Aphthous Ulcer is common during stressful condition. As reactivation of HSV is always associated with decreased immunity due to any cause. Decreased immunity is most common during prolong stress and so we can imply aphthous ulcer to reactivation of HSV. Recurrence of stress is common and so recurrence of aphthous ulcer also common. This recurrence can be prevented by levamisole for many years.
Article LEVAMISOLE IN THE PREVENTION OF RECURRENT INFECTIONS IN IMMU...
Nongenital herpes simplex virus type 1 is a common infection usually transmitted during childhood via nonsexual contact. Most of these infections involve the oral mucosa or lips (herpes labialis). The diagnosis of an infection with herpes simplex virus type 1 is usually made by the appearance of the lesions (grouped vesicles or ulcers on an erythematous base) and patient history. However, if uncertain, the diagnosis of herpes labialis can be made by viral culture, polymerase chain reaction, serology, direct fluorescent antibody testing, or Tzanck test. Other nonoral herpes simplex virus type 1 infections include herpetic keratitis, herpetic whitlow, herpes gladiatorum, and herpetic sycosis of the beard area. The differential diagnosis of nongenital herpes simplex virus infection includes aphthous ulcers, acute paronychia, varicellazoster virus infection, herpangina, herpes gestationis (pemphigoid gestationis), pemphigus vulgaris, and Behçet syndrome. Oral acyclovir suspension is an effective treatment for children with primary herpetic gingivostomatitis. Oral acyclovir, valacyclovir, and famciclovir are effective in treating acute recurrence of herpes labialis (cold sores). Recurrences of herpes labialis may be diminished with daily oral acyclovir or valacyclovir. Topical acyclovir, penciclovir, and docosanol are optional treatments for recurrent herpes labialis, but they are less effective than oral treatment.
http://www.aafp.org/afp/2010/1101/p1075.html
Thank you Ali A R Aldallal
"Recurrences of herpes labialis may be diminished with daily oral acyclovir or valacyclovir" -when and how long will you suggest to take the costly medicine with many side effects? I think it is not better than levamisole which prevents recurrence for several years with a single course.I have followed upto 12 years few cases those did not recur after a single course of levamisole.
It varies. It can be a symptom of HSV reactivation or it may be from an irritant stimulus, such as ascorbic acid from citrus or strawberries, for some people.
HSV infection can manifest as aphthous stomatitis, but without specific vesicles on mucosa observed (only ulcers), I would probably question its ethiology and perform laboratory tests.
I understand that the price for levamisole and acyclovir can vary between countries, but the course you suggest in case of levamisole in Russia would cost approximately 7 USD, while 7 days acyclovir (generic of course) 1000 mg daily just 2 USD. Why do you expect frequent recurrence of HSV in your patient? Acyclovir is generally well tolerated, and has much less side effects when compared to levamisole.
Thank you Alexandra Kazanov, Costing is not the main factor. Acyclovir is used for the treatment of the disease but Levamisole will prevent recurrence due to reactivation for several years. It also prevents herpes labialis, radiculopathy due to post herptics neuralgia causing back pain ( which is very frequent after each time of stress condition) at the same time. In most of my patient recurrence is common on average within 2-3 months and maximum 6 month. In Bangladesh one course of levamisole cost 0.5USD and 400mg acyclovir 3 times a day for one week 5.5USD. Levamisole cures most of the immunodeficiency state. I have suggested, in my article, for the treatment of AIDS which is very rare in our country particularly in our district only one case reported in the past 15 yrs. You can try levamisole for the benefit of the AIDS patients if possible.
no , the ulcer of recurrent herpes infection is different from aphthous ulcers
Hi. Mostly aphthous ulcers, can be a result of stress, certain vitamin deficiency, hormonal fluctuations and even unintended mouth injuries.
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