Oral Herpes Simplex
NICE CKS Herpes simplex – oral. Last revised: May 2024.
Guidelines
Investigation and Diagnosis
Clinical diagnosis
- Investigations not routinely needed in primary care
- Only consider investigating for underlying immunosuppression if there are unexplained recurrent infections that are severe or persistent
Typical clinical features:
- Prodrome of pain / burning / tingling / itching / paraesthesia (typically 6-48 hours)
- Crops of vesicles → rupture → superficial ulcers that crust over and heal
- Most common location: mucocutaneous junction of lower lip
Management
Admission Criteria
Consider admission if:
- Unable to swallow due to pain + at risk of dehydration (esp. in children)
- Immunocompromised with severe oral herpes simplex infection
- Serious complication that requires IV antiviral treatment
General Advice / Conservative Management
Reassure that oral herpes simplex infections are usually self-limiting and lesions should heal without scarring.
Symptom relief measurements:
- Paracetamol and/or ibuprofen
- Adequate fluid intake
- Topical analgesics / anaesthetics
Anti-Viral Therapy
DO NOT routinely prescribe topical antiviral.
Only consider oral aciclovir / valaciclovir in the following:
- Immunocompromised
- Primary infection in healthy people
- Severe / frequent / persistent / recurrent infection in healthy people
The evidence on the benefits of oral antivirals is limited, and oral treatment needs to be initiated at the onset of prodromal symptoms which may be difficult for people in practice.