Stress management for decreasing recurrence of herpes simplex virus infection

Introduction: Oral infection caused by Herpes Simplex Virus (HSV) commonly occurs in childhood. However, recurrent infections are more common among adults with a prevalence of 70 - 80%. Stress is one of trigger factors that contributes to HSV reactivation. Stress is a condition that tends to disrupt the immune system, resulting in biological systemic alterations. This case report aimed to describe the importance of stress management in decreasing recurrence of HSV infection. Case report: A 30-year-old female patient came to the oral medicine clinic at Universitas Indonesia with a chief complaint of a sore mouth, preceded by fever and malaise. Such symptoms caused difficulty in eating and swallowing over the last week. Similar symptoms occurred few times before. The patient was otherwise healthy, except recent fatigue and psychological stress postpartum. She felt very anxious about a possible oral malignant lesion. Clinical examination revealed poor oral hygiene, multiple ulcers surrounded by an erythematous area 0.5 - 6mm in size located throughout the oral cavity. Lympadenopathy of both submandibular regions was also noted. Result of IgG HSV-1 test was positive and she was diagnosed with recurrent intra-oral herpes (RIH). Therapy included 100mg doxycycline mouthwash, 200mg Acyclovir and 7 days of oral multivitamin. Patient was advised to take sufficient rest time, to eat more nutritious foods, increase fluid intake and manage possible underlying psychological disorders. The lesions were clinically resolved in the patients 4th visit to the clinic. Conclusion: It is important to understand the association between psychological stress and recurrence of HSV infection. Adopting stress management with a cognitive psychotherapy approach may improve self-confidence in patients to have rational and positive thoughts and reduce future recurrence of HSV. Lympadenopathy of both submandibular regions was also noted. Result of IgG HSV-1 test was positive and she was diagnosed with recurrent intra-oral herpes (RIH). Therapy included 100mg doxycycline mouthwash, 200mg Acyclovir and 7 days of oral multivitamin. Patient was advised to take sufficient rest time, to eat more nutritious foods, increase fluid intake and manage possible underlying psychological disorders. The lesions were clinically resolved in the patients 4th visit to the clinic. Conclusion: It is important to understand the association between psychological stress and recurrence of HSV infection. Adopting stress management with a cognitive psychotherapy approach may improve self-confidence in patients to have rational and positive thoughts and reduce future recurrence of HSV.