Oral Herpes is predominantly caused by HSV 1 though in some cases it can also be caused by HSV 2. Oral herpes is the most common herpes simplex virus infection amongst the masses throughout the world and is a self-limiting condition. It can occur at any age but mainly affects infants and children (between 10 months and 5 years). Most often, the infection is mild or sub clinical. Almost 100% of children below the age of 5 years have been infected with it. About 80% of the people are asymptomatic carriers.

As mentioned above, HSV type I virus is the cause of Oral Herpes in most cases. HSV type 2 can also cause Oral herpes in some cases especially if Oro-genital contact has been the cause of infection.

Transmission of the infection occurs mainly via the following routes:

• Contact with infected saliva
• Kissing or other close contact with infected person
• Cross-infection of type 1 and 2 viruses may occur from oral-genital contact
• Exposure of health care providers (physicians, dentists and nurses) to oral secretions during procedures
• Infection may spread to breast feeding mother's nipple from the infected mouth of the baby
• Inoculation of virus into a susceptible mucosal surface
• Injuries or minor cuts helps to inoculate the virus especially into the skin
• Nail biters or thumb suckers get herpetic whitlow (herpetic finger infection) through the infected saliva
• Skin-to-skin contact in wrestlers and rugby players
• Occasionally through sharing food and drinks, utensils, towels, underclothes, etc

The incubation period is 3-7 days before the following constitutional symptoms begin

• Fever, which may be high (102 -104 degrees F) and subsides after 3-5 days
• Bodyache
• Headache
• Loss of appetite
• Weight loss
• Listlessness
• Irritability and crankiness in children
• Abrupt onset of complaints

Symptoms of the disease:

• Lesions appear as raised erythematous patches that turn into papules. These papules get filled with fluid to form vesicles
• Beginning of blister formation or vesicles in clusters on the lips and on the inside of the mouth called as cold sores or gingivostomatitis.
• Vesicles occur in white patches. They break open, coalesce and form painful ulcers with a yellowish coating. Eventually there is scab formation over the ulcers
• Pain, burning and tingling at the site
• Skin around the mouth is also affected due to infected saliva
• Difficulty in eating and drinking
• Sore throat
• Foul breath
• In adults, at times, there are vesicles in the interior of the nose, pinna of the ear, eyebrows
• Finger infection called herpetic whitlow is seen in health care providers

After the acute infection subsides in about 2 weeks, the virus remains in a latent or inactive state and may become active again at a later stage. Reactivation of the virus may result in 'Recurrence' of the symptoms. This recurrence can be triggered by:

• Exposure to sunlight (ultra violet radiation)
• Fever
• Acute infections e.g. common cold, upper respiratory infections, etc
• Emotional stress
• Hormonal changes in pregnancy and during menstruation
• Minor trauma
• Dental surgery
• Operations of the nerves of the face or conditions affecting the nerves of the face
• Systemic diseases that lower the immunity. E.g. AIDS, cancer etc
• Intake of drugs like corticosteroids that suppress the immunity
• Intake of large quantities of chocolates and peanuts

• The lesions of HSV have a characteristic appearance and so can be easily diagnosed clinically by naked eye examination.
• Antibody testing
• Tissue culture of the lesion
• Direct fluorescent antibody (DFA) test
• Tzanck test: To see the peculiar cytological changes of the HSV infection
• Punch biopsy for histological examination
• Examination of cerebrospinal fluid
• Brain biopsy and imaging in cases of HSV encephalitis

The following conditions may mimic Oral Herpes and have to be differentiated:

