Dermatology Patient Education

Randy Jacobs, M.D.

951-672-7673

 

HERPES SIMPLEX: Q & A

Introduction

Herpes simplex is a virus infection. It occurs occasionally in some people and again and again in others. It produces what is commonly known as a fever blister. Herpes virus has the peculiar ability to go into a latent stage, lying dormant in the body. It appears that this virus stays with us for life. The virus causing chicken pox and that causing herpes infection are close relatives, and it is not surprising that they produce similar lesions. Both have the ability to lie dormant and to be reactivated. They are not inherited and not a sign of cancer. Herpes virus can also set up shop in broken skin on any part of the body and is a common affliction of wrestlers, whose skin is subjected to unusually rough treatment. Children with eczema are also prone to this infection. Herpes virus can easily gain entrance to the damaged skin and establish an infection in all involved areas, resulting in a serious illness. Girls are prone to herpes infections of the vagina and vaginal lips. The blisters and ulcers of herpes simplex teem with virus and are contagious until they heal, in both the initial and reactivated stages. Whether an ill child who needs home care should also be isolated is an unanswered question. The illness is usually so mild in childhood that it almost seems better to get it over with rather than run the risk of reaching adulthood without immunity. The pain disappears several days before the ulcers heal completely, which usually occurs between 4 and 9 days 1 week on the average. There are all degrees of illness. We believe that this virus is always present in the skin or mucous membrane and is just waiting for an opportunity to become active. It is likely to become active under the following circumstances: during menstrual periods, overexposure to sunlight, colds, and other upper respiratory infections, fever from any source, physical or emotional stress, reactions to drugs of foods, and injuries (such as stretching of the skin around the mouth).

What causes herpes simplex?

Herpes simplex, commonly called cold sores of fever blisters, may occur once or return again and again. It's caused by the herpes hominis virus. There are two kinds of herpes virus, type 1 and type 2. Type 1 virus causes the cold sores so common on the lips and face. Herpes of the genital area is usually caused by type 2 virus. Herpes simplex begins as a group of small red bumps that blister. You may have noticed itching or discomfort before the rash appeared. The blisters begin to dry up after a few days and form yellow crusts. The crusts gradually fall off and leave slowly fading red areas. The whole process takes about 10 to 14 days. No scars form. These mild symptoms are typical of recurring herpes simplex. The very first infections with type 1 herpes virus usually happens in childhood. It may go unrecognized, but often it causes fever, general illness, and much local soreness. Once you've had a herpes simplex infection, the virus becomes permanently established in your nerve tissue. Recurring herpes results from activation of this virus. Between attacks it lives quietly in nerve tissue. Fever and sun exposure are the most common factors triggering type 1 herpes simplex virus. That's when cold sores or fever blisters break out. Often the virus becomes activated without any apparent reason.

 

Contagion

Like most other viral agents, herpes simplex virus is contagious to people who have never had the infection before. Anyone who's had a fever blister or cold sore on the face is resistant to type 1 virus. Herpes simplex type 1 virus is not very contagious. Close contact such as kissing is necessary to transmit the infection. Genital herpes (type 2) is usually spread through sexual intercourse and is essentially a disease of adults. It's also contagious when in the active stages. Recurring herpes is not a reinfection, but activation of virus present in a quiet form in nerve tissue.

 

POINTS IN TREATMENT

Unfortunately, we have no effective treatment for herpes simplex infections. In most cases, herpes simplex heals by itself in about 10 days. The amount of time depends on the size of the blisters and their location. Two simple remedies will make you more comfortable while you're getting over herpes. Activity: There is usually no need to restrict your activity. You should avoid overexposure to the sun. If you must go into bright sunlight for an extended period, protect the skin and lips with a sun screen. Diet: Avoid any foods you think you may be allergic to. Changing your diet will neither help nor hurt. Since hot or cold foods may make your mouth hurt more, you may feel better taking soups or milk shakes through a straw. Good nutrition is important for healing.

 

GENERAL MEASURES:

Avoid getting the sores wet. Apply a sun-screening medication (may be obtained without prescription) to the lips if you must be exposed to much sunlight. PLEASE NOTIFY OUR OFFICE IF ANY OF THE FOLLOWING HAPPENS: Development of widespread lesions or   Irritation to the eyes. On rare occasions, herpes virus can infect the cornea of the eye, producing a very serious infection requiring care by an eye specialist. In certain rare cases, herpes virus infects the brain and other parts of the central nervous system, particularly in the non-immune adult, producing meningitis and encephalitis.

