Nongenital Herpes Simplex Virus
RICHARD P. USATINE, MD, and ROCHELLE TINITIGAN, MD, University of Texas Health Science Center, San Antonio, Texas
Am Fam Physician. 2010 Nov 1 82:1075-1082.
Patient information: See related handout on cold sores, written by the authors of this article.
Nongenital herpes simplex virus type 1 is a common infection that most often involves the oral mucosa or lips . The primary oral infection may range from asymptomatic to very painful, leading to poor oral intake and dehydration. Recurrent infections cause cold sores that can affect appearance and quality of life. Although HSV-2 also can affect the oral mucosa, this is much less common and does not tend to become recurrent.
SORT: KEY RECOMMENDATIONS FOR PRACTICE
Oral acyclovir suspension is an effective treatment for children with primary herpetic gingivostomatitis.
Oral acyclovir, valacyclovir , and famciclovir are effective for the treatment of acute recurrences of herpes labialis.
Recurrences of herpes labialis are suppressed with daily oral acyclovir or valacyclovir.
Topical acyclovir, penciclovir , and docosanol are optional treatments for recurrent herpes labialis.
A = consistent, good-quality patient-oriented evidence B = inconsistent or limited-quality patient-oriented evidence C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to .
Try Taking The Supplement Lysine
In terms of taking supplements to prevent breakouts, I especially recommend L-lysine. This is the primary supplement for herpes, Gade says. L-lysine is an , a building block of protein. When you have an outbreak, it can be taken orally to shorten the outbreak in conjunction with an antiviral medication.
Lysine appears to be useful in reducing the number and the severity of outbreaks. The usual daily dose is between 1 and 3 milligrams.
Some studies suggest that taking lysine regularly may help prevent outbreaks of both and herpes sores. In Gades experience, patients have had no side effects using lysine. In some people, though, there have been reports of the supplement causing and diarrhea.
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Transmission And Prevention Of Herpes Simplex Labialis
When pharmacists counsel patients with HSV-1 infection, it is helpful to explain how the infection was contracted. An explanation of the transmission process can help patients and their families avoid further spread. Patients must understand that HSV-1 is highly contagious. The greatest point of risk is when blisters appear, as blister exudate contains millions of viral particles. But there is a risk of transferring the virus to others during other stages, and those affected must take great care to guard others from the prodromal stage until full healing is clearly achieved.
Patients with an outbreak must avoid touching the lesions, since virus on the hands can transfer to towels, dishes, or any other item shared with others. They must ensure that others do not drink from a glass they have used. They must completely avoid kissing and oral/genital sexual activity, and they must always ensure that anything that touches their lips is disinfected or immediately discarded, including eating utensils. Sharing lip balms is absolutely prohibited. Parents can transfer the virus to their children during routine child care, as the virus may be on the hands.
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Etiology Of Herpes Simplex Labialis
The most common cause of herpes simplex labialis is the type 1 herpes simplex virus, abbreviated as HSV-1.3 HSV-1 is the causal agent in more than 95% of patients who experience recurrent fever blisters.4 The remainder of cases are caused by HSV type 2 , the infective agent associated with genital herpes. Having oral sex with a person infected with HSV-2 can result in HSV-2 herpes simplex labialis.
Why Isnt There A Cure For Herpes Already
No company has managed to successfully develop a commercially ready herpes vaccine, however, several HSV vaccines have undergone phase I and II trials. Until recently, at least three pharmaceutical companies were overseeing clinical trials for herpes vaccine candidates. All three companies recently abandoned their research after failing to meet their primary endpoints.
How does herpes continue to hoodwink experienced researchers and scientists, when other devastating diseases like the measles, mumps, hepatitis B, and whooping cough have been nearly eliminated?
It all comes down to the unique behavior of the herpes simplex virus.
Herpes is a complex virus that knows exactly how to evade the immune systems grasp. It lies dormant in nerve cells for months or years at a time, then emerges without any warning to reactivate the infection. In this way, herpes behaves like a cancer that lurks in the body undetected until the damage is already done.
To make matters worse, as long as just a minuscule amount of infection remains after an outbreak fades, herpes can easily survive and reappear in future outbreaks.
