HSV-1 Oral-Labial Ulcers

• Primary infection involves contact with the infectious agent, replication in the skin, viral entrance into the sensory nerve endings, retrograde transport to the sensory ganglion, andlatent infection.
• Reactivation involves a transformation from latent to lytic viral replication within the sensory ganglion, followed by anterograde axonal transport back to the skin, and ultimately viral replication and ulceration within the skin.

• Starts with pain at the labial borders.
• ~ 1 day later, vesicles form at that site.
• Pain dissipates within 1 - 3 days.
• Vesicles crust/heal within 5 - 10 days.

There are numerous potential HSV-1 complications/manifestations, including, but not limited to:

• Genital (Note that HSV-2 is the most common cause of genital herpes but HSV-1 is another potential cause)
• Cutaneous (eg, Herpetic whitlow: HSV infection of the finger)
• Ocular (eg, Keratitis, causing corneal blindness)
• Neurologic (eg, Encephalitis, especially of the medial temporal lobes)
• Hepatic (Fulminant liver inflammation)
• Respiratory tract (eg, Epiglottitis)
• Esophageal (Esophagitis, esp. in the immune-suppressed)

There are numerous other potential causes of oral ulcers, including, but not limited to:

• Aphthous stomatitis
• Enteroviruses
• Herpes viruses other than HSV-1 (CMV, EBV, etc...)
• HIV
• Behcet's disease

Herpes Simplex Virus 1