Herpes simplex infections of the mouth and lips

ICD-10 code: B00.1-2

Description
General Measures
Medicine Treatment
Referral 

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DESCRIPTION

Acute, painful vesicular eruptions of the lips or ulcerations of the lips and mouth caused by Herpes simplex virus and characterised by:

• shallow, painful ulcers on the lips, gingiva, tongue and pharynx.
• pain exacerbated by eating.

It is a self-limiting infection with symptoms subsiding within 10 days.

GENERAL MEASURES

• Rinse mouth with homemade salt mouthwash for one minute twice daily (i.e. 1⁄2 medicine measure of table salt in a glass of lukewarm water).
• Ensure adequate hydration.
• Fluid diet for children.
• Avoid acidic drinks, e.g. orange juice or soft drinks, as they may cause pain.

MEDICINE TREATMENT 

• Cover lesions on the lips with petroleum jelly.

Pain:

Children

• Paracetamol, oral, 10–15 mg/kg/dose 6 hourly when required. See dosing table.

Adults

• Paracetamol, oral, 1 g 4–6 hourly when required.
  • Maximum dose: 15 mg/kg/dose.
  • Maximum dose: 4 g in 24 hours.

Extensive oral herpes:

For children > 6 years and adults

• Tetracaine 0.5 %, topical, applied every 6 hours.
  • Apply a thin layer on the affected areas only (may be used inside mouth).

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Note: Safety in children < 6 years of age has not been established.

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The following patients should be treated with an antiviral:

• Children with extensive oral herpes provided treatment can be started within 72 hours of onset of symptoms.
• PLHIV with herpes infections of the lips or mouth.

Children < 15 years of age

• Aciclovir, oral, 250 mg/m2/dose, 8 hourly for 7 days. See dosing table.

Children ≥ 15 years of age and adults

• Antiviral, (active against herpes simplex) e.g.:
  • Aciclovir, oral, 400 mg, 8 hourly for 7 days.

REFERRAL

• Severe condition.
• Dehydrated patients.
• No improvement after 1 week of treatment.

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare Level, Updated for the 2023 Edition