The first eruption of skin or mouth sores with the herpes simplex virus (HSV) is called primary herpes. This may be more severe than the more commonly recognized than secondary, or recurrent, herpes infections, which are also called cold sores or fever blisters.
Either herpes simplex virus type 1 (HSV-1) or herpes simplex virus type 2 (HSV-2) can cause infection. HSV-1 is the most common cause of lesions that appear around the mouth and on the lips. HSV-2 is the typical cause of genital herpes. Both conditions are highly contagious and are spread by direct contact with the lesions of another infected individual such as a playmate, parent, or caretaker. The virus can even spread in the absence of symptoms or visible lesions.
The attacks of both forms of HSV usually recur in the same skin region, and most individuals report burning, itching, and a tingling sensation before the actual lesions appear.
HSV can occur on virtually any body surface.
The primary episode usually heals in 7–10 days. Once a person is infected, the virus tends to stay hidden in the body (latent) lifelong.
Who's At Risk
Infection with HSV is very common. Most people never even know they have been infected, as their immune system suppresses symptoms. At least one-third of children are infected by HSV by the end of childhood.
Some people will have symptoms when first infected; the infection may be more severe in newborns and in those with a weak immune system.
Signs and Symptoms
Primary herpes looks different than recurrent herpes attacks. Most commonly, primary herpes is seen in children with painful blisters and erosions of the gums and the skin around or lining the mouth. There may also be fever, swollen lymph nodes in the neck, irritability, and a poor appetite. If HSV was introduced on other body sites, there will be painful blisters and sores in that location (finger, face, genitals) with swelling and similar systemic symptoms.
- Give acetaminophen or ibuprofen for pain. Relief of pain, so that eating and sleeping are possible, is most important.
- The child should be encouraged to drink as much fluid as possible to avoid dehydration.
- Avoid contact with other children, especially newborns and those with eczema or a weak immune system, until healed.
When to Seek Medical Care
Although those with mild recurrent herpes do not usually need any medical care, see your child's doctor if you think he/she has primary herpes.
Treatments Your Physician May Prescribe
Antiviral medications may be prescribed (acyclovir, valacyclovir, famciclovir). Anesthetic mouthwashes or pain medication may be given to reduce pain. Sometimes a child will need to be given intravenous fluids for dehydration.
Bolognia, Jean L., ed. Dermatology
, pp.1240-1241, 2028, 1236-1239. New York: Mosby, 2003.
Freedberg, Irwin M., ed. Fitzpatrick's Dermatology in General Medicine
ed. pp.2059-2062, 2065, 2366, 2434-2437. New York: McGraw-Hill, 2003.