Oral herpes simplex virus infection in pregnancy: what are the concerns?

Although epidemiologic data and the potentially serious effects of transmission of genital herpes from mother to infant during birth have been widely reported, published reports on oral herpes disease in pregnancy remain scarce and no clear management guidelines exist. Thus, questions remain about acquisition, transmission and outcome of infection, especially with respect to acute gingivostomatitis in pregnancy. In response to these questions, we summarize previous reports on herpes simplex virus 1 (HSV-1) oral disease in pregnancy and, briefly, present 2 cases of primary gingivostomatitis in the first trimester of pregnancy, resulting in a favourable outcome for both mother and infant. We also point out the most recent data on rare, potentially severe in outcome, but treatable, primary central nervous system HSV-1 infection in later stages of pregnancy. Finally, we emphasize a multidisciplinary approach to oral HSV disease in pregnancy, with dentist participation in the diagnosis and treatment.

An update on short-course intermittent and prevention therapies for herpes labialis

Infection with herpes simplex virus (HSV) has increased in prevalence worldwide over the past two decades, making it a major public health concern. Approximately 90% of recurrent HSV type 1 (HSV-1) infections manifest as non-genital disease, primarily as orofacial lesions known as herpes labialis. Improvements in our understanding of the natural history of herpes labialis support the rationale for early treatment (during the prodrome or erythema stages) with high doses of antiviral agents in order to maximize drug benefit. When evaluating the efficacy of different antiviral and anti-inflammatory agents in clinical trials, episode duration, lesion healing time, reduction in maximum lesion size and the proportion of aborted lesions should be used as the most reliable measures of therapeutic efficacy. There has also been considerable research into the most beneficial treatment for recurrent episodes of herpes labialis in immunocompetent individuals. Data from clinical studies confirm that short-course, high-dose oral antiviral therapy should be offered to patients with recurrent herpes labialis to accelerate healing, reduce pain and most likely increase treatment adherence. Optimal benefits may be obtained when these oral antiviral agents are combined with topical corticosteroids, but more research is needed with this combination. Patients undergoing facial cosmetic procedures (i.e.facial resurfacing) are at risk of HSV reactivation, but further data are required on the actual risk according to the specific procedure. Aciclovir, valaciclovir and famciclovir all provide effective prophylaxis against HSV-1 reactivation following ablative facial resurfacing. However, no definitive recommendations can be made regarding prophylactic therapy for minimally invasive procedures at present.

Herpes simplex virus: an occupational hazard in dentistry

Approximately 70% of the population in the western world become infected with the herpes simplex virus type 1 (HSV-1) by the second decade of life. This review discusses the role of the HSV-1 as a potential occupational hazard for dental workers, focusing on herpes labialis, herpetic whitlow and keratitis. The risks associated with the dental treatment of patients with HSV-1, both from the perspective of the clinician and the patient are presented. Procedures for minimising the impact of HSV-1 within the dental practice, in particular infection control, delivery of treatment and patient education, are addressed. The management options for recurrent herpes labialis are also reviewed.

Salivary defense factors in herpes simplex virus infection

Saliva may contribute to a lowering of the infectious herpes simplex virus (HSV) dose during transmission and consequently abrogate infection or lead to decreased reactivation. To test this hypothesis, we assayed saliva for innate defense factors, immunoglobulin content, and the capacity to interfere with HSV infection. Serum or salivary anti-HSV IgG levels did not correlate with control of recurrent labial herpes (RLH) and were significantly higher in subjects with RLH compared with asymptomatic seropositive subjects. Although no differences in levels or output rate of innate defense factors between the groups were observed, the salivary neutralizing activity correlated with lactoferrin and hypothiocyanite concentrations in the asymptomatic seropositive group. Our results suggest that saliva contains factors, in addition to anti-HSV immunoglobulins, that neutralize HSV and may indirectly contribute to the control of RLH.

