The virus is most commonly transmitted through direct skin contact or sexual contact with a person with active lesions. To a lesser extent, the transmission can occur by an asymptomatic carrier, i.e. by a person who does not present visible lesions. More rarely, herpes labialis can be transmitted via indirect contact with contaminated objects, such as towels, razors, and other personal items.
Herpes virus is present in large amounts in the secretions of the human body, such as saliva and genital secretions. Even the contact of a minimally damaged skin with these secretions leads to infection. The virus enters the body, multiplies and causes the appearance of the typical lesions. The time that elapses between contact with the virus and onset of the symptoms is 4 ‑ 5 days. Then, the lesions resolve but the virus migrates to the sensory ganglia of the neurons or to the lymphatic tissue and once the defense mechanisms of the body are impaired it multiplies again leading to reactivation.
Factors like stress, tiredness, possible injury, cold or flu, extreme weather conditions, pregnancy and menstruation, favor the recurrence of herpes labialis.
First contact with herpes virus (primary infection)
Usually, first contact with herpes virus at an early age is very mild. In this way the patient does not realize that he/she is infected. However, 20 ‑ 30% of people infected at a young age as well as older patients experience first contact with the virus in a more severe form, called primary herpetic gingivostomatitis. Initially there are precursor symptoms such as fever, chills and bilateral regional lymphadenopathy. The clinical presentation includes erosion of the gums (desquamative gingivitis) and confluent, friable bullous lesions in the oral mucosa; ulcerative lesions may also form. The lesions are very painful causing difficulty in the consumption of food and drinks.
Recurrent herpes labialis
Before the occurrence of the rash, tingling, stinging, burning or itching sensation may occur at the site at which herpes has inoculated. Then, one or more bullae containing a clear liquid are formed over an erythematosus (red) base in the lip area. The bullae (blisters) break forming scab and healing occurs after 5‑6 days.
Treatment should be administered within 48‑72 hours of onset of precursor symptoms in order to halt virus replication and to reduce the severity of the episode. Treatment is not likely to lead to the eradication of the virus. However, in frequent recurrences of herpes labialis and in particular in more than 6 episodes a year, prophylactic suppressive treatment with antiviral drugs is recommended, using, however, the lowest dosage for a long period of time for 6 months or a year.
It is also possible to use:Topical antimicrobial creams to reduce the risk of infections
Topical antiviral creams with questionable effectiveness