Herpes simplex virus

The Herpes simplex virus infection (common names: herpes, cold sores) is a common, contagious, incurable, and in some cases sexually transmitted disease caused by a double-stranded DNA virus.

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Table of contents

1 Symptoms
2 Course of outbreak

2.1 "Oral" infections
2.2 "Genital" infections

3 Transmission
4 HSV-1 and HSV-2
5 Prevalence
6 Prevention
7 Treatments
8 Long-term effects
9 Myths
10 Other herpes viruses

Symptoms

The most obvious symptom of Herpes simplex virus is blisters anywhere on the body, but especially near the mouth or genital areas. Some people may experience prodromal symptoms: tingling, pain, burning, or itching in the area a few days before the blisters appear. The period from the time the blisters appear until the sores heal is known as an active outbreak.

Course of outbreak

The ways in which Herpes simplex virus infections manifest themselves vary tremendously among individuals. Following are general descriptions of the courses outbreaks may take in the oral and genital regions.

"Oral" infections

Prodromal symptoms
Skin appears irritated
Sore or cluster of fluid-filled blisters appear
Lesion begins to heal, usually without scarring

These infections may appear on the lips, nose, or in surrounding areas. The sores may appear to be either weeping or dry, and may resemble a pimple, insect bite, or large chickenpox lesion. Lesions typically heal after a few days to a week (or more); this varies among individuals.

"Genital" infections

Prodromal symptoms
Sore appears
Lesion begins to heal, usually without scarring

In men, the lesions may occur on the shaft of the penis, in the genital region, on the inner thigh, buttocks, or anus. In women, lesions may occur on or near the pubis, labia, clitoris, vulva, buttocks, or anus.

The appearance of Herpes simplex virus lesions and the experience of outbreaks in these areas varies tremendously among indivuals. Herpes simplex virus lesions on/near the genitals may look like cold sores. They may not. An outbreak may look like a paper cut, or chafing, or appear to be a yeast infection. Symptoms of a genital outbreak may include aches and pains in the area, discharge from the penis or vagina, and discomfort when urinating.

Initial outbreaks are usually more severe than subsequent ones, and generally also involve flu-like symptoms and swollen glands for a week or so. Subsequent outbreaks tend to be periodic or episodic, typically occur four to five times a year, and can be triggered by stress, illness, fatigue, menstruation, and other changes. The virus sequesters in the nerve endings (where the blisters were) during non-eruptive periods, where it cannot be conventionally eliminated by the body's immune system. The blisters can spread to any part of the body, and can cause damage if spread to the eyes.

Transmission

Herpes simplex virus is contracted through direct skin contact (not necessarily in the genital area) with an infected person. The virus travels through tiny breaks in the skin or through moist areas, but symptoms may not appear for at least a month after infection. Transmission is most common during an active outbreak.

HSV-1 and HSV-2

There are two main kinds of Herpes simplex virus; types 1 (HSV-1) and 2 (HSV-2). Both types of HSV can infect either the oral or genital regions. It is easier to acquire an HSV-1 infection in the oral region, and for most people with HSV-1, that is where outbreaks occur. It is easier to acquire an HSV-2 infection in the genital region, and for most people with HSV-2, that is where outbreaks occur.

The terminology of herpes can be quite confusing; the two viruses are sometimes referred to by the sites they preferentially infect. Thus, HSV-1 can be called "oral herpes," (or sometimes "cold sores") and HSV-2 can be called "genital herpes." However, it is perfectly possible to have an HSV-1 infection of the genitals, or an HSV-2 infection of the oral area.

Another factor adds to the confusion; herpes is also sometimes described by the site of the infection. Thus, a Herpes simplex virus infection located in the genital region may be called "genital herpes," and a Herpes simplex virus infection located in the oral region may be called "oral herpes," irrespective of which virus is actually present.

People whose herpes infections are not located in the virus' "preferred" location may experience fewer, less severe outbreaks. For example, if Alfred has an HSV-1 infection of the mouth, and Bill has an HSV-1 infection of the genitals, Alfred is likely to experience more frequent and/or severer outbreaks than Bill.

