Herpes

Herpes is a viral infection that commonly affects the facial skin and mucous membrane of the mouth and genital area. This infection causes sores initially in the area where the virus gains entry into the body, which then form blisters that are very painful and itchy. The blisters seem to heal completely and then reappear.

There are two types of herpes infections:

Herpes Simplex Virus (HSV) infection: It is a viral infection caused by either herpes simplex type 1 or 2 virus. Herpes simplex type 1 virus causes Orolabial herpes or Herpes labialis or cold sores. It is very common and appears on the lips and around the mouth. It spreads through contact with saliva carrying the virus or from using contaminated utensils. Herpes simplex type 2 virus causes genital herpes which appears on the genital, anal, and buttocks areas. Type 2 is sexually transmitted.

Herpes Zoster (Shingles) This type of herpes is a skin rash caused by Varicella zoster virus that causes chicken pox in childhood. After a childhood infection, this virus remains dormant in the nervous system. Certain conditions such as stress or immunodeficiency such as with AIDS or cancer, can cause herpes zoster infection due to reactivation of the virus.

Signs and Symptoms

Primary Herpes simplex virus-1 (HSV-1) infection often occurs in children and the symptoms include:

Fever

Sore throat

Mouth sores

Enlarged lymph nodes in the neck or groin.

Tiny vesicles filled with fluid form on the lips, the gums, and the roof of the mouth or tongue. These lesions may ulcerate and heal within 2-3 weeks.

Recurrent infection: The disease may remain in a latent stage for some period of time. Recurrent vesicular lesions cause pain, burning sensation or even loss of sensation. These lesions may ulcerate or form a crust. The lesions most commonly occur in the lips.

Primary genital herpes symptoms last for usually 2-3 weeks.

In men, painful, red vesicles occur on the penis, anus or the perineum that may ulcerate. In women, vesicles or ulcers occur on the cervix and painful vesicles occur on the genitals, vagina and the buttocks.

Fever, tiredness, and swelling due to water accumulation

Enlarged lymph nodes

Vaginal or penile discharge

Recurrent infection: After the primary infection heals, the virus may be latent for some months or even years. Recurrent infections are milder but still cause pain, itching, tingling, burning, or loss of sensation.

Other Herpes Simplex Virus infections include:

Herpetic whitlow are vesicular lesions on the hands and fingers caused by HSV-1. It usually occurs in children with a thumb sucking habit.

Disseminated HSV infection can occur in pregnant women and immunosuppressed persons.

Neonatal HSV usually appears in an infant during the first two weeks of life. It can cause infection in the skin, eyes and lungs.

Herpes zoster: The first symptom that appears is severe pain with burning or tingling sensation in the area where the rash develops. The rash may appear as red patches on the skin, followed by small vesicles which form ulcers and crust off within 7-10 days. Other symptoms such as fever, tiredness, headache, and itching may also accompany the rash.

Your doctor will make a diagnosis based on your detailed history and physical examination of the lesions. Some tests that help to confirm the diagnosis include:

Viral culture from skin vesicles

Monoclonal antibody testing

Serology

Herpes simplex Treatment

Your doctor will prescribe antiviral medications to relieve your symptoms but these will not cure the disease as herpes simplex virus remains latent in the nerve cells.

Antiviral drugs limit the virus multiplication and suppress your symptoms.

Acyclovir (Zovirax)  is an antiviral drug used for genital HSV, herpes labialis and to prevent recurrent infections.

Famciclovir (Famvir) or valacyclovir (Valtrex) is also given for recurrent infections of genital HSV. The use of antiviral agents such as valacyclovir and acyclovir is safe in pregnancy also.

Pain medication will be given to control the pain. Narcotics may be given in cases of severe pain.

Docosanol cream (Abreva) is recommended for cold sores. It is applied 5 times daily over the lesion until it heals. It prevents entry and multiplication of the virus.

Herpes zoster:

Antiviral medicines such as Acyclovir, Famciclovir, and valacyclovir are used to reduce pain.

Anti-inflammatory drugs such as corticosteroids are given to reduce swelling.

Antihistamines can be taken by mouth or skin creams can be applied to the rash to reduce itching.

Some of the precautionary measures that help prevent herpes include:

Health care personnel (medical and dental) should always wear protective hand gloves while treating patients to prevent herpetic whitlow.

Use sunscreen creams to prevent recurrent infection of oral herpes.

Avoid contact with an open herpetic lesion.

Avoid contact with newborns, children with eczema, immunocompromised people if you have an active lesion.