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Oral Herpes Simplex

NICE CKS Herpes simplex - oral. Last revised: May 2024.

Guidelines

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

Consider admission if:

Unable to swallow due to pain + at risk of dehydration (esp. in children)
Immunocompromised with severe oral herpes simplex infection
Serious ocmplication that requires IV antiviral treatment

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

DO NOT routinely prescribe topical antiviral.

Only consider oral aciclovir / valaciclovri in the following:

Immunocompromised
Primary infeciton 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.

References

NICE CKS Herpes simplex - oral

Author: Adams Lau
Reviewer:
Last edited: 03/05/25

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