Primary Herpes Simplex Infection
Cold sores
Causes of Cold Sores in Children
Risk Factors and Complications
Diagnosis and Treatment in Children
Preventing Cold Sores in Children
When to Seek Medical Attention for Children
Primary Herpes Simplex Infection
Primary infection with HSV can be mild or subclinical, but symptomatic infection tends to be more severe than recurrences. Type 2 HSV is more often symptomatic than Type 1 HSV.
Primary Type 1 HSV most often presents as gingivostomatitis in children between 1 and 5 years of age. Symptoms include fever, which may be high, restlessness, and excessive drooling. Drinking and eating are painful, and the breath is foul. The gums are swollen, red, and bleed easily. Whitish vesicles evolve into yellowish ulcers on the tongue, throat, palate, and inside the cheeks. Local lymph glands are enlarged and tender. The fever subsides after 3–5 days, and recovery is usually complete within two weeks.
Primary Type 2 HSV usually presents as genital herpes after the onset of sexual activity. Painful vesicles, ulcers, redness, and swelling last for 2 to 3 weeks if untreated, and are often accompanied by fever and tender inguinal lymphadenopathy. In males, herpes most often affects the glans, foreskin, and shaft of the penis. Anal herpes is more common in males who have sex with men than with heterosexual partners. In females, herpes most often arises on the vulva and in the vagina, making it painful or difficult to pass urine.
Recurrent Herpes Simplex Infection
After the initial infection, whether symptomatic or not, there may be no further clinical manifestations throughout life. However, recurrences are common, particularly with Type 2 genital herpes. Triggers for recurrences include minor trauma, surgery, upper respiratory tract infections, sun exposure, hormonal changes, and emotional stress. The vesicles tend to be smaller and more closely grouped in recurrent herpes, usually returning to the same site as the primary infection. They heal in 7–10 days without scarring, although white patches or scars may occur at the site of recurrent attacks, especially in individuals with darker skin.
Diagnosis and Complications of Herpes Simplex
If there is clinical doubt, HSV can be confirmed by culture or PCR of a viral swab taken from fresh vesicles. Complications of herpes simplex include:
- Eye Infection: HSV can cause swollen eyelids and conjunctivitis, leading to superficial ulceration of the cornea.
- Throat Infection: HSV may cause painful throat infections, interfering with swallowing.
- Eczema Herpeticum: Severe and widespread infection in patients with atopic dermatitis, characterized by numerous blisters on the face or body, swollen lymph glands, and fever.
- Erythema Multiforme: An uncommon reaction to HSV, presenting as symmetrical plaques on hands, forearms, feet, and lower legs, characterized by target lesions with central blisters.
References
– Mayo Clinic. (2023). Cold sores (oral herpes). Retrieved from https://www.mayoclinic.org/diseases-conditions/cold-sore
– NHS. (2023). Cold sores. Retrieved from https://www.nhs.uk/conditions/cold-sores/
– Harvard Health. (2023). Cold sores: Prevention and treatment. Retrieved from https://www.health.harvard.edu/a_to_z/cold-sores
– Stanford Health. (2023). Herpes Simplex Virus. Retrieved from https://stanfordhealthcare.org/medical-conditions/skin-and-hair/herpes-simplex-virus.html
– Dermnet. (2023). Herpes simplex. Retrieved from https://dermnetnz.org/topics/herpes-simplex
