Herpes Virus

Gabrielle and Pick

1, 2, 3, 4

Gabrielle & Pick

Overview:
Introduction to each variant

Transmission

Treatment

Clinic Management

Practice Test Questions

Oral Herpes
Human Herpesvirus Type I (HHV-1)

Herpes Simplex Virus Type I (HSV-1)

What is it: commonly known as oral herpes,

primary infection typically occurs in children but
can occur at any age, especially the https://www.verywellhealth.com/is-it-a-pimple-or-a-cold-sore-15612

immunocompromised.

Characteristics: small fluid filled lesions, called Signs and Symptoms:

cold sores or fever blisters. Ulcerations can also
● Sore lip, tingling, ulcers
occur depending on the type of infection. Can be
● Blister, rashes, ulcers or redness
transmissible even when sores are not present

Causative Agent: virus Four different types of infections:

Oral Herpes: Types of Infections
● Primary Herpetic Gingivostomatitis
○ Oral ulcers
○ Can involve pharyngeal areas
○ Latent infection
● Herpes Labialis
○ Cold sore, fever blisters
○ Recurrence is common (triggers include: stress, trauma, illness)
○ Lesions are infectious
● Herpetic Whitlow
○ Herpes simplex infection of the fingers (HSV-1 & HSV-2 entering through abrasions around the
fingernails)
● Ocular/Ophthalmic Herpes
○ Herpes simplex lesions in the eye and may lead to blindness
○ Transmission can occur from splashing saliva or fluid into the eye
Genital Herpes Signs and symptoms

- Fluid filled lesions in the genital region

Human Herpesvirus Type II: HHV-2 - Blister or multiple blisters on or around
affected areas-- genitals or rectum
Herpes Simplex Virus Type II: HSV-2

What is it: Commonly known as genital herpes

but it also occurs as an oral and perioral infection

Characteristics: A sexual transmitted disease

often spreads through sexual contact and/or skin
to skin. Painful vesicles and ulcers with redness
and swelling

Causative Agent: Virus

https://www.mymed.com/image/1470/medicalarticle/800
Genital Herpes (cont.)

Neonatal Herpes
- Mothers can spread infection during
delivery
- Can cause delayed mental development,
blindness, neurologic problems, and death
- Obstetricians may recommend delivery by
cesarean section to women with active
genital herpes to avoid transmission

https://www.goodrx.com/womens-health/cesarean-section-pregnancy
Varicella Zoster Virus (VZV)
Chickenpox (Varicella) / Shingles (Zoster) Signs and Symptoms:

HHV-3 or VZV ● Blisters

● Scabs
Characteristics: primary infections cause varicella ● Ulcers
or chickenpox, reactivation may occur years later ● Red spot
in the form of herpes zoster or shingles. ● May be accompanied by fever and rash

-Varicella-mostly affects children, not seen as Virus remains latent in the dorsal root ganglia and
often due to vaccine. can later reactivate causing Herpes Zoster

-Zoster-occurs in older adults (age 50 or older) ● Pain (where rash will soon develop)
● Rash
Causative Agent: virus ● One side of the face or body
● Blisters
Varicella: Zoster:

https://www.cdc.gov/chickenpox/about/photos.html https://www.mayoclinic.org/diseases-conditions/shingles/symptoms-causes/syc-20353054
Epstein-Barr Virus (EBV)
Sign and Symptoms:
Epstein Barr Virus: EBV also known as human herpesvirus 4

Explain: Spreads most commonly through bodily fluids, - Fatigue

primarily saliva. Can also be spread through sexual contact, - Fever
organ transplant, and blood transfusions. - sore/ inflamed throat
Characteristics: - Swollen lymph nodes (neck)
●
- Enlarged spleen
Mostly infected in childhood usually do not cause
symptoms - Swollen liver
● Symptoms last 2-4 weeks usually in teenagers and - Rash
adults. - Oral hairy leukoplakia
● Symptoms are similar to other illnesses.
● May be a long period of lasting carrier state

