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. |
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) |
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 |
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Recommended treatment |
Duration |
Non-severe – immune competent |
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5 days (if indicated) |
Severe infection-immune competent |
Aciclovir |
5 days1 |
Non severe- Immunocompromised |
Aciclovir |
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
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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: |
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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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