A Nurse Practitioner's Guide to the Management of Herpes Simplex Virus-1 in Children

Janel M. Drugge, MSM, RN, PNP; Patricia Jackson Allen, MS, RN, PNP, FAAN


Dermatology Nursing. 2008;20(6):455-466. 

In This Article

Abstract and Introduction


This state of the science clinical article focuses on ways clinicians can manage herpes simplex virus-1 (HSV-1) infections in children and adolescents. HSV-1 infections can be transmitted during close contact with asymptomatic and symptomatic individuals (Waggoner-Fountain & Grossman, 2004). Recurrent HSV-1 outbreaks are believed to be caused by various endogenous and exogenous triggers. These HSV-1 outbreaks cause physical and emotional consequences in children and their families. HSV-1 infections in children most commonly cause gingivostomatitis, but these infections can also cause various skin infections, including herpetic whitlow, herpes gladiatorum, eczema herpeticum, and herpes genitalis. It is critical for clinicians to be familiar with the pathophysiology and clinical manifestations in order to effectively identify, manage, and treat HSV-1 infections with a variety of topical or systemic medications, as well as with prevention strategies and nutritional supplementations.


Herpes simplex virus (HSV) was first reported over 2,000 years ago by the Greeks who used the term herpes, meaning creepy or crawling (Andreae, 2004; Szinnai, Schaad, & Heininger, 2001). Today, HSV infections have crossed all ethnic and minority barriers by affecting populations equally worldwide (Stock et al., 2001). Approximately 60% to 95% of older adults are believed to have been infected with HSV-1, with more than 40% of the infections of HSV-1 occurring by age 15 (Andreae, 2004; Brady & Bernstein, 2004).

Infections with HSV-1 usually involve the skin, oral cavity, lips, and face ("above the waist"), and infections with herpes simplex virus-2 (HSV-2) usually involve genitalia ("below the waist") in teenagers and adults who are sexually active (Ensor, 2005; Waggoner-Fountain & Grossman, 2004). HSV-1 infections, usually referred to as oral lesions or cold sores, cause outbreaks that range from painful and uncomfortable to severe and life-threatening in infants, children, and adolescents (Ensor, 2005). There is currently no cure for HSV infections; however, many topical and systemic medications that treat HSV outbreaks exist. More clinical trials are needed to determine effective treatment options and dosages of these medications in the pediatric population.

Once infected with the HSV-1 virus, internal and external triggers have been associated with the reactivation of HSV-1 infections (Stock et al., 2001). More research is needed to determine the exact mechanism the triggers have in recurrent HSV-1 outbreaks (Stock et al., 2001). Further research is also necessary to develop a vaccine that would decrease transmission and minimize recurrence of HSV-1 infections (Rupp, Rosenthal, & Stanberry, 2005).

Advanced practice nurses are in a position to identify and manage HSV-1 infections and to educate children and their families on appropriate prevention strategies to decrease the reoccurrence of HSV-1 outbreaks. HSV-1 lesions cause pain, distress, and anxiety due to the visibility of outbreaks and the chance of transmitting the virus onto family members, other children, or partners (Boon et al., 2000; Spruance et al., 1997). Clinicians need to be familiar with the pathophysiology and clinical manifestations of this condition, as well as the most current evidence-based prevention, diagnosis, and treatment options (including topical, systemic, and nutritional supplementation) to effectively identify, manage, and treat HSV-1 in infants, children, and adolescents.


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