 

MORE FACTS ABOUT HERPES

The herpes simplex virus (HSV) can cause blister-like sores almost anywhere on a person's skin, though it usually occurs around the mouth and nose or the buttocks and genitals. HSV infections can become a real nuisance because they tend to reappear. The sores may be painful and embarrassing, often interfering with work and personal lives. For some chronically ill people and newborn babies, the viral infections can be serious and occasionally fatal. There are two types of HSV: Type 1 and Type 2. Studies show that most people contract Type 1 which usually affects the lips, mouth, nose, chin, or cheeks during infancy or childhood. They usually acquire it from close contact with family members or friends who carry the virus and transmit it to them by touching, kissing, and by the use of common eating utensils and towels. A rash or cold sores involving the mouth and gums appear shortly after exposure. Symptoms may be barely noticeable or may necessitate medical attention for pain relief. Type 2 which usually occurs in the genital area following sexual contact with an infected person has reached epidermic numbers, affecting anywhere between five and 20 million persons in the United States, or up to 20% of all sexually active adults. It has become the most prominent sexually transmitted disease of the past decade.

What is herpes?

Herpes is a family name for some 50 related viruses. In addition to herpes simplex, the family also contains the viruses responsible for infectious mononucleosis (Epstein-Barr Virus), chicken pox (varicella), and shingles (herpes zoster). Patients sometimes confuse herpes simplex and herpes zoster because of the similarity in names. Herpes zoster (shingles) is caused by the same virus that produces chicken pox. It may occur in childhood, but it is seen most frequently in adults. It is extremely rare to have recurrent infection with the virus. Clinically, the infection is manifested by burning, itching, and pain, accompanied by grouped blisters which proceed to crust and are distributed over one side of the body. The most frequent sites of involvement are the trunk and head.

 

What is herpes simplex Type 1?

Called fever blisters or cold sores, HSV Type 1 infections typically take the form of tiny, clear, fluid-filled blisters on the face. Type 1 infections may also occur in the genital area after oral sexual exposure with an individual who has a herpes infection on the face. Type 1 occurs on mucous membranes and may also develop in wounds on the skin. Nurses, physicians, dentists, and other health care workers sometimes contact a herpetic sore after HSV enters a break in the skin of their fingers. There are two kinds of infection primary and recurrent. Though most individuals contract the virus, only 10% or so will actually develop symptoms indicative of a primary, or first, infection. The primary infection lasts from seven to ten days and appears two or twenty days after direct exposure to an infected person. The number of blisters varies, from one to a whole cluster. Before the blisters erupt, the soon-to-be-infected skin may itch or become very sensitive. The natural course of the blisters is to break spontaneously or as a result of minor trauma, allowing the fluid contents of ooze. Eventually, scabs form and slough, leaving slightly red skin. Though the primary infection heals completely, rarely causing a scar, the virus that caused it remains in the body, migrating to nerve cells where it remains in a dormant phase. Many people will not experience another infection or recurrence. Others will be plagued with recurrences, either in the same location as the first infection or in a nearby location. The infections may recur every few weeks or infrequently. Recurrent infections, which tend to be milder than primary infections, may be triggered by a variety of stresses including fever, exposure to the sun, and menstruation. However, for many individuals, the recurrences are unpredictable and have no recognizable precipitating cause.

 

What is herpes simplex virus Type 2?

Infection with herpes simplex virus Type 2 usually occurs below the waist, on the buttocks, penis, vagina, or cervix, two to twenty days after contact with an infected person. While sexual intercourse is a frequent means of transmission, infection may occur in spite of complete abstinence. Symptoms of both primary and repeat attacks can include a minor ash or itching, painful sores, fever, muscle ache, and a burning sensation during urination. Researches have confirmed that HSV Type 1 infections can occur in the genital area. Likewise, HSV Type 2 can occur in locations other than the genital area. Symptoms and consequences are the same with either virus tape in any location. As with Type 1, sites and frequency of return bouts are variable. The initial episode can be so mild that a person does not realize that he or she has a herpetic infection. Years later when there is a recurrence of HSV it may be mistaken as an initial attack and lead to accusations of infidelity by a partner. After the initial attack, the virus moves to nerve cells near the brain or spinal cord, remaining there until provoked by a trigger-menstrual period, fever, physical contact, or stress. Prodrome: Both primary and recurrent infections may be preceded by a pain or unusual tenderness in the thigh, buttock, or genital area between one and several days before a sore or sores develop.

