Case Scenario: Need Feedback!

[prominence]

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Case: a college female presents with oral cold sores and receives a prescription of (Valtrex) valcyclovir, whats the likely dx?

what i think: looks like herpes labialis, which is caused by herpes simplex virus (HSV). i was under the impression that although HSV-1 and 2 can both cause oral cold sores and genital lesions, but HSV-1 is more associated with oral lesions, while HSV-2 is more associated with genital lesions. also, i think HSV-1 is predominantly found in kids.

1. specifically, what are the different indications for Valtrex (valcyclovir)?
2. are HSV-1 and HSV-2 both transmitted the same way? is HSV sexually transmitted only, or can it be by kissing or felaccio as well?

this is a case i have to discuss later in the week. any feedback to the above 2 questions would be helpful. thanks.

 

[Smurfette]

Case: a college female presents with oral cold sores and receives a prescription of (Valtrex) valcyclovir, whats the likely dx?

what i think: looks like herpes labialis, which is caused by herpes simplex virus (HSV). i was under the impression that although HSV-1 and 2 can both cause oral cold sores and genital lesions, but HSV-1 is more associated with oral lesions, while HSV-2 is more associated with genital lesions. also, i think HSV-1 is predominantly found in kids.

1. specifically, what are the different indications for Valtrex (valcyclovir)?
2. are HSV-1 and HSV-2 both transmitted the same way? is HSV sexually transmitted only, or can it be by kissing or felaccio as well?

this is a case i have to discuss later in the week. any feedback to the above 2 questions would be helpful. thanks.

1. herpes (oral and genital), zoster (shingles) most commonly, and other viral infections
2. yes, no and yes (this makes me cringe that people don't know this...no offense). Sharing chapstick or lipstick can spread it as well, fyi (not as common, but still)

FYI, if you have HSV, you essentially always have it...it sort of "hibernates". It's not a "children's thing". Some people only break out with cold sores or genital lesions once or a few times, some break out frequently, and others may go 10-20+ years between break-outs. A large percentage of the population is infected with one or both subtypes.

 

[prominence]

thanks for the reply smurfette.

3 quick follow-up questions:

1. is it possible for HSV to be transmitted to an non-infected person by drinking out of the same soda container that an infected person has drank out of?

2. is the Valtrex treatment continued for "life", or symptomatically?

3. besides herpes, what other kind of viral infections can be treated with Valtrex?

thanks again!

 

[doc05]

1. yes
2. only for outbreaks
3. look it up.

 

[prominence]

doc05, thanks for your reply.

does anyone know if oral cold sores can be caused by another virus besides herpes virus?

 

[jdig]

"cold sores" and "fever blisters" are almost always hsv-1 outbreak. it is estimated that 90% of american adults have hsv-1, but like many viruses, it resides near the spinal cord (dorsal root ganglion for hsv-2, not sure about hsv-1) and only makes appearences when it deems fit. (like zoster/shingles) there is speculation that stress and otehr factors play a part. i think it all depends on the individual. many people never have outbreaks after the primary. the primary is usually the worse.
as for hsv-2, 25% of american adults have it. usually genital, though can be perineal or anal...yikes. dont get it! hsv-1 hsv-2 are "contact" spread, you dont have to have an open orifice or open wound.
do not confuse hsv-1 with "canker sores" which are IN the mouth and usually bacterial. (ie you bite your cheek and it gets infected. these resolve on their own in 10-14 days usually.
after the initial hsv 2 contact pts will often have NO symptoms, but the "classic" presentation is tingling/itching/burning in the genitals 2-14 days after contact followed by close group lesions (resembling pimples) which after 2-3 days break into open sores. until they heal, herpes is transmittable. many feel that after the lesions heal and new skin is formed, hsv isnt "contagious" but some research shows othereise. dont take your chances!
hope that helps.

 

[kas23]

The common "cold sore," as everyone calls, it is not due to any known virus. The medical term for a cold sore is an aphthous ulcer and it is an autoimmune phenomenon. HSV 1 or 2, or 9239 for that matter, all cause vesicles, usually around the lip-cutaneous border. As doc05 puts it, look it up, or ask your fellow derm friends.

however, if your question stem talks about acyclovir, then they probably want a discussion about HSV.

 

[prominence]

i appreciate all the helpful replies. happy new year!

 

[docB]

The common "cold sore," as everyone calls, it is not due to any known virus. The medical term for a cold sore is an aphthous ulcer and it is an autoimmune phenomenon. HSV 1 or 2, or 9239 for that matter, all cause vesicles, usually around the lip-cutaneous border. As doc05 puts it, look it up, or ask your fellow derm friends.

however, if your question stem talks about acyclovir, then they probably want a discussion about HSV.

I thought aphthous ulcers and cold sores were different. Aphthous ulcers are intraoral while cold sores are on the lip, usually around the vermillion border. As far as I know the cold sores ARE due to HSV.

 

[Harrie]

cold sore = HSV
canker sore = apthous ulcer = unknown cause