[Natural history of HSV1 and HSV2 transmission modes and epidemiology consequences of HSV infection on HIV infection. Prevention]

Both Herpes simplex viruses HSV1 and HSV2 are transmitted by direct mucosal or cutaneo-mucosal contact between individuals. HSV1 is the leading cause of orofacial herpes and HSV2 the most frequently encountered cause of genital herpes. There are however a number of environmental and behavioral factors that modify the epidemiological pattern in both infections. These factors also affect virus dynamics and spread. In developing countries, HSV1 infections continues to be acquired in early childhood. In developed countries, displacement of this acquisition towards adolescence and adulthood explains, in part, the increase in genital herpes caused by HSV1. HVS2 infection progresses in the sexually active population worldwide. Although the rate of seroprevalance varies greatly from one continent to another, women are still more often infected than men. HSV2 genital infection is a cofactor for transmission and acquisition of HIV, which, in certain African regions where the two infections are highly prevalent, explains in part the progression of the HIV epidemic. Until a vaccine becomes available, the prevention depends on abstention from all oral and genital contact during periods of active disease. For genital herpes, use of a preservative has only a relative protective effect and the contribution of suppressive treatment in potentially contaminated subjects is under evaluation.

Effects of antiviral usage on transmission dynamics of herpes simplex virus type 1 and on antiviral resistance: predictions of mathematical models

Herpes simplex virus type 1 (HSV-1) causes recurrent herpes labialis (RHL), a common disease afflicting up to 40% of adults worldwide. Mathematical models are used to analyze the effect of antiviral treatment on the transmission of, and the prevalence of drug resistance in, HSV-1 in the United States. Three scenarios are analyzed: no antiviral use, the current level of use, and a substantial increase in nucleoside analogue use, such as might occur if topical penciclovir were available over-the-counter for the treatment of RHL. A basic model predicts that present level of nucleoside analogue use has a negligible effect on HSV-1 transmission and that even if use of topical penciclovir for (RHL) increased substantially, the overall prevalence of infectious HSV-1 is unlikely to be reduced by more than 5%. An expanded model, which allows for acquired resistance and includes immunocompromised hosts and other more realistic features, predicts that current antiviral use is unlikely to lead to any noticeable increase in resistance. If antiviral use increases, the resulting rise in resistance in the population will depend primarily on the probability that immunocompetent hosts will acquire permanent resistance upon treatment. This probability is known to be small, but its exact value remains uncertain. If acquired resistance occurs less than once per 2,500 treated episodes, then in the community at large, the frequency of HSV-1 resistance is predicted to increase slowly, if at all (remaining below 0.5% for >50 years), even with extensive nucleoside analogue use. If acquired resistance emerges in 1 of 625 treated episodes (the maximum of an approximate 95% confidence interval derived from the results of several studies of resistance in treated hosts), then the prevalence of infection with resistant HSV-1 could rise from about 0.2% to 1.5 to 3% within 50 years. The limitations of existing data on acquired resistance and the potential impact of acquired resistance if it occurs are discussed, and strategies are suggested for enhancing information on acquired resistance. The predictions of this model contrast with the more rapid increases in antimicrobial resistance anticipated by models and observed for other pathogenic bacteria and viruses. The reasons for these contrasting predictions are discussed.

[Herpes labialis and genitalis in general medicine]

OBJECTIVE

The purpose of this study was to determine the respective importance of herpes labialis and genitalis in patients consulting general practitioners and ascertain their knowledge and opinions concerning herpes labialis and genitalis in order to analyze patient behavior in case of flare-ups.

PATIENTS AND METHOD

A questionnaire was proposed to a representative sample of patients aged 15 years and older seen at consultation by 49 general practitioners participating in the General Medicine Observatory of the French Society of General Practitioners.

RESULTS

Among the 4,403 patients who responded, a known history of herpes labialis was reported by 39. 9 p.100 and of herpes genitalis by 2.5 p.100. Their answers to the questions demonstrated insufficient knowledge of avoidable risks of herpes as a sexually transmitted disease, with very significant misunderstanding by men. Among the 1,711 patients who had experienced herpes labialis, 62.9 p.100 initiated self-medication, 29 p.100 preferred to wait and see and 7.5 p.100 sought medical assistance. Among the 108 patients who had experienced herpes genitalis, at the last flare-up 40 p.100 initiated self-medication, 7.5 p.100 preferred to wait and see and 52 p.100 sought medical assistance. The general practitioner was the first physician consulted for both types of herpes.

DISCUSSION

This study illustrates the importance of herpes infections in the general medicine patients. It also confirms that new interventional strategies are needed both for health care and for health education.

Patient recognition of recrudescent herpes labialis: a clinical and virological assessment

OBJECTIVES

The purpose of this study was to ascertain how accurate the general public was at diagnosing the condition of recrudescent herpes labialis.

