Nongenital herpes simplex virus type 1 is a common
infection usually transmitted during childhood via nonsexual contact. Most of these
infections involve the oral mucosa or lips (
herpes labialis). The diagnosis of an
infection with herpes simplex virus type 1 is usually made by the appearance of the lesions (grouped vesicles or
ulcers on an erythematous base) and patient history. However, if uncertain, the diagnosis of
herpes labialis can be made by viral culture, polymerase chain reaction, serology, direct fluorescent antibody testing, or Tzanck test. Other nonoral herpes simplex virus type 1
infections include
herpetic keratitis, herpetic whitlow, herpes gladiatorum, and herpetic
sycosis of the beard area. The differential diagnosis of nongenital
herpes simplex virus infection includes
aphthous ulcers, acute
paronychia,
varicella-zoster virus infection,
herpangina,
herpes gestationis (
pemphigoid gestationis),
pemphigus vulgaris, and Behçet syndrome. Oral
acyclovir suspension is an effective treatment for children with primary
herpetic gingivostomatitis. Oral
acyclovir,
valacyclovir, and
famciclovir are effective in treating acute recurrence of
herpes labialis (
cold sores). Recurrences of
herpes labialis may be diminished with daily oral
acyclovir or
valacyclovir. Topical
acyclovir,
penciclovir, and
docosanol are optional treatments for recurrent
herpes labialis, but they are less effective than oral treatment.