment of herpes simplex gingivostomatitis with aciclovir in children: a randomised double blind placebo controlled study. Interventions for the prevention and treatment of herpes simplex virus in patients being treated for cancer.
Cochrane Database Syst Rev. Single-dose, patient-initiated famciclovir: a randomized, double-blind, placebo-controlled trial for episodic treatment of herpes labialis.
J Am Acad Dermatol. Valacyclovir and topical clobetasol gel for the episodic treatment of herpes labialis: a patient-initiated, double-blind, placebo-controlled pilot trial.
J Eur Acad Dermatol Venereol.
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