Causative Agent: virus

Epstein-barr: Types of Infections
● Infectious mononucleosis (kissing disease)
○ Symptomatic disease
● Oral hairy leukoplakia
○ Clinical appearance of white linear patches on the lateral border of the tongue.
● Periapical lesions
○ Tooth abscess (pocket of pus around the tip/root of tooth)
● Periodontal disease (severity)
○ Gingival infection that damages the soft tissue,
● Lymphoepithelial cysts of parotid gland
● More Severe Infections:
○ Lymphatic cancers
○ Nasopharyngeal cancers
○ Burkitt’s lymphoma
 Epstein- Barr Virus

https://image.shutterstock.com/z/stock-photo-infectious-mononucleosis-mouth-with-pharyngitis-epstein-barr-virus-and-reactive-lymphocytes-in-725570239.jpg

https://i1.wp.com/www.joygoal.top/wp-content/uploads/2020/07/103048_EpsteinSymptoms_072617.png?fit=720%2C1100&ssl=1
Transmission
HSV-1: HSV-2

● Highly contagious infection ● Sexually transmitted disease

● Oral-to-oral contact ● Contact genital surfaces, skin, sores, or
● Saliva fluids
● Sores ● Can be transmitted in the absence of
● Higher transmission when active infection symptoms
● Can still be transmitted with no active ● Neonatal herpes
infection ○ Occurs when infant is exposed to HSV (1 or
● Life-log infection 2) in the genital tract during delivery
● HSV-1 can be transmitted during oral sex
Transmission
Varicella Zoster Virus: Epstein-Barr Virus:

● Extremely contagious ● Spreads through bodily fluids

○ Especially saliva
● Inhalation of aerosols ○ Blood
● Direct skin contact ○ Semen

● Indirect contact ● Can be spread through objects

○ Toothbrush
○ Clothing ○ Sharing drinks/lip products
● Blisters that are dry/crusted no ○ Toys that kids drool on

longer able to spread ● Virus can be spread for weeks prior

● Latent state to symptoms
● Latent state
Treatment:
HSV-1: Varicella Zoster:

● Recurrent lifelong disease ● Varicella vaccine

● No cure ○ First dose ages 12-15 months
● ○ Second dose ages 4-6 years old
Antiviral medications
● Zoster vaccine recommended for all adults
HSV-2: 50 years and older
● Recurrent lifelong disease Epstein-Barr Virus:
● No cure
● ● No vaccine available
Antiviral medications
● OTC drugs to help with pain and fever
Clinical Management
● Postpone appointments if patient has active lesion.
● Explain the contagious nature of the disease
○ Limit personal contact with people through saliva transfer involving sharing of drinks, etc
○ Be cautious of limiting autoinfection through the touching of the lesion and later touching other
areas that are susceptible like the eyes and genitals.
● The prodromal stage can be the most transmissible to clinicians and other patients
● Autoinoculation is possible from instrumentation splashing of the virus to the patient's eye or
extending the the lesion to the nose.
● Irritation to the lesions can prolong course and increase the severity of infection
● Avoid using dental jargon that can alarm patients. Use pain language such as “cold sore, fever blister”
to ensure patient understanding
Practice Test Question 1
A patient with Varicella Zoster Virus will have all of the following signs and
symptoms except:
a. Blisters
b. Oral hairy leukoplakia
c. Ulcers
d. Red spot
Answer
B. Oral hairy leukoplakia

Oral hairy leukoplakia is a common infection of the Epstein-Barr Virus. It is seen as white patches on the
tongue that are usually found on the lateral sides.. These are some dental consideration when dealing with a
patient with EBV.
Practice Test Question 2
True or False

Genital herpes is a sexually transmitted disease that is only transmissible through

HSV-2.
Answer
False-

Genital herpes is transmissible through both HSV-1 and HSV-2. The herpe
simplexs cannot be distinguishable.

HSV-1 can be spread through oral sex

Resources
Centers for Disease Control and Prevention. (2017, August 28). STD Facts - Genital Herpes. Centers for Disease Control and
Prevention. https://www.cdc.gov/std/herpes/stdfact-herpes.htm.

Centers for Disease Control and Prevention. (2019, July 1). How Shingles Spreads. Centers for Disease Control and Prevention.
https://www.cdc.gov/shingles/about/transmission.html.

Centers for Disease Control and Prevention. (2020, September 28). About Epstein-Barr Virus (EBV). Centers for Disease Control and
Prevention. https://www.cdc.gov/epstein-barr/about-ebv.html.

Boyd, L. D., Mallonee, L. F., & Wyche, C. J. (2013). Wilkins' clinical practice of the dental hygienist (13th ed.). Jones & Bartlett
Learning.