• Simple allergic rash
• Razor burn
• Rash due to perspiration or tight clothing
• Apthous ulceration: There is no fever associated with this generally
• Impetigo: It is a bacterial skin infection usually caused by staphylococci, which is commonly seen in babies and children, and mainly occurring on the face and the limbs
• Primary oral chancre of syphilis: Initial manifestation is a small macule that becomes a papule, which breaks down to form an ulcer (primary chancre). The ulcer is solitary, painless with a well-defined margin and an indurated base, and fails to bleed on trauma
• Oral candidiasis: It presents with soreness and white patches on an erythematous background. There are no blisters seen in this condition
• Herpes zoster involving the second branch of the trigeminal nerve. It is associated with conjunctivitis, keratitis, corneal ulceration, iridocyclitis, glaucoma, ocular cranial-nerve palsies and blindness
• Steven-Johnson syndrome: It is characterized by severe erythematous lesions and blisters all over the body with conjunctival involvement, blistering and erosion of oral and genital mucosa
• Infectious mononucleosis: It is an acute infectious disease associated with Epstein Barr virus. Symptoms include fever, malaise, sore throat and lymphadenopathy
• Coxsackie virus infection: This virus causes a painful infection of the mouth called herpangina, which is characterized by blisters in the mouth and fever. It lasts for 3-6 days

These are rare but may be seen in some cases:

• Keratoconjunctivitis
• Eczema herpetiform
• Bacterial and fungal super-infection
• Pneumonia
• Infection of the trachea
• Pharyngitis
• Tonsillitis
• Dehydration in children
• Herpetic whitlow
• Widespread infection and life threatening complications in debilitated patients, HIV patients and organ transplant recipients
• Bell's palsy
• Hemiparesis
• Disseminated HSV 1 infection can result in HSV hepatitis, herpetic oesophagitis, adrenal necrosis, interstitial pneumonia, HSV cystitis, arthritis, ganglionitis, myelitis etc

• Take adequate rest till recovery
• Keep the area dry and clean
• Apply cold bag or ice cube locally for transient relief
• Do not touch the lesions with a bare hand, or wash your hands cleanly if you do so
• Give more fluids to children to prevent dehydration
• Give a soft diet to children
• Take a diet, which is rich in the amino acid lysine like beans, lentils, cheese, nuts, soya beans (tofu), fenugreek seed, meat (red meat, pork), poultry, eggs, fish (cod and sardines)
• Children should consciously avoid thumb sucking or nail biting
• Keep the temperature under control
• Regular mouthwash is essential
• Avoid kissing
• Do not share the same towels, clothing etc with an infected person
• Avoid using common utensils, spoons, lip balms etc
• Use sun protection like sunscreens
• Breast-feeding mothers should avoid feeding their infected baby for about 3 weeks

• Improve the general health and life style
• Avoid direct contact with open lesions.
• Neonates, children with eczema and individuals with a lowered immunity should keep away from infected people.
• Use of latex gloves by health care workers can prevent herpetic whitlow Avoid excessive intake of chocolates and peanuts to avoid recurrence

Homeopathy does not consider Herpes Simplex as a local affection of the skin but as something that has deeper roots within the system of the patient. Hence the treatment is not simply symptomatic; rather it is based on a detailed case study and endeavors to treat the disease from the root cause.

Homeopathic medicines work at two levels:

• Taking care of the acute symptoms
• Preventing recurrence of the infection

Overall, the medicines improve the immunity of the individual so that he doesn't fall prey to recurrent infections.

The homeopathic approach to treatment of Herpes Simplex (or any other disease) is called as the 'Constitutional approach'. In this approach, detailed study of the following aspects of the patient is done:

• Chief complaints
• Other associated complaints
• Evaluation of the causative factor
• Detailed study of the mind, temperament of the patient
• Detailed study of general features such as appetite, thirst, likes and dislikes about food, etc
• Study of past history of diseases
• Study of family history of diseases
• Examination of patient
• Investigations done

Based on the study of all these factors, a single Homeopathic remedy is selected which covers all the important features and helps in curing the disease in that patient. The medicine not only helps in alleviating the lesions, the pain and the discomfort associated with Herpes Simplex but it also helps in preventing future outbreaks of the same. An important aspect to be noted is that the medicines do not have any suppressive effects and they are without any side-effects whatsoever.