When initially localized, it may resemble aphthous stomatitis, but primary herpes always affects the attached gingiva and may affect other tissues, whereas aphthous stomatitis never affects attached gingiva. With herpes, fever and pain are often present. Difficulty in eating and drinking may lead to dehydration. The infection typically lasts 10 to 14 days. The virus then moves to the semilunar ganglion and can be reactivated by stress, changes in the immune system, or trauma.
Treatment is symptomatic.
Secondary herpes simplex outbreaks occur as cold sores on the vermilion border of the lip or, much less commonly, as ulcerations of the mucosa of the hard palate. Usually, a patient notes a prodromal sensation, typically a tingling or burning of the lip. During the prodromal phase, treatment with oral acyclovir 200 mg five times a day can lessen the duration and severity of the outbreak. Topical acyclovir does not help. It should be started during the prodrome or immediately upon the first appearance of a lesion.