Identifying the Multifactorial Triggers of Monthly Recurrent HSV-1 Reactivation: A Case Report

Herpes simplex virus 1 (HSV-1) causes recurrent oral lesions with reactivation triggered by factors such as stress, hormones, and nutrition. Immune suppression caused by these factors plays an important role in HSV-1 reactivation and requires comprehensive management.

This case report aims to analyze the relationship between triggering factors and recurrent HSV-1 infection and to achieve therapy to prevent recurrence.

A 39-year-old woman came with recurrent ulcers every month during her menstrual cycle. The results of the anamnesis showed other factors such as malnutrition and stress. Clinical examination showed ulcers on the lips, labial mucosa, and gingiva. A hemogram (complete blood count) examination revealed normal results, IgG anti-HSV-1 with reactive results, and IgM anti-HSV-1 non-reactive. The diagnosis was Herpes Labialis and Recurrent Intraoral Herpes (RIH).

Pharmacological therapy was acyclovir cream, chlorine dioxide mouthwash, acyclovir tablets, and vitamins. Non-pharmacological therapy includes improving oral hygiene, stress management (evaluation using the Depression Anxiety Stress Scale-21/DASS-21), and improving nutrition. By the third visit, ulcers on the labial mucosa and lip commissures showed improvement, however, a new ulcer developed on the lower labial mucosa. The use of oral acyclovir tablets, hyaluronic acid gel, and stress management monitored using DASS-21 resulted in complete ulcer healing by the fifth visit.

The multifactorial triggers for recurrent HSV-1 infection in this case are stress, hormonal, and nutritional. Pharmacological therapy in the form of acyclovir and chlorhexidine requires comprehensive management that combines antiviral therapy, stress management, and lifestyle changes by improving nutrition to overcome recurrent HSV-1 infections in the future.