Herpes simplex infections of the mouth and lips

B00.1-2

DESCRIPTION

Acute, painful vesicular eruptions of the lips or ulcerations of the lips and mouth caused by Herpes simplex virus and characterised by:

  • shallow painful ulcers on the lips, gingiva, tongue and pharynx
  • pain exacerbated by eating

It is a self-limiting infection with symptoms subsiding within 10 days.

GENERAL MEASURES

  • Rinse mouth with homemade salt mouthwash for one minute twice daily (i.e. ½ medicine measure of table salt with a glass of lukewarm water).
  • Ensure adequate hydration.
  • Fluid diet for children.
  • Avoid acidic drinks, e.g. orange juice or soft drinks as they may cause pain.

MEDICINE TREATMENT

  • Cover lesions on the lips with petroleum jelly.

Pain:

Children

Adults

  • Paracetamol, oral, 1 g 4–6 hourly when required.
    • Maximum dose: 15 mg/kg/dose.
    • Maximum dose: 4 g in 24 hours.

Extensive oral herpes:

For children > 6 years and adults

  • Tetracaine 0.5%, topical, applied every 6 hours.
    • Apply a thin layer on the affected areas only (may be used inside mouth).

Note: Safety in children < 6 years of age has not been established.

The following patients should be treated with aciclovir:

  • Children with extensive oral herpes provided treatment can be started within 72 hours of onset of symptoms.
  • HIV infected patients with herpes infections of the lips or mouth.

Children < 15 years of age

Children ≥ 15 years of age and adults

  • Antiviral, (active against herpes simplex) e.g.:
  • Aciclovir, oral, 400 mg, 8 hourly for 7 days

LOEII[2]

REFERRAL

  • Severe condition.
  • Dehydrated patients.
  • No improvement after 1 week of treatment.