How is HSV infection diagnosed?

The clinical appearance of infection is often so characteristic that no further testing is necessary for confirmation. However, if the diagnosis is uncertain, as it may be when it occurs on the genitals or cervix, a specimen may be taken and submitted to the laboratory for analysis. Several laboratory techniques are available for diagnosis including the staining of a smear, tissue culture, and blood test for antibodies. More than one of these tests may be required to confirm the presence of herpes. Genital herpes can be mistaken for other diseases, including syphilis. A small number of women with genital herpes don't know they have it because it occurs on the cervix which is not sensitive to pain.

 

How are herpes infections treated?

Medications for the treatment of herpes include Valtrex, Zovirax, and Famvir. The medications work best when started early. To date, no vaccine has been developed to prevent this infections disease from occurring, and no reliable cure has been discovered to halt the annoying symptoms. Eventually, many people develop immunity. Recurrent attacks of facial herpes simplex may be decreased by avoiding of excessive sun exposure and use of a good sunscreen preparation. Over the years, at least 25 "treatments" for herpes simplex of the skin ranging from plausible to bizarre have been featured in newspaper headlines. According to results of scientific studies, none has proven effective and worthwhile. Vitamin and mineral treatments, special diet, smallpox vaccinations, and numerous drugs have received initial acclaim only to be discarded later as ineffective. One promising drug is an anti-viral preparation used successfully to prevent herpes infections in chronically ill persons. Tests are underway to determine its effectiveness for preventing recurrences.

How to prevent transmission?

Between 200,000 and 500,000 persons from all socioeconomic classes and ethnic groups "catch" genital herpes each year. And the number of Type 1 infections is many times higher. So prevention of this disease, which is contagious before and during an outbreak, is important. If tingling, burning, itching, or tenderness signs of a recurrence are present in an area of the body where you have had a herpes infection, then that area should be kept away from others. For persons with genital herpes, this means abstinence from sexual relations or oral/genital contact during the period of symptoms or active lesions. Towels should be segregated and no underclothing or swimsuits should be exchanged. What are the serious implications of HSV? Eye infection. The virus may infect the eye and lead to a condition called herpes keratitis. The inflammation results in a feeling that there is something in the eye, pain, sensitivity to light, and discharge. Without prompt treatment, scarring of the eye may result. Fortunately, there are two drugs available in ointment form which are quite effective in preventing severe scarring of the cornea and eliminating infection (idoxuridine, adenine arabinoside). Infections in babies. A pregnant woman who has genital herpes at the time of the delivery may transmitted the virus to her baby as it passes through the birth canal, touching the affected area. The baby can die or suffer severe damage, particularly mental retardation. Women who know that they have had genital herpes or think they might have it during their pregnancies should tell their physicians so preventive measures can be taken. A Caesarean section is indicated for some patients. It is estimated that only half of the infants delivered through an infected vagina acquire the disease, but the ones that do are at risk for having a severe infection. The final decision on how to deliver the child is based on the relative risks for both mother and child. Near the time of delivery, it is recommended that certain women be tested for vaginal infection. These include women with genital sores, those with a prior history of genital herpes, and those whose sexual partners have a history of genital herpes. A diagnosis, in most instances, can be made in a few days by taking vaginal and cervical scrapings for a viral culture and Papanicolaou smear. The newborn can also be infected by exposure to the virus from non-genital lesions. If the mother or a person working in the nursery has active blisters on the lips or hands, the baby can become infected. Family members and friends with active HSV should not handle the newborn child. Pregnant women should avoid sexual contact, especially in late pregnancy, with a partner who has active genital herpes. The use of condoms can be suggested for those who will not abstain. The risk of orogenital sex should be recognized. There is no evidence at the present time to suggest that infection of the infant with HSV Type 1 carries a different risk than infection with HSV Type 2. No special precautions need to be taken by the woman who has inactive herpes (genital or non-genital) at term. Since the mother's infection is not active, the infant is not at risk. HSV and the seriously ill: HSV can be life-threatening to the person who has cancer, the person who has had an organ transplant, or anyone who has some other major illness because their immunity to infections has been drastically reduced. HSV and Cancer of the Cervix: Medical scientists have determined that women who have had genital herpes have a five to eight times greater risk of developing cervical cancer. Frequent Pap smear test should detect any cell changes indicative of cancer, usually in time for a near 100% cure rate. Please call our office if you have further questions.