Oral herpes simplex virus infection in pregnancy: what are the concerns?

Although epidemiologic data and the potentially serious effects of transmission of genital herpes from mother to infant during birth have been widely reported, published reports on oral herpes disease in pregnancy remain scarce and no clear management guidelines exist. Thus, questions remain about acquisition, transmission and outcome of infection, especially with respect to acute gingivostomatitis in pregnancy. In response to these questions, we summarize previous reports on herpes simplex virus 1 (HSV-1) oral disease in pregnancy and, briefly, present 2 cases of primary gingivostomatitis in the first trimester of pregnancy, resulting in a favourable outcome for both mother and infant. We also point out the most recent data on rare, potentially severe in outcome, but treatable, primary central nervous system HSV-1 infection in later stages of pregnancy. Finally, we emphasize a multidisciplinary approach to oral HSV disease in pregnancy, with dentist participation in the diagnosis and treatment.

Treating patients with herpes simplex virus infections: dental and dental hygiene students' knowledge, attitudes, and professional behavior.

Dental and dental hygiene students frequently interact with patients with herpes simplex virus (HSV) infections, often simply referred to as cold sores. The objectives of this study were to assess dental and dental hygiene students' knowledge, attitudes, and professional behavior concerning the treatment of patients with HSV infections and to investigate the relationships among knowledge, attitudes, and professional behavior. Questionnaire data were collected from 337 dental and seventy-three dental hygiene students at regularly scheduled classes. Dental and dental hygiene students did not differ in their overall knowledge concerning HSV infections. Dental hygiene students were more apprehensive about treating patients with these infections, but used more appropriate professional behavior compared to dental students. Dental students' knowledge and appropriateness of professional behavior increased over the course of their education. Overall, it was found that an increase in student knowledge was associated with increased apprehension related to treating these patients. However, the more apprehensive they were, the more they engaged in appropriate professional behavior. Educating future health care providers about the treatment of patients with infectious and communicable diseases can potentially increase the students' apprehension/negative attitudes concerning providing care, while at the same time increasing appropriate professional behavior during their education. Addressing students' apprehensions might be a crucial moderator that will determine whether they will provide the best possible care for these patients in their future professional lives.

Case report: symptomatic oral herpes simplex virus type 2 and asymptomatic genital shedding.

A 42-year-old bisexual man with a history of recurrent oral herpes and no history of genital herpes was noted to have antibody to herpes simplex virus type 2 (HSV-2) only. During a symptomatic oral recurrence, HSV-2 was found in a perioral lesion as well as in the genital area.

Case study: inoculation herpes barbae.

A 21-year-old white man in otherwise excellent general health was referred for a painful, progressive, facial eruption with associated fever, malaise, and cervicofacial lymphadenopathy. The patient reported that a vesicular eruption progressed from the left side of his face to also involve the right side of his face over the 48 hours preceding his clinic visit. He also reported some lesions in his throat and the back of his mouth causing pain and difficulty swallowing. Four to 7 days before presentation to us, the patient noted exposure to his girlfriend's cold sore. Additionally, he complained of a personal history of cold sores, but had no recent outbreaks. Physical examination revealed a somewhat ill man with numerous vesicles and donut-shaped, 2-4 mm, crusted erosions predominantly on the left side of the bearded facial skin. There were fewer, but similar-appearing lesions, on the right-bearded skin. The lesions appeared folliculocentric (Figure). Cervical and submandibular lymphadenopathy was present. Oral exam showed shallow erosions on the tonsillar pillars and soft palate. Genital examination was normal. The remainder of the physical exam was unremarkable. A Tzanck smear of vesicular lesions was positive for balloon cells and many multinucleated giant cells with nuclear molding. A viral culture was performed which, in several days, came back positive for herpes simplex virus. The complete blood cell count documented a white blood cell count of 8000/mm3 with 82.6% neutrophils and 9.0% lymphocytes. Based on the clinical presentation and the positive Tzanck smear, the patient was diagnosed with herpes simplex barbae, most likely spread by shaving. The patient was started on acyclovir 200 mg p.o. five times daily for 10 days. Oxycodone 5 mg in addition to acetaminophen 325 mg (Percocet; Endo Pharmaceuticals, Chadds Ford, PA) was prescribed for pain relief. A 1:1:1 suspension of viscous lidocaine (Xylocaine; AstraZeneca Pharmaceuticals LP, Wilmington, DE), diphenhydramine (Benadryl; Pfizer Inc., New York, NY), and attapulgite (Kaopectate; Pfizer Inc., New York, NY) was given as a swish and spit to relieve the oral discomfort. Good hygiene, no skin-to-skin contact with others, and no further shaving to prevent autoinoculation were stressed. He was advised to discard his old razor.

