2. • ‘HERPES’ – most common viral infection in oral
cavity .
• The term ‘herpes simplex’ –herpes labialis(cold
sores) & herpes progenital(genital herpes), fever
blisters

3. • Herpes viridae family includes
I. HSV-1
II. HSV-2
III. Varicella zoster
IV. Epstein –Barr virus
V. Cytomegalovirus
VI. HHV-6
VII. HHV 7
VIII. HHV 8
IX.Herpes virus simian

4. • HSV-1 (oral herpes) - permanent infection ,
very infectious
• Oral herpes simplex virus infection(HSV 1) –
herpes simplex virus(HSV)

5. Structure:
• VIRION - > double stranded - DNA genome
,icosahedral protein cage - capsid ,lipid bilayer –
envelope ,envelope joined to capsid – tegument .
•HSV1 & HSV2 – 74 genes within genome .
• DNA core – control replication & infectivity of the
virus .

6. • Ballooning degeneration, contain intranuclear
inclusions known as Lipschitiz bodies.
• Cytoplasm of the infected cell forms giant cells
.

7.  Types of HSV –> HSV 1 - >physical contact in oral
cavity .
• HSV 2 ->’new epidemic
disease’ -contracted through sexual
contact .
 HSV 1 &2 occurs as:
1. Primary infection
2. Recurrent infection – milder than primary infection

8. Susceptible host
Virus
primary infection
Recurrent manifestation
Clinical Subclinical
disease 1% disease 99%
Excitants
Carries (70% -80% of population)
Antibodies & virus presist

9. • Primary infection
• Incubation period –> 1-26 days.
• Prodromal Symptoms –( fever ,headache ,loss of
appetite , tiredness , irritation .)
• Appearance- group of small red bumps that blister,
begin to dry , form yellow crust - preceded by itching
&burning -10 to14 days
• Red swollen , bleeding gums or sore throat and
enlarged lymph node
• Gingivastomatitis - in infant from mother
• HSV -latent infection in trigeminal ganglion

10. • Severe in immunodeficient & neonates .
• Complication – meningoencephalitis and
keratoconjuctivis

11. • Impetigo
• Aphthous ulcers
• Hand foot & mouth disease

12.  Clinical
 Lab test:
• Smear test
• Tissue culture
• Biopsy

13.  Antiviral
• Acyclovir -> orally- 400mg -800mg .
• injection-10mg/kg body weight .
• Famciclovir -> 250mg & 500mg .
• Valacyclovir -> 500mg & 1gm
 Antibiotic- (secondary infection
 like bacteria )
• Always keep the infected area
dry

14. VIRAL THYMIDINE KINASE
CELLULAR KINASE

15. ACYCLOVIR
• Used to treat herpes group of virus
• Pharmacokinetics – poor biocompatibility 20%
• widely distributed
• Excreted- mainly in urine ,renal impairment dose
reduction
• Effective in normal as well as deficient immune
status
• Adverse effect – tiredness ,rashes ,hypotension
• Toxicity ->
1. Decrease in Glomerular filtration rate &produces
reversible neurological manifestation to higher
doses

16. FAMCYCLOVIR
• Ester prodrug of guanine nucleoside –penciclovir
• Good oral biocompatibility ,prolonged intracellular t
½ active triphosphate metabolite
• Treat ->Herpes zoster(shingles)->500mg every 8
hours HSV2 ->250mg 5 days
Herpes labialis (immunodeficient patients)-
>1500mg oral dose
• Toxicity is more in famciclovir especially in bone
marrow

17. VALACYCLOVIR
• VALACYCLOVIR –herpes simplex
• Prodrug ->esterases ->aminoacid valine->via
hepatic first pass metabolism,greater
biocompatibility(55%) than acyclovir(10-20%)
• Dosage –Valtrex ->500mg & 1mg /day
• Adverse effect –Vertigo ,edema ,arthralgia

18. • Avoid touching the affected area .
• Vaccines – under research
• HSV 2 – condoms can be used