Herpes simplex

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Herpes Simplex or simply Herpes is an infection that is caused by the herpes simplex virus. It usually manifests as sores, especially where the virus entered. They enter through the oral cavity or through the genitals. These sores eventually become blisters that become painfully itchy. They heal gradually in the end but might appear again in form of outbreaks.

Contents

Causes

There are two types of herpes simplex viruses (HSV):

  • Herpes simplex virus type-1 (HSV-1) often causes cold sores in the mouth. It is the most common strain as many people get it in their childhood. This is typically through sharing towels, using the same eating utensils, or planting a casual kiss. Infection in this age is frequently higher in people with low socio-economic status. Thirty to ninety percent of people who have reached adulthood would have developed antibodies for this virus. They enter the body through the lips, mouth and face. It is transmitted through direct contact with infected saliva.
  • Herpes simplex virus type-2 is most often, but not always, sexually transmitted. Once the virus infects the body, it is never cured. It often stays dormant and stays in the nerve tissues. In the nerve tissues it will replicate until certain triggers cause it to reactivate and symptoms of such infection may recur. Triggers for its recurrence include excessive sunlight exposure, fever, stress, acute illnesses or drugs that may weaken the immune system, like corticosteroids.

Symptoms

Two types of infection occur in people affected with herpes. These may be primary or recurring. Sores in a primary infection often appear two to twenty days after contact. There is enlargement of the lymph nodes either in the neck or groin during the time of the initial infection.

In the initial infection, there is a prodrome stage. Before any blisters appear, the skin will itch, sting, burn or tingle. When they do break, usually through mild trauma, the fluid inside the blisters oozes and crusts over. Over time, the crusts will fall off and leave a slightly reddish healing skin.

HSV-1 may cause lesions in the mouth or infection in the eye (like in the conjunctiva or cornea). Sometimes they cause meningoencephalitis, where it infects the brain lining.

HSV-2 often causes genital ulcers. However, some infected persons may not exhibit any symptom at all. These genital ulcers may initially cause a burning or tingling sensation.

HSV-1 infections occur above the waist while HSV-2 causes those below the waist. In genital herpes, there is usually a minor rash or itchy, painful ulcers, fever, muscle pain and burning sensation during urination.

Sores from the primary infection rarely leave a scar. The lesions caused by herpes simplex viruses gradually heal by itself within a week. But it may be longer for people with compromised immune systems. Cross-infection with both strains of HSV is possible especially through oral-genital contact.

Herpetic whitlow is another form of HSV infection. This is typically found in health professionals who are often exposed to infected saliva during medical procedures such as dentists and oral hygienists.

Diagnostic tests

Most medical professionals can tell if one is infected with herpes simplex by looking at the sores.

In addition, especially to confirm their diagnosis, most doctors will run a series of tests like serological tests for antibodies of HSV in the blood, direct fluorescent antibody (DFA) to test cells which are taken from the lesions present and viral culture.

Treatment

Some cases of herpes simplex infection are often mild and would require no treatment. Treatment is often recommended for people who have prolonged outbreaks (which is usually in the initial infection), those with problems with their immune system, or those with frequent recurrences.

Medications

Doctors may prescribe oral antiviral medications. Nausea and headaches are the common side effects in taking these drugs.

  • Acyclovir is usually given to reduce the reproduction of the herpes simplex virus in initial outbreaks. This lessens the number of subsequent outbreaks. However, in order to be effective, it must be taken after the first lesions appear.
  • Famcyclovir has similar effects as that of acyclovir with the addition of making nerve cells a less hospitable place for the virus to remain dormant.
  • Valacyclovir has same actions but is taken only once a day. It is the pro-drug of acyclovir.

Topical antibiotic ointments are also given to prevent addition bacterial infection of the sores. Topical antiviral creams are less effective in HSV infections.

  • Penciclovir heals HSV-1 sores by healing it faster, reduce shedding of the virus, and lessens pain. It should be applied within the first hour symptoms appear and re-applied every two hours during waking periods for four consecutive days.

Meanwhile, docosanol is a non-prescription cream for oral herpes in the United States. It is applied five times a day, usually at the beginning of pain.

Aspirin, acetaminophen, or ibuprofen may also be given for the pain.

Additional treatments

Sores may be soaked in warm brine solution to reduce discomfort. Wearing cotton underwear or loose fitting clothes keep the affected area dry, clean and aerated.

Herbal drugs like echinacea (Echinacea purpurea), siberian ginseng (Eleutherococcus senticosus), and aloe (Aloe vera) as well as other dietary supplements like lysine, zinc, and bee propolis have claimed to fight herpes by boosting the immune system.

Echinacea often affects drugs that affect the immune system. Siberian ginseng cannot be given with antibiotics or anti-virals as it might inactivate the latter. Aloes might cause diarrhea. Zinc, when taken for more than 200 milligrams will cause stomach upset. Lastly, some people are allergic towards bee products like propolis.

Complications

An infected mother may transmit the virus to her baby during vaginal delivery. This is possible especially when the mother has active infection during time of birth. However, other doctors advocate the use of acyclovir in the 3rd trimester to prevent neonatal infections and eliminate the need for cesarean section.

Other complications include eczema herpetiform dermatitis, encephalitis, keratoconjunctivitis, meningitis, and pneumonia.

Herpes simplex infection in newborns and people with compromised immune systems are often serious but not fatal.

Occurence

Internationally, HSV-1 infections in early adulthood is about 55-85%. Meanwhile, HSV-2 infections affect 13-40% of people worldwide. It is reported than more than 1/3 of the world's population has recurrent HSV infections.

Prevention

Herpes simplex is quite difficult to prevent because people with no symptoms spread the virus to others. Avoidance of direct contact with herpetic lesions lowers the risk of infection.

People with genital herpes must avoid engaging in sex especially when they have active infection. Using condoms and other safer sex practices may lessen the chance of catching the infection.

Pregnant women with acting HSV infections are often recommended to undergo cesarean delivery to lower the chances of having the baby get the virus during delivery.

Since 2002, the United States National Institute for Health has been developing a vaccine for herpes. Simplirix ® is given to women who have not been previously infected with the herpes simplex virus. It is not effective in men. Currently, the vaccine is in its Phase III trials.

Similar conditions

Some medical conditions are often confused as herpes.

Simple corneal scratches will cause pain similar to a HSV-1 infection. However, they resolve within a day and do not have the corneal lesions typical of herpes.

In the Philippines

Information campaigns regarding herpes simplex infections are currently being advocated as people, particularly women, from rural areas and lower socio-economic class have yet to recognize and differentiate the infection.

Condom use might lower the outbreak of genital herpes in the country but the Department of Health (DOH) still has to contend with the Roman Catholic Church’s advocacy towards ‘’pro-life’’. This is despite the fact that the current pope himself, admitted that condom use is permissible if it will prevent infective diseases.

Herbologists offer local concoctions to alleviate the tingling and itching that often accompany the herpetic sores.

References