Herpes simplex virus: an occupational hazard in dentistry.

Approximately 70% of the population in the western world become infected with the herpes simplex virus type 1 (HSV-1) by the second decade of life. This review discusses the role of the HSV-1 as a potential occupational hazard for dental workers, focusing on herpes labialis, herpetic whitlow and keratitis. The risks associated with the dental treatment of patients with HSV-1, both from the perspective of the clinician and the patient are presented. Procedures for minimising the impact of HSV-1 within the dental practice, in particular infection control, delivery of treatment and patient education, are addressed. The management options for recurrent herpes labialis are also reviewed.

Primary herpetic gingivostomatitis in young children.

Oral infections caused by herpes simplex type 1 are widespread, even among otherwise healthy people. While most of these herpetic infections are asymptomatic, young children are at risk for developing extensive oropharyngeal vesicular eruptions when first infected with the virus. This initial outbreak is known as primary herpetic gingivostomatitis. Although a self-limiting disease, this oral infection can cause significant mouth discomfort, fever, lymphadenopathy, and difficulty with eating and drinking. Symptoms may persist for 2 weeks. Diagnosis can be made clinically and confirmed by laboratory tests. Some young children require hospitalization for management of dehydration and pain control. Pediatric nurses working in both primary and acute care settings will encounter this oral infection in young children. Antiviral therapy with acyclovir has proven effective in the management of primary herpetic gingivostomatitis. Providing supportive care and educating parents about transmission of the virus are important aspects of nursing care.

Differential diagnosis: is it herpes or aphthous?

Recurrent aphthous stomatitis (RAS) and recurrent intraoral herpes (RIH) are the two most commonly presenting oral lesions in the dental setting. It is critical that the oral health professional be able to accurately discriminate between these disorders. To facilitate the differential diagnosis between RAS and RIH, important components of assessment are discussed. These include: prodromal signs and symptoms, lesion location, and appearance of the initial and mature lesion. The comparative etiology, prevalence, pathogenesis, and treatment considerations for these lesions are presented. A familial case report is provided.

Clinical aspects of recurrent oral herpes simplex virus infection.

Recurrent oral ulcerations are the most common pathologic condition seen by general dentists. Because the etiology of oral ulcers is diverse, it is a continuous challenge for clinicians to reach a correct diagnosis. Recurrent herpes simplex virus (HSV)-associated ulcerations mainly affect the lip (herpes labialis). However, intraoral ulcerations may also be a sign of recurrent disease. For many patients, these sores are painful and unsightly. Up to 85% to 90% of adults show serologic evidence of exposure to HSV. HSV infections can cause high morbidity beyond oral and genital lesions. Furthermore, HSV poses an infectious risk to both patients and oral health care providers, so it is important that dental professionals are up-to-date on appropriate therapies and precautions. This article discusses recurrent oral HSV infection and nonoral manifestations of HSV infection.

Subclinical reactivation of herpes simplex virus type 1 in the oral cavity.

Reactivation in the oral cavity either symptomatically (recrudescence) or without symptoms (recurrence) may contribute to the transmission of herpes simplex virus type 1 (HSV-1), especially in critical areas of exposure such as dentistry. In order to measure the frequency of HSV-1 reactivation, nested polymerase chain reaction (PCR) was performed on oral swabs collected from 30 healthy people over a period of 58-161 days. In total 19 of 25 (76%) seropositive people were PCR-positive at least once, 6 of these 19 (32%) had recrudescence and 13 (68%) had only asymptomatic reactivation. Frequencies of additional recurrences were higher in people showing symptomatic reactivation than in those who had only recurrences. Recrudescence is a risk factor for elevated levels of asymptomatic HSV-shedding. In most cases HSV-1 was detected only by nested PCR investigated by early onset of therapy or time span before sampling.

Herpes simplex type 1 infections in group day care.

To characterize patterns of herpes simplex virus type 1 infection, illness and transmission among children in group day care, the data for 115 children who had been followed longitudinally from early infancy in a research day care center were examined. By 5 years of age 37% of study children had evidence of herpes simplex virus type 1 infection as demonstrated by virus isolation and/or seroconversion. The incidence of infection was highest among children 1 to 2 years old. Four small clusters of primary infections were observed over the 12-year study period but no cluster involved more than 6 children. Fifty-five percent of primary infections occurred during these small outbreaks; the remainder were sporadic. Gingivostomatitis was observed in 26% of children with primary culture-proved infections; no child with infection identified solely by serologic means had a history of gingivostomatitis. The occurrence of gingivostomatitis did not appear to be associated with increased transmission of herpes simplex virus type 1 infection in this day-care setting.