Management of Oral Herpes Simplex in the Maternity and Neonatal Unit GL373 Approval Approval Group Job Title, Chair of Committee Date Paediatric clinical governance chair Chair of the Paediatric Governance Procedure and Policy Subcommittee January 2018 Change History Version Date Author, job title Reason 2 July 2009 V Withers ANNP Update expired Guideline 3 Aug 2015 D Falcus ANNP Update expired Guideline 4 Jan 2018 D Falcus ANNP No changes Page 1 of 5
Contents 1.0 Purpose 2.0 The Function of the Guideline 3.0 Introduction 4.0 Management 5.0 References Page 2 of 5
Guideline for the Management of Oral Herpes Simplex Purpose The purpose of this guideline is to minimise the transmission of Herpes Simplex Infection to the Neonatal Inpatient Population. The Function of the Guideline To provide Guidance on the management of Mothers and Staff Members with active Herpes Simplex Infection (Cold Sores) Introduction Herpes simplex virus type 1 (HSV-1) is usually the cause of oral herpes (rarely, herpes simplex virus type 2). Primary HSV-1 infection may be asymptomatic, but may present as gingivostomatitis and pharyngitis. Recurrent oral disease is usually caused by HSV-1 infection. Symptoms of active infection include a painful mouth and throat, salivation, and drooling. Signs include: Vesicles which can affect the border of the lip with the skin, and the pharyngeal and oral mucosa (soft palate, buccal mucosa, tongue, and floor of the mouth). Breaking down of the vesicles into small, red lesions. These enlarge and develop central ulcerations covered by yellow/grey membranes. Page 3 of 5
Management Management of cold sores involves: Reassuring the person that the condition is self limiting and that lesions will heal without scarring usually within 7 10 days. Paracetamol or ibuprofen to relieve pain if required. Advising that the benefits of topical antivirals (aciclovir or penciclovir) are small and require treatment to be initiated at the onset of symptoms (erythema or prodromal stage) before vesicles appears. A Mother with active lesions should not be separated from her baby but advised to avoid kissing or having the baby in close contact with the lesions. Extra care with hand washing and avoid touching the lesions. Newborn Infants should be observed for any signs of infection and if there are any concerns they should be treated with intravenous Aciclovir. Staff need not be excluded from work but must not handle Infants until lesions are crusted and dry. This Guideline should be read in conjunction with the neonatal Guideline for Genital Herpes. Page 4 of 5
References Arduino, P.G. and Porter, S.R. (2006) Oral and perioral herpes simplex virus type 1 (HSV-I) infection: review of its management. Oral Diseases 12(3), 254-260. Brown Z. Preventing herpes simplex virus transmission to the neonate. Herpes 2004;11 Suppl 3: 175A-186A Demmler-Harrison GJ. Neonatal herpes simplex virus infection: Management and prevention. UpToDate, 2013: HPA North West (2011) Herpes Simplex (Cold Sores) Health Protection Agency. www.hpa.org.uk Kimberlin, D.W. (2007) Herpes simplex virus infections of the newborn. Seminars in Perinatology 31(1), 19-25. Straface, G., Selmin, A., Zanardo, V. et al. (2012) Herpes simplex virus infection in pregnancy. Infectious Diseases in Obstetrics and Gynecology 2012(), 385697. Page 5 of 5