Pharmaceutical companies are eager to uncover a cure for herpes, but they must first overcome an extremely long and expensive research process.
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How To Use This Medicine:
- Your doctor will tell you how much of this medicine to apply and how often. Do not use more medicine or apply it more often than your doctor tells you to. Start using this medicine at the first sign of a cold sore or fever blister .
- This medicine is for use on the lips and face only and will not treat genital herpes. Do not apply it near your eyes or on your genitals.
- Wash your hands with soap and water before and after using this medicine.
- Apply a thin layer to the affected area. Rub it in gently and thoroughly.
- Never share your medicine with anyone.
If a dose is missed:
- If you miss a dose or forget to use your medicine, apply it as soon as you can. If it is almost time for your next dose, wait until then to apply the medicine and skip the missed dose.
- Do not apply extra medicine to make up for a missed dose.
Episodic Topical Treatment For Recurrent Herpes Labialis
Topical treatment for herpes labialis is less effective than oral treatment. An RCT of treatment with topical penciclovir 1% cream showed healing was marginally faster in the penciclovir group compared with placebo .16 The participants were adults in otherwise good health who had at least three episodes of herpes labialis per year. 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 4.1 to 3.5 days, sped up the healing of classic lesions from 5.5 to 4.8 days, and did not change median time of viral shedding .16
Docosanol cream is a saturated, 22-carbon, aliphatic alcohol with antiviral activity. It is available without prescription. One RCT of 743 patients with herpes labialis showed a faster healing time in patients treated with docosanol 10% cream compared with placebo cream , as well as reduced duration of pain symptoms .17 More than 90 percent of patients in both groups healed completely within 10 days.17 Treatment with docosanol cream, when applied five times per day and within 12 hours of episode onset, is safe and somewhat effective.
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Important: How To Use This Information
This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Episodic Oral Treatment For Primary Herpetic Gingivostomatitis
Oral acyclovir suspension can be used to treat herpetic gingivostomatitis in young children. In one randomized controlled trial , children receiving acyclovir had oral lesions for a shorter time than children receiving placebo . The treatment group also had earlier resolution of the following signs and symptoms: fever eating difficulties and drinking difficulties .12 Viral shedding was significantly shorter in the group treated with acyclovir .12 Children should be treated symptomatically with oral analgesics and cold, soothing foods such as ice pops and ice cream. Various concoctions of topical anesthetics and other medications have been used to numb the painful ulcers so that children can be kept well hydrated.
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Home Remedies And Lifestyle
There are some things that you can do at home to lessen the pain of a cold sore or genital herpes, prevent worsening of your condition, and reduce the risk of spreading the infection to others.
- Apply cold compresses: Place a well-insulated ice pack on your lesions for as long as it makes you feel better. The cold will not worsen or improve the lesion, but it can lessen the pain.
- Don’t scratch: Avoid touching and scratching lesions caused by herpes, as this can spread the infection to other areas of your own skin.
- Keep the sores clean: Cold sores and genital herpes infections can become infected with bacteria from your hands or, in the latter case, from urine or feces. Keep the sores and blisters, and the areas around them, clean and dry to avoid an additional infection.
- Reduce stress: Stress can affect how well your immune system can keep your herpes infection in check. Reducing your stress may help prevent excessive herpes recurrences.
Rule #: Use Medication
At the very first onset of signs of an outbreak, you can use antiviral medications like acyclovir. Before the blisters even become visible, you might notice a tingling or burning sensation on your skin. Your healthcare provider can prescribe topical medications to apply to the lesion area . If you have had herpes before, a prescription should be readily available .
Its important to note that acyclovir ointment can be used to treat genital herpes but doesnt typically reduce the length or severity of outbreaks. You should not apply acyclovir cream to the genitals because it may irritate these parts of your body.
If you suffer from frequent or severe outbreaks, your healthcare provider may recommend trying prescription drugs to take by mouth. There are multiple options, including acyclovir, famciclovir, and valacyclovir . Studies have shown that oral antiviral drugs for herpes can shorten the duration of lesion episodes and pain by approximately one day . Your healthcare provider will choose the option thats best for you.
