Primary HSV-1 infection results in gingivostomatitis, pharyngitis, and up to 2 weeks of fever, malaise, myalgia, inability to eat, and cervical adenopathy, with lesions on the palate, gingiva, tongue, lip, face, posterior pharynx, and/or tonsillar pillars and occasional exudative pharyngitis.

• Reactivation of HSV from the trigeminal ganglia is associated with asymptomatic viral excretion in the saliva, intraoral mucosal ulcerations, or ulcers on the vermilion border of the lip or external facial skin.
  • - Approximately 50-70% of pts undergoing trigeminal nerve-root decompression and 10-15% of pts undergoing dental extraction develop oral-labial herpes a median of 3 days after the procedure.
  • - Reactivation of HSV-1 or VZV in the mandibular portion of the facial nerve causes flaccid paralysis (Bell's palsy).
• Immunosuppressed pts can have a severe infection that extends into the mucosa and skin, causing friability, necrosis, bleeding, pain, and inability to eat or drink.
• Pts with atopic dermatitis may also develop severe oral-facial HSV infection (eczema herpeticum), with extensive skin lesions and occasional visceral dissemination.
• HSV infection is the precipitating event in ~75% of cases of erythema multiforme.