[Orofacial herpes and other localizations (genital herpes and neonatal herpes excluded)]

Herpes is a pandemic infection in the human species. The purpose of this work was to conduct a critical analysis of the literature devoted to the pathophysiology and treatment of orofacial herpes an other localizations (genital herpes and neonatal herpes excluded).

We searched for articles in English and French devoted to orofacial herpes and other herpetic localizations indexed in Medline (1980-July 001), EmBase, and the Cochrane Library (1995-July 2001). Critical analysis was based on level of proof using the ANAES methodology.

More than 700 articles were identified. One hundred four were selected for this report. Primary HSV1 infection usually occurred before adulthood and involved acute gingivo-stomatitis in the majority of the cases. Several primary HIV1 infections were asymptomatic or aspecific and non-recognized. After the primary infection, the virus remains in the ganglion of the trigeminal nerve in a latent state and can be reactivated sporadically. Reactivation is associated with viral excretion and can be symptomatic (herpetic recrudescence) or not (recurrence). Recrudescence of orofacial herpes is typically labial. No currently available vaccine can prevent acquisition of HSV1. Treatment of acute gingivostomatitis has been standardized and is based on aciclovir. Inversely, the effectiveness of aciclovir and other nucleoside analogs with anti-herpes activity has not been clearly established for prevention or cure of recrudescence of orofacial herpes. Other localizations (hand, anus, diffuse skin localizations in contact sports, Kaposi-Juliusberg syndrome) are much more exceptional. Treatment has not been standardized.

Despite the abundance of the literature on orofacial herpes, consistent quality is lacking, particularly concerning therapeutic studies. The quality of these reports is generally inferior to those devoted to genital herpes. There has however been a general trend towards improved methodology over the last years. Very little has been reported on exceptional localizations of orofacial herpes.