Lesions described as tender, recurrent reddish vesicles on the hard palate are most likely caused by which virus?

• A. HSV-1
• B. HSV-2
• C. Varicella zoster
• D. Coxsackie virus

Answer: (A)

Recurrent tender vesicles on the hard palate point to herpes simplex virus type 1. HSV-1 hides in the trigeminal ganglion and reactivates to produce painful oral vesicles on keratinized mucosa like the hard palate and attached gingiva. HSV-2 is mainly genital and less often causes recurrent oral lesions. Varicella zoster causes shingles or chickenpox with dermatomal, unilateral distribution rather than recurrent oral lesions. Coxsackie virus tends to cause herpangina or hand-foot-mouth disease with lesions on the soft palate and oropharynx, usually in children, and is not the typical pattern for recurrent hard-palate lesions.