Herpes Labialis (Cold Sore) - University of Saskatchewan

Assess patient factors

Assess for red flag symptoms

Herpes Labialis (Cold Sore)

Are any of the following present?

Age < 12 years

YES

Symptoms not resolved 7 days after treatment.

NO

Are any of the following present? Fever, swollen glands, severe pharyngitis, other systemic

symptoms (suggestive of primary infection) Lesion is present for > 14 days Lesion on or around the nose or with ocular involvement Lesion excessively red, swollen, or containing pus (suggestive of

non-HSV infection)

NO

Assess Immune Status and Refer if necessary

YES REFER

Are symptoms typical of a cold sore?

Prodromal symptoms including pain, numbness, swelling, itching, tingling, or burning

Unilateral vesicular lesion surrounded by erythema

NO

Lesion appears on the border of the lip

Vesicle breaks open leaking a clear, sticky fluid & heals with no scarring within 7-10 days

YES

Prodrome ? lesion present 48 hours

Nonpharmacologic management ? Symptomatic relief AND

Consider prescribing antiviral for next episode

Prodrome ? lesion present < 48 hours

Nonpharmacologic management ? Symptomatic relief

AND Antiviral: Oral antiviral (acyclovir,

famciclovir, or valacyclovir) OR Acyclovir 5% applied 5x/day for 4

days OR Acyclovir 5% / Hydrocortisone

1% applied 5x/day for 5 days OR Docosanol 10% applied 5x/day

until healed (up to 10 days)

Rx for future episode

Antiviral: Oral antiviral (acyclovir,

famciclovir, or valacyclovir) OR Acyclovir 5% applied 5x/day for

4 days OR Acyclovir 5% / Hydrocortisone

1% applied 5x/day for 5 days OR Docosanol 10% applied 5x/day

until healed (up to 10 days)

Counsel on prevention Consider referral for

chronic prophylaxis if indicated.

Follow up in 7 days

YES

Assess benefit-are NO

symptoms resolving?

REFER

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