Oropharyngeal Herpes Simplex Infection in Adults - Guideline for the management of

Publication: 01/08/2008  
Next review: 12/01/2026  
Clinical Guideline
CURRENT 
ID: 1392 
Approved By: Improving Antimicrobial Prescribing Group 
Copyright© Leeds Teaching Hospitals NHS Trust 2023  

 

This Clinical Guideline is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

Guideline for the management of Oropharyngeal Herpes Simplex Infection in Adults

Diagnostics

Diagnosis is often clinical in the case of uncomplicated HSV infection.
Symptomatic oropharyngeal disease is characterised by lesions of the buccal and gingival mucosa. Intraoral lesions indicate a primary infection whilst lip lesions suggest reactivation. Primary infection is also normally more severe in nature. Recurrent lesions are preceded by pain, burning or tingling – vesicles may then appear a few hours later. It is this prodromal time that affords a window of opportunity for treatment. The vesicles then become pustules and finally crust over. The lesions are normally healed within 10 days.
In an immunocompromised host the disease process can be much more severe and even life threatening in some cases.

Most patient require no investigations

PCR of vesicle fluid can be done in difficult to diagnose cases (deroof a vesicle if there are no open lesions)

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Non-Antimicrobial Management

  • Rehydration: consider as appropriate especially if severe lesions and unable to drink.
  • Lubricant- petroleum jelly to prevent cracked lips
  • Consider simple analgesia (paracetamol and ibuprofen) to relieve pain and fever.
  • Consider topical anaesthetics or mouthwashes for symptom relief.

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Empirical Treatment

Doses assume normal renal and hepatic function.

Empirical options for oropharyngeal herpes

 

Recommended treatment

Duration

Non-severe – immune competent

  • Oral antivirals not recommended routinely  
  • In early infection, consider topical  Aciclovir electronic Medicines Compendium information on Aciclovir 5% cream (no benefit once crust has formed) 

5 days (if indicated)

Severe infection-immune competent

Aciclovir electronic Medicines Compendium information on Aciclovir  PO 400mg 3 times a day

5 days1

Non severe-

Immunocompromised

Aciclovir electronic Medicines Compendium information on Aciclovir  PO 400mg 5 times a day2

First infection:

10 days.

Recurrent infection:

Minimum of 5 days1

Contact virology if failed to respond by day 10.

Severe infection:

Immunocompromised

Valaciclovir PO 1g 12-hourly

OR

if concerns about swallowing or oral absorption

Aciclovir electronic Medicines Compendium information on Aciclovir  IV 5mg/kg 8 hourly

 

First infection:

10 days.

Recurrent infection: Minimum of 5 days1

Contact virology if failed to respond by day 10.

Allergies to above options

contact Microbiology or Infectious Diseases for advice

 

 

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Provenance

Record: 1392
Objective:

 

Clinical condition:

Oropharyngeal Herpes Simplex

Target patient group: Adults
Target professional group(s): Pharmacists
Secondary Care Doctors
Adapted from:

Evidence base

Footnotes

  1. Duration can be increased if new lesions appear during treatment or if healing incomplete.
  2. Aim to give every 4 hours

Prophylaxis

The role of prophylaxis of recurrent herpes simplex infection is beyond the scope of this guideline. If this is to be considered, contact [BS1] Virology or Infectious Diseases for advice

Evidence Base

Approved By

Improving Antimicrobial Prescribing Group

Document history

LHP version 2.0

Related information

Not supplied

Equity and Diversity

The Leeds Teaching Hospitals NHS Trust is committed to ensuring that the way that we provide services and the way we recruit and treat staff reflects individual needs, promotes equality and does not discriminate unfairly against any particular individual or group.