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22 years
Are Herpes labialis contagious only during the outbreaks? Or always and forever?
Oct 8, 2014
2nd opinion

Dr. Zakia Dimassi Pediatrics
Recurrent oral infection is more common with HSV-1 infections than with HSV-2. Symptoms typically progress through eight stages:
1- Latent (weeks to months incident-free): This is the remission period whereby after initial infection, the viruses move to sensory nerve ganglia, where they become dormant, latent viruses. Asymptomatic shedding of contagious virus particles can occur during this stage.
2- Prodromal (day 0–1): Symptoms that typically precede a recurrent include tingling (itching) and reddening of the skin around the infected site. This stage can last from a few days to a few hours preceding the clear appearance of an infection and is the best time to start treatment.
3- Inflammation (day 1): the virus begins to multiply and infects cells at the end of the nerve. The healthy cells thus swell up and become red.
4- Pre-sore (day 2–3): small, hard, inflamed papules and vesicles are present itch and are painfully sensitive to touch. These blisters coalesce together to form a cluster on the lip (labial) tissue, the area between the lip and skin (vermilion border), and can extend to involve the nose, chin, and cheeks.
5- Open lesion (day 4): This is the most painful and contagious stage. All the tiny vesicles break open and merge to create one big, open, weeping ulcer. Fluid oozes from the affected area and is full of active viral particles; it is particularly contagious. Reactive lymph nodes may appear under the chin.
6- Crusting (day 5–8): A honey-colored crust starts to form; it is not composed of active virus but of blood serum containing useful proteins such as immunoglobulins. It is part of the healing process. Virus-filled fluid will continue to ooze of the sore through any cracks.
7- Healing (day 9–14): New skin begins to form underneath the scab as the virus retreats into latency. A series of scabs will form over the sore.
8- Post-scab (12–14 days): A reddish area may persist at affected the site as the destroyed cells are regenerated. Virus shedding can still occur during this stage..
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