Herpes Simplex Virus (HSV) infections

Studies show that genital herpes simplex  virus is common. In the United States, one out of five of the total adolescent and adult population are infected with herpes simplex virus. 

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

HSV type 2 is  the one that most commonly causes genital herpes. You  can get  HSV type  2 during sexual contact with someone who has a genital HSV-2 infection. The infection causes painful sores on the genitals  in both men and women.

HSV type 1 is  the herpes virus that is usually responsible for cold sores  of the mouth,  the so-called "fever blisters." You get HSV-1  by coming into contact with  the saliva of an infected person. 

However, HSV type 1 can cause genital herpes, usually caused by oral-genital sexual contact with a person who has the oral HSV-1 infection,  and HSV type 2 can cause cold sores. 

Description  of Herpes Simplex

Herpes can be treated but not cured. Symptoms appear briefly and then disappear; the disease lies  dormant in nerve cells, but it  may be reactivated by stress or illness. It is believed to be more contagious during active periods when blisters are present, however, it  can be transmitted person-to-person without active lesions. 

Persons taking drugs that suppress  the body's immune system (for example, cancer or organ transplant patients) are at a higher risk  of contracting herpes because their bodies are in a weakened state. There is also some evidence that links genital herpes with a higher rate of cancer  of the cervix in women. 

There are some serious complications of herpes simplex: 

Eye infections  -  the herpes virus may  infect the eye and lead to a condition called herpes keratitis. The inflammation results  in the feeling that there is something in the eye, pain, sensitivity to light  and discharge. Drugs are available that prevent severe scarring of  the cornea and in eliminating infection. 

Infections in babies  - a pregnant woman who has genital herpes at  the time of delivery can transmit the virus to her baby as it passes through the birth canal  and touches 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 pregnancy should tell their physician so preventive measures can be taken. 

A Cesarian section is indicated for some patients. It is estimated that only half  of all infants delivered through an infected vagina acquire  the disease, but  the ones that do are at risk for having a severe infection. 

The newborn also is 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 herpes simplex virus should not handle a newborn. 

Symptoms of Herpes Simplex 

Herpes symptoms  can vary. Many infected individuals have few, if any, noticeable symptoms. In people who do have symptoms, the symptoms start 2  to 20 days after the person was exposed to someone with HSV infection. Symptoms may last for several weeks. 

The first episode  of herpes is usually worse than outbreaks that come later. The predominant symptom of herpes is  the outbreak of painful, itching blisters filled with fluid on  and around  the external sexual organs or, for oral herpes, on or very near  the lip. Females may have a vaginal discharge. Symptoms vaguely similar to those of flu may accompany these outbreaks, including fever, headache, muscle aches  and fatigue. There may be painful urination,  and swollen and tender lymph glands in  the groin. 

Usually the blisters will disappear without treatment in two to 10 days, but the virus will remain in the body, lying dormant among clusters  of nerve cells until another outbreak is triggered. Factors that can trigger an outbreak include stress, illness such as a cold, fever, fatigue, sunburn, menstruation or sexual intercourse. 

Many patients are able to anticipate an outbreak when they notice a warning sign (a tingling sensation, called a prodrome) of the approaching illness. It is when they feel signs  that an outbreak is about to start that they are particularly contagious, even though  the skin still appears normal 

Most people with genital herpes have five to eight outbreaks per year, but not everyone has recurrent symptoms. As time goes on, the number  of outbreaks usually decreases. Oral  herpes can recur as often as monthly or only one or two times each year. 

Sores typically come back near the site  of the first infection. Usually, as the outbreaks recur, there are fewer sores and they heal faster and are less painful. 

Treatment  of Herpes Simplex 

Unlike other sexually transmitted diseases, herpes cannot be cured because medication that will attack the virus while it lies dormant in the nerve cells will also damage the nerve cells. However, there is treatment available for acute an outbreak that involves the use of anti-viral drugs such as Acyclovir, Valaclovir or Famcyclovir. 

Acyclovir has been found to reduce the reproduction of the  virus in initial outbreaks, thus possibly lessening  the number of subsequent outbreaks. To be effective, therapy must be started immediately after  the first sores appear. Every sexual partner  of the infected person needs to be examined,  and if necessary, treated. 

Famcyclovir has similar effects and may work to prevent a herpes infection from establishing itself if taken soon enough  in the course of the illness. Valaclovir has similar effects. 

Long-term drug therapy ('suppressive treatment')  may be helpful for individuals who suffer frequent recurrent outbreaks. Suppressive treatment will reduce outbreaks by 85 percent  and reduces viral shedding by more than 90 percent. 

Topical antibiotic ointments also may be applied to prevent secondary bacterial infections. 

• During an outbreak of genital herpes, a number of measures can be taken to make  the patient more comfortable: 
• Wear loose clothing 
• Avoid excessive heat or sunlight 
• Keep the sore  area clean and dry 
• Place cool or lukewarm cloths  on the sore area for short periods of time 
• Do not use perfumed soaps, sprays, feminine deodorants, or douches 
• Take aspirin, acetaminophen or ibuprofen for  the pain 
• Avoid touching sores 
• Wash hands if you do touch  the sores 

Prevention of Herpes Simplex 

Because  the chances of contracting this disease increase with  the number  of sexual partners a person has, limiting  the number of partners  is the first step toward prevention. 

To keep  herpes from spreading, intimate  contact should be avoided when sores are on  the body. Itching, burning or tingling may occur just  before the sores develop. Sexual intercourse should be avoided during this time. 

Herpes can even be spread  when there are no sores  or symptoms. To minimize  the risk of spreading herpes, latex condoms should be used during all sexual contact. Spermicidal foams and jellies may offer added protection although the evidence on this  is controversial. 

The herpes virus can also be spread by touching the sores  and then touching another part of  the body. If you touch the sores,  wash your hands with soap and water as soon as possible. Also, do not share towels or clothing with anyone. 

Babies can be infected with  the herpes virus. If pregnant, you should tell your doctor if you have ever been exposed  to anyone with herpes, even if you have never had any symptoms. Your doctor can take special precautions at  the time of delivery to protect  the baby from getting infected with herpes. 

Questions To Ask Your Doctor About Herpes Simplex 

What type of treatment will you recommend  to decrease  the symptoms or the length of the active period? 

• Will you  be prescribing any medication? 
• What are the side effects? 
• Can laser therapy  be used? 
• How  is laser therapy performed? 
• How effective is this therapy?