The two common herpes infections seen in general practice are caused by the herpes simplex virus (HSV) and the varicella zoster virus (VZV). The resulting infection is life-long, and may be recurrent. There are two types of the herpes simplex virus: HSV 1 mostly causes lesions on the face, although may occasionally cause genital lesions whereas HSV 2 only causes genital herpes. Cold sores Oro-labial herpes infections are commonly termed 'cold sores'. In herpes simplex type 1 there is almost always a prodromal phase, in which the patient will be aware of a tingling or burning sensation for a day or two before the lesion erupts. The facial lesions are mostly around the lips. The primary infection is usually the most severe and consists of painful blisters, with erosions and crusting (Fig. 1). Lesions inside the mouth are painful whitish ulcers that can cause difficulty in eating and swallowing. In addition, the patient may have a temperature, malaise and lymphadenopathy. Subsequent infections tend to be milder and there may be just one or a few blisters or ulcers.
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