Prevention of herpes simplex virus type 1 infection in immunocompetent patients
- Robyn S Klein, MD, PhD
Robyn S Klein, MD, PhD
- Associate Professor of Medicine
- Washington University School of Medicine
Herpes simplex virus type 1 (HSV-1) may cause gingivostomatitis, which is characterized by vesiculoulcerative lesions of the oral mucosa. Reactivation of HSV-1 occurs in the trigeminal sensory ganglion and may lead to herpes labialis (eg, "cold sores"), which often occurs along the vermillion border of the lip.
The prevention of HSV-1 infections will be reviewed here. The clinical manifestations and treatment of primary and episodic recurrent HSV infections are discussed elsewhere. (See "Clinical manifestations and diagnosis of herpes simplex virus type 1 infection" and "Treatment of herpes simplex virus type 1 infection in immunocompetent patients".)
The treatment and prophylaxis of HSV-1 infections in the immunocompromised patient are discussed elsewhere. (See "Prevention of infections in hematopoietic cell transplant recipients".)
There is currently no effective vaccine against HSV-1 infection .
In recurrent cutaneous HSV-1 infection, there is a sequential infiltrate of CD4+ and then CD8+ T lymphocytes into lesions. CD4 lymphocytes produce intralesional IFN-gamma and recognize the structural proteins of HSV (ie, glycoproteins D and B) when restimulated in vitro. Research on the immunodominant epitopes of these two glycoproteins may help inform future vaccine trials in humans [2,3].To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Whitley RJ, Roizman B. Herpes simplex viruses: is a vaccine tenable? J Clin Invest 2002; 110:145.
- Kim M, Taylor J, Sidney J, et al. Immunodominant epitopes in herpes simplex virus type 2 glycoprotein D are recognized by CD4 lymphocytes from both HSV-1 and HSV-2 seropositive subjects. J Immunol 2008; 181:6604.
- Chentoufi AA, Zhang X, Lamberth K, et al. HLA-A*0201-restricted CD8+ cytotoxic T lymphocyte epitopes identified from herpes simplex virus glycoprotein D. J Immunol 2008; 180:426.
- Kesson AM. Use of aciclovir in herpes simplex virus infections. J Paediatr Child Health 1998; 34:9.
- Weston WL, Morelli JG. Herpes simplex virus-associated erythema multiforme in prepubertal children. Arch Pediatr Adolesc Med 1997; 151:1014.
- Raborn GW, Martel AY, Grace MG, McGaw WT. Oral acyclovir in prevention of herpes labialis. A randomized, double-blind, multi-centered clinical trial. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998; 85:55.
- Spruance SL, Rowe NH, Raborn GW, et al. Peroral famciclovir in the treatment of experimental ultraviolet radiation-induced herpes simplex labialis: A double-blind, dose-ranging, placebo-controlled, multicenter trial. J Infect Dis 1999; 179:303.
- Spruance SL, Freeman DJ, Stewart JC, et al. The natural history of ultraviolet radiation-induced herpes simplex labialis and response to therapy with peroral and topical formulations of acyclovir. J Infect Dis 1991; 163:728.
- Gilbert SC. Suppressive therapy versus episodic therapy with oral valacyclovir for recurrent herpes labialis: efficacy and tolerability in an open-label, crossover study. J Drugs Dermatol 2007; 6:400.
- Mills J, Hauer L, Gottlieb A, et al. Recurrent herpes labialis in skiers. Clinical observations and effect of sunscreen. Am J Sports Med 1987; 15:76.
- Rooney JF, Bryson Y, Mannix ML, et al. Prevention of ultraviolet-light-induced herpes labialis by sunscreen. Lancet 1991; 338:1419.
- Evans TG, Bernstein DI, Raborn GW, et al. Double-blind, randomized, placebo-controlled study of topical 5% acyclovir-1% hydrocortisone cream (ME-609) for treatment of UV radiation-induced herpes labialis. Antimicrob Agents Chemother 2002; 46:1870.
- Bernstein DI, Schleupner CJ, Evans TG, et al. Effect of foscarnet cream on experimental UV radiation-induced herpes labialis. Antimicrob Agents Chemother 1997; 41:1961.
- Spruance SL, Hamill ML, Hoge WS, et al. Acyclovir prevents reactivation of herpes simplex labialis in skiers. JAMA 1988; 260:1597.
- Wall SH, Ramey SJ, Wall F. Famciclovir as antiviral prophylaxis in laser resurfacing procedures. Plast Reconstr Surg 1999; 104:1103.
- Alster TS, Nanni CA. Famciclovir prophylaxis of herpes simplex virus reactivation after laser skin resurfacing. Dermatol Surg 1999; 25:242.
- Whitley RJ, Gnann JW Jr. Acyclovir: a decade later. N Engl J Med 1992; 327:782.
- Martin ET, Krantz E, Gottlieb SL, et al. A pooled analysis of the effect of condoms in preventing HSV-2 acquisition. Arch Intern Med 2009; 169:1233.
- Openshaw H, Bennett HE. Recurrence of herpes simplex virus after dental extraction. J Infect Dis 1982; 146:707.
- Hyland PL, Coulter WA, Abu-Ruman I, et al. Asymptomatic shedding of HSV-1 in patients undergoing oral surgical procedures and attending for noninvasive treatment. Oral Dis 2007; 13:414.
- Marques-Silva L, Castro WH, Gomez EL, et al. The impact of dental surgery on HSV-1 reactivation in the oral mucosa of seropositive patients. J Oral Maxillofac Surg 2007; 65:2269.
- Schädelin J, Schilt HU, Rohner M. Preventive therapy of herpes labialis associated with trigeminal surgery. Am J Med 1988; 85:46.
- Gilbert S, McBurney E. Use of valacyclovir for herpes simplex virus-1 (HSV-1) prophylaxis after facial resurfacing: A randomized clinical trial of dosing regimens. Dermatol Surg 2000; 26:50.
- Glinšek Biškup U, Uršič T, Petrovec M. Laboratory diagnosis and epidemiology of herpes simplex 1 and 2 genital infections. Acta Dermatovenerol Alp Pannonica Adriat 2015; 24:31.
- Roberts CM, Pfister JR, Spear SJ. Increasing proportion of herpes simplex virus type 1 as a cause of genital herpes infection in college students. Sex Transm Dis 2003; 30:797.
- Wald A, Langenberg AG, Link K, et al. Effect of condoms on reducing the transmission of herpes simplex virus type 2 from men to women. JAMA 2001; 285:3100.
- Wald A, Krantz E, Selke S, et al. Knowledge of partners' genital herpes protects against herpes simplex virus type 2 acquisition. J Infect Dis 2006; 194:42.
- Magaret AS, Mujugira A, Hughes JP, et al. Effect of Condom Use on Per-act HSV-2 Transmission Risk in HIV-1, HSV-2-discordant Couples. Clin Infect Dis 2016; 62:456.
- PREVENTIVE VACCINE
- AVAILABLE ANTIVIRAL AGENTS
- PROPHYLAXIS FOR RECURRENT HSV WITH IDENTIFIED TRIGGER
- Sunlight exposure
- - Sunscreen
- - Topical therapy
- - Oral antiviral therapy
- Surgical procedures
- HSV-ASSOCIATED ERYTHEMA MULTIFORME
- PREVENTION OF HSV IN HEALTH CARE WORKERS
- PREVENTION OF SEXUAL TRANSMISSION
- Transmission of HSV-1
- Condom use
- Antiviral therapy
- SUMMARY AND RECOMMENDATIONS