Prevalence

Although thousands of years old, herpes garnered media prominence in 1982, and the incidence of herpes has risen 30% since the 1970s. Women over 30 are especially susceptible to this disease and have more potential complications. Infected women can give their children herpes at birth, but this is rare, and can be prevented with a Caesarean section.

Prevention

Condoms can help prevent contracting herpes, but do not work consistently because some blisters might not be covered by the condom. Abstinence is an effective way to prevent contracting or spreading this disease (including abstinence from oral sex). When one partner has herpes simplex infection and the other doesn't, the use of valaciclovir, in conjunction with a condom, has been demonstrated to further decrease the chances of transmission to the uninfected partner, and the FDA approved this as a new indication for the drug in August 2003.

Treatments

Pharmacotherapy
There are several prescription antiviral medications for controlling herpes outbreaks, including aciclovir (Zovirax), valaciclovir (Valtrex), famciclovir (Famvir), and penciclovir. Aciclovir was the original and prototypical member of this class and generic brands are now available at a greatly reduced cost. Valaciclovir and famciclovir are prodrugs of aciclovir and penciclovir respectively, with improved oral bioavailability.

Docosanol (Abreva) is another treatment that may be effective.

Non-prescription analgesics can reduce pain and fever during initial outbreaks.

Aciclovir is the recommended antiviral for suppressive therapy to prevent transmission of herpes simplex to the neonate. The use of valaciclovir and famciclovir, while potentially improving treatment compliance and efficacy, are still undergoing safety evaluation in this context. (Leung & Sacks, 2003)

Complementary
Since herpes is a viral infection, a daily multi-vitamin to maintain immune system health can help lessen and shorten outbreaks. Eating dairy products and other foods high in lysine and low in arginine might also help; additionally, many pharmacies and health food stores carry lysine supplements.

Experimental
Limited evidence suggests that low dose aspirin (125 mg daily) might be beneficial in patients with recurrent HSV infections. A small study of 21 volunteers with recurrent HSV indicated a significant reduction in duration of active HSV infections, milder symptoms, and longer symptom-free periods as compared to a control group. (Karadi, Karpati & Romics, 1998) A recent animal study found that aspirin inhibited thermal stress-induced ocular viral shedding of HSV-1, and a possible benefit in reducing recurrences. (Gebhardt, Varnell, & Kaufman, 2004)

Aspirin is not recommended in persons under 18 years of age with herpes simplex due to the increased risk of Reye's syndrome.

Long-term effects

The long-term effects of herpes are not well known, but the blisters may leave scars, and historically it was thought to contribute to the risk of cervical cancer in women. Subsequently, another virus, human papillomavirus (HPV), has been shown to be the cause of cervical cancer in women. Additionally, people with herpes are at a higher risk of HIV transmission because of open blisters. In newborns, however, herpes can cause serious damage: death, neurological damage, mental retardation, and blindness.

Myths

Some common myths and misconceptions about herpes are that it is fatal (only true for newborns, where it is rare, or if it infects the brain, which is again unusual), that it only affects the genital areas (it can affect any part of the body), that condoms are completely effective in preventing the spread of this disease, that it is transmittable only in the presence of symptoms, that it can make you sterile, that Pap smears detect herpes, and that only promiscuous people get it (it is so common that anyone having sex is at risk). There is a basis in truth that herpes could be transmitted via an inanimate object such as a toilet seat or wet towel but the conditions required for this kind of transmission (brief time, high heat, high moisture, and exposure) make it highly unlikely. Although there has never been a known case of this type of transmission, sharing a towel with somebody with active lesions should be avoided.

Other herpes viruses

There are eight members of the herpesvirus family that are known to cause human disease, including not only the Herpes Simplex virus (HSV-1 and HSV-2), but also the varicella-zoster virus (VZV), Epstein-Barr virus (EBV) and the cytomegalovirus (CMV).



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