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How Quickly Does Abreva Work
cold sorescold soresHow can you prevent cold sores?
Understanding Herpes With H Hunter Handsfield Md
Herpes expert H. Hunter Handsfield, MD, explains the basics about genital herpes, including the difference between genital HSV-1 and HSV-2 infection, testing options and the importance of knowing virus type, and the three-prong strategy for prevention. See more herpes videos at sexualhealthTV.com.
Have a question about herpes youd like Dr. Handsfield or our other experts to answer? Visit our Ask the Experts page to learn how.
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How Should I Apply Abreva Cream
You may use your fingertip or a cotton swab to apply Abreva® Cream. Be sure to apply enough to completely cover your cold sore and follow the directions on the package. If you do use your finger to apply the cream, make sure to wash your hands before and after applying Abreva® Cream.
You should apply Abreva® Cream five times a day during waking hoursapproximately every 3-4 hoursfor up to 10 days. For best results, apply Abreva® Cream after you wash your face.
see the answer to this question
Abreva® Cream is indicated only for the treatment of cold sores caused by herpes simplex virus type 1.
For best results, use an ample amount to completely cover your cold sore and the area around your cold sore. Per package directions, rub in the cream gently, but completely.
How To Use Abreva Cream
Follow all directions on the product package, or use as directed by your doctor. Use this medication at the first signs of a cold sore . Wash and dry your hands before applying the medication. Clean and dry the affected areas. Apply a thin layer of medication to completely cover the area of the cold sore or the area of tingling/itching/redness/swelling and rub in gently, usually 5 times a day every 3-4 hours, or as directed by your doctor. Wash your hands with soap and water after applying. If you have any questions, ask your doctor or pharmacist.
Apply to skin only. Do not apply this medication in or near the eyes since this medication can irritate the eyes. If you do get medication in your eyes, flush with plenty of water. Do not apply inside the mouth or nose.
Remove any cosmetics from the affected area before applying. You may apply cosmetics after applying but use a separate applicator on infected areas to prevent spreading the infection. If you accidentally wipe off the medication, reapply as soon as possible.
Dosage is based on your medical condition, type of infection, and response to treatment. Do not use this drug more often or for longer than directed.
Use this medication regularly to get the most benefit from it. This medication works best when the amount of drug absorbed by the skin stays at a constant level. Therefore, use this drug at evenly spaced intervals. To help you remember, use it at the same times each day.
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What Are The Pros Cons And Price Of Luminance Red
Luminance RED is supported by clinical studies that prove its ability to achieve lasting results. According to clinical research, patients who received Luminance RED treatment averaged 37.5 weeks before their next cold sore episode, compared to 3 weeks for those who did not receive treatment. Patients treated with Luminance Red also experienced a 49% reduction in healing time and a 77% reduction in pain.
Overall, Luminance RED offers an advanced way to reduce the severity of cold sore outbreaks, accelerate healing, and prevent the frequency of future outbreaks. Its available online for $399. If youre not satisfied, Luminance RED offers a 6-month, 100% money-back guarantee.
What Should I Know About Storage And Disposal Of This Medication
Keep this medication in the container it came in, with the cap on and tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture . Never leave this medication in your car in cold or hot weather.
Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDAs Safe Disposal of Medicines website for more information if you do not have access to a take-back program.
It is important to keep all medication out of sight and reach of children as many containers are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location â one that is up and away and out of their sight and reach.
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Is Abreva Ok To Use For Genital Herpes
- 5 Apr 2012 by Anonymous
Abreva is not actually indicated for the treatment of genital herpes.
Abreva is an antiviral medication used to treat cold sore infections caused by the herpes simplex virus. Docosanol shortens the healing time and the length of time symptoms are present.
Docosanol topical is used to treat cold sores on the face and lips.
Can I Use Abreva Cream Longer Than 10 Days
No. It is not recommended for use Abreva cream longer than 10 days. Also, it could be the sign of a more serious infection.
You should contact your doctor if your cold sore has not healed within 10 days while using Abreva cream. Getting the doctor to look at it will ensure that you receive an updated diagnosis and possibly additional treatment.
Cold sores are caused by a viral infection.
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Report Problems To The Food And Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.