Viral Infections

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Overview

Herpes simplex viruses HSV-1 and HSV-2 cause outbreaks on the skin and mucous membranes. After the initial infection, the virus travels to a nerve cell and becomes dormant. When reactivated by ultraviolet light, emotional stress, surgery, trauma, or hormone level fluctuation, the virus reproduces and travels down the nerve to the skin, where it produces recurring infections.

Transmission
Contact with open sores may result in infection to others. Some infected individuals shed herpesvirus from affected areas, even when no active lesion is present.

Both HSV-1 and HSV-2 are associated with oral-facial herpes (i.e., cold sores or fever blisters) and genital herpes.

Incidence and Prevalence
Approximately one-third of the U.S. population is afflicted by cold sores and over three-fourths have been exposed to HSV-1. About 15% of the U.S. population aged 15-75 have been exposed to HSV-2.

Causes

Primary infection is caused by direct contact (usually sexual) with an infected individual. Signs of infection usually appear within 2 weeks of exposure. While the virus can persist on surfaces such as towels or toilet seats for as long as 60 minutes, it is extremely unusual for an infection to result from contact with these surfaces.

Signs and Symptoms

Primary infections are usually severe and are often accompanied by painful, small, fluid-filled blisters; fever; and flu-like symptoms. The blisters may spread extensively. Primary infection may last 2 to 3 weeks.

Recurrent episodes usually begin with itching, tingling, or burning at the site of infection. A red bump or cluster of bumps then form on the skin and rapidly progress to fluid- or pus-filled blisters. After a few days, scabs form and the lesions heal usually within 8 days.

About one-half of men experience a recurrence within 4 months, and one-half of women experience a recurrence within 8 months. In time, the severity, duration, and frequency of symptoms usually decrease.

There are various potential triggers of HSV such as stress, sunlight, changing hormone levels, and illness.

The disease is highly contagious when sores are present. Patients have been known to infect themselves in a new location by touching an active herpes sore and then touching an area of broken skin. Pregnant women can pass the virus to their infants during birth.

Diagnosis

The most reliable diagnostic method to identify a herpes simplex infection is viral culture. The doctor swabs the base of a blister and submits it to the lab for identification. A rapid diagnosis can be made by taking a scraping of the debris at the base of the blister and examining it under a microscope using a special stain (called a Tzanck preparation). A blood test can indicate prior exposure to one or both herpes simplex viruses.

Treatment

There is no cure for herpes. Attempts to develop an effective herpes vaccine have not been successful.

Treatment for herpes simplex is not necessary because it is self-limiting. Oral antiviral medications like famciclovir (Famvir®), valacyclovir (Valtrex®) and acyclovir (Zovirax®) may be given to treat recurrent episodes or to prevent recurrent outbreaks, especially in patients who experience recurrences every 2 months or less.

A topical antiviral cream, penciclovir (Denavir®), and numerous over-the-counter topical remedies are available. Some people respond to lysine, zinc, and vitamin C supplements. Ointments such as Vaseline® or topical antibiotics can relieve discomfort. It is important to keep the area around a sore clean.

Prevention

Limiting intimate contact minimizes the risk of exposure to the herpes simplex virus. Open discussions with potential sexual partners are important to prevent spreading herpes. Condoms should be used, although they are not always effective because the condom may not completely cover the area of infection. Someone with an active outbreak should avoid sex until all the lesions have crusted over.

Measures to prevent infecting infants during birth vary, depending upon whether the mother's infection is active or dormant.

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