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

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
Non-Antimicrobial Management
Empirical Treatment

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)

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.

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 5% cream (no benefit once crust has formed)	5 days (if indicated)
Severe infection-immune competent	Aciclovir PO 400mg3 times a day	5 days¹
Non severe- Immunocompromised	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 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

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

Duration can be increased if new lesions appear during treatment or if healing incomplete.
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

BNF (British National Formulary). Accessed online 21/4/2022.
NICE CKS: Herpes simplex oral. Accessed online 21/4/2022.[CW2]
EACS guidelines. guidelines-11.1_final_09-10.pdf (eacsociety.org) Accessed 10/1/23

Approved By

Improving Antimicrobial Prescribing Group

Document history

LHP version 2.0

Related information

Not supplied

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