Primary attack. This may occur in adulthood and can be severe causing fever, toxicity, oral ulceration and lymphadenopathy. Acute urinary retention may occur in pelvic disease. Healing occurs in 2 weeks.
Recurrent attacks. Most attacks are mild and occur at site of initial infection.
Sun protection is useful in preventing recurrences.
Frequent recurrence may be prevented with prophylactic treatment.
Recurrences can be complicated by erythema multiforme which can be more troublesome than the infection itself.
Eczema herpeticum. In the presence of dermatitis secondary attacks may disseminate causing a generalized eruption with groups of vesicles, weeping and skin tenderness.
Infectivity. All lesions are infectious and may cause infection, particularly on the fingers (Whitlow) among staff. Use gloves.
Diagnosis:
Usually clinical.
If in doubt take a sample of fluid and cells from the ulcer base for PCR or immunofluorescence with a cotton swab. Place in viral transport medium to send to the laboratory.
Treatment:
Primary herpes infection:
Aciclovir 400 mg PO 3 times daily for 5 days.
If cannot swallow or unwell aciclovir 5 mg/kg IV q8h.
Immunosuppressedpatients:
Aciclovir 400 mg PO 5 times daily 5-7 days. IV aciclovir as above if unwell.
Recurrences:
Normal host - minor attacks - povidone iodine cream 10% TDS. Aciclovir cream of minimal benefit. Aciclovir 400 mg PO 3 times daily only of benefit if started early.