Herpes simplex type 1 most commonly affects the oral cavity. Herpes simplex type 2 can occur orally and will be discussed later. The primary infection, herpes gingivostomatitis, causes acute painful ulcerations on the gingiva and mucosal surfaces. Fever and lymphadenopathy are commonly associated findings and may occur up to 3 days prior to the appearance of oral lesions. Vesicular lesions appear and rupture after 1 to 2 days, leaving painful ulcers that heal gradually over 1 to 2 weeks. Secondary infection affects mostly the lips but may affect the hard palate and attached gingiva. By adulthood, most of the population has been exposed to herpes simplex type 1. The virus is harbored in sensory ganglion such as the gasserian ganglion of the trigeminal nerve. Periodic stresses activate the virus from its normally dormant state and allow for infection along the sensory distribution of the affected nerve. A prodrome of burning or tingling frequently occurs 1 to 2 days preceding outbreak of the characteristic vesicular lesion. Vesicles rupture within 2 to 3 days, forming small, shallow ulcers that heal in 6 to 10 days. Treatment is usually palliative; however, antiviral therapy with acyclovir 400 mg tid or valacyclovir 500 mg bid for 5 days initiated during the prodromal phase lessens the severity and duration of the ulceration.111.6
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