METHODS

An advertisement was placed in a local newspaper inviting patients to attend the Oral Medicine Clinic as soon as they thought they developed the clinically evident stage of herpes labialis. At the clinic, patients were examined to confirm the clinical presence of herpes labialis and also had a swab of the lesion(s) taken for virus culture. Virus culture was by the HEP-2 culture technique capable of detecting both herpes simplex Type 1 and herpes simplex Type 2. Patients also completed a detailed questionnaire concerning their knowledge of herpes labialis.

RESULTS

In total, 41 patients attended for screening. The findings were that all patients had clinical herpes labialis, and herpes simplex virus was isolated in 96% of cases. In contrast, in only about 50% of cases were patients aware that their herpes labialis was caused by a virus.

CONCLUSIONS

The general public are very good at recognizing herpes labialis lesions but need to be given more information about their infectivity.

Herpetic whitlow

This paper describes a case of transmission of herpetic whitlow to the index finger of a dental student from a patient with herpes simplex virus. The recognition of intraoral viral infections in patients is important because these viruses have serious implications for health care providers. Rubber gloves must be worn when patients with primary or secondary herpetic lesions are treated. Asymptomatic permanent herpes virus carriers must also be treated with appropriate precautions.

Natural history, management and complications of herpes labialis

Infection with herpes simplex virus (HSV) is a common worldwide problem. Primary infection with HSV-1 rarely causes significant problems although widespread involvement in atopic eczema can be life-threatening as may associated encephalitis. Keratoconjunctivitis, pharyngitis and hepatitis can also complicate primary infection. Twenty to 40% of the population at some stage have recurrent orolabial infections with HSV although in only 1% of these cases is this recurrence severe. Recurrent erythema multiforme appears to be associated with HSV-65% of patients are thought to have preceding herpes labialis. Many primary and recurrent infections with HSV-1 require little more than topical antiseptic therapy to control secondary infection. Systemic acyclovir, however, is indicated in various situations including complicated primary infection, infection in neonates, eczema herpeticum, HSV infections in the immunocompromised, and recurrent erythema multiforme. In the latter, prophylactic treatment with 6 months acyclovir appears to be effective.

Lack of oral HSV-2 in a college student population

A population of individuals with a high incidence of genital herpes simplex virus type 1 (HSV-1), due most likely to oro-genital contact, was examined to determine the incidence of oral herpes simplex virus type 2 (HSV-2) infection. Herpes simplex virus was isolated from the oral cavity of 43 college students whose symptoms ranged from singular lesions of the lips with minimal discomfort to severe oral disease with systemic involvement resulting in lymphadenopathy, chills, sweat, myalgia, and fever. The virus isolated from each case was identified by serum neutralization and typed as HSV-1 or HSV-2 using (E)-5-(2-bromovinyl)-2'-deoxyuridine (BVDU) sensitivity, monoclonal antibody immunofluorescence, and restriction endonuclease EcoRI digestion of viral DNA. In every instance the isolate was HSV-1. Additional identification and typing of head and neck isolates as well as oral samples from non-university patients demonstrated that all were also HSV-1. Therefore, while HSV-1 appears to be readily transmitted to the genitalia in this group of individuals, the transmission of HSV-2 to the oral cavity may not be as common, even though clinical histories revealed that several of these patients were engaging in oro-genital contact.

The herpes simplex viruses: the facts health professionals need to know

Herpes labialis and herpes genitalis are described, including the symptoms, complications, treatment, and research of the disease. The article explains how transmission or contraction of the herpes virus occurs, particularly in the hospital setting, and how it can be avoided by the health professional.

Disseminated neonatal herpes simplex virus infection acquired from the father

A disseminated herpes virus type 1 infection in a baby was acquired from the father, who had herpes labialis. This was shown by virus strain typing using restriction endonuclease DNA analysis. Labial herpes, a common infection in adults, must be recognised as a potential threat to newborn babies.

Postnatal acquisition of herpes simplex virus by the newborn infant: a review of the literature

The literature relating to the hazards of herpes simplex virus acquired by newborn infants after birth is reviewed. A total of 24 infants has been reported who have acquired the infection in this manner; 66% of these infants expired. Transmission of virus from mothers, adults (including personnel) other than the mother, and other infants has been reported. In order to prevent this infrequent but life-threatening illness, separation of the newborn infant from any person with active lesions caused by herpes simplex virus is recommended.