Medical & Surgical Dermatology

Herpes Simplex

The herpes simplex virus (HSV) causes blisters and sores around the mouth, nose, genitals, and buttocks, but they may occur almost anywhere on the skin.

HSV infections can be very annoying because they may reappear periodically. The sores may be painful and unsightly. For chronically ill people and newborn babies, the viral infection can be serious, but rarely fatal. There are two types of HSV - Type 1 and Type 2.

Herpes Simplex Virus Type 1

Often referred to as fever blisters or cold sores, HSV Type 1 infections are tiny, clear, fluid-filled blisters that most often occur on the face. Less frequently, Type 1 infections can occur in the genital area. Type 1 may also develop in wounds on the skin.

There are two kinds of infections - primary and recurrent. Although most people get infected when exposed to the virus, only 10 percent will actually develop sores. The sores of a primary infection appear two to twenty days after contact with an infected person and can last from seven to ten days.

The number of blisters varies from one to a group of blisters. Before the blisters appear, the skin may itch, sting, burn, or tingle. The blisters can break as a result of minor injury, allowing the fluid inside the blisters to ooze and crust. Eventually, crusts fall off, leaving slightly red healing skin.

The sores from the primary infection heal completely and rarely leave a scar. However, the virus that caused the infection remains in the body. It moves to nerve cells where it remains in a resting state.
People may then have a recurrence either in the same location as the first infection or in a nearby site. The infection may recur every few weeks or not at all.

Recurrent infections tend to be mild. They can be set off by a variety of factors including fever, sun exposure, a menstrual period, trauma (including surgery), or nothing at all.

Herpes Simplex Virus Type 2

Infection with HSV Type 2 usually results in sores on the buttocks, penis, vagina, or cervix, two to twenty days after contact with an infected person. Sexual intercourse is the most frequent means of getting the infection. Both primary and repeat attacks can cause problems including: a minor rash or itching, painful sores, fever, aching muscles, and a burning sensation with urination. HSV Type 2 may also occur in other locations, but is usually found below the waist.

As with Type 1, sites and frequency of repeated bouts vary. The initial episode can be so mild that a person does not realize that he or she has an infection. Years later, when there is a recurrence of HSV, it may be mistaken for an initial attack, leading to unfair accusations about the source of infection.

How do you get herpes?

Most people get Type 1 infections, which cause cold sores, during infancy or childhood. They usually get it from close contact with family members or friends who carry the virus. It can be transmitted by kissing, sharing eating utensils, or by sharing towels. The sores most commonly affect the lips, mouth, nose, chin, or cheeks and occur shortly after exposure. Patients may barely notice any symptoms or find these sores annoying and seek medical attention.

Most people get Type 2 infections, which cause genital sores, following sexual contact with an infected person. The virus affects anywhere between five and twenty million people, up to 20% of all sexually active adults in the United States.

The lesions of both types of herpes simplex, can be spread by touching an unaffected part of the body immediately after touching a herpes lesion.

How are the HSV infections diagnosed?

The appearance of HSV is often typical and no testing is needed to confirm the diagnosis. If diagnosis is uncertain, a swab from the infected skin for culture or smear may be taken and sent to the laboratory for analysis. Laboratory tests include special microscopic examinations and blood tests for antibodies. Some tests are only valid in the early stages, and 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 do not know they have it because it occurs on the cervix.

How are herpes infections treated?

Oral anti-viral medications such as acyclovir, famciclovir, or valacyclovir have been developed to effectively treat herpes infections. These medications can be used to treat an outbreak or can be used constantly to suppress herpes recurrences, reduce outbreaks, and spreading by viral shedding.

How do you prevent transmission?

Between 200,000 and 500,000 people "catch" genital herpes each year. The number of Type 1 infections is many times higher. There is no vaccine that prevents this contagious disease, but other methods of prevention before and during an outbreak are important.

If tingling, burning, itching, or tenderness occurs in an area of the body where there is a herpes infection, the area should be kept away from other people. With mouth herpes, one should avoid kissing, sharing cups, or lip balms. For persons with genital herpes, this means avoiding sexual relations, including oral/genital contact during the period of symptoms or active lesions. Condoms can help prevent transmission of genital herpes between sexual partners and should always be used. However, they will not protect against the virus that may be living on nearby genital skin that is not covered by the condom.

Can herpes be spread if there is no visible sore?

Yes. Patients have been aware for many years that if they kissed someone while having a fever blister, or had sex with their partner with an outbreak of genital herpes, they were likely to transmit the virus. However, most herpes is transmitted in the absence of lesions! It is now estimated that over 80% of all genital herpes is transmitted when there are no lesions and no symptoms. This phenomenon is known as asymptomatic viral shedding. People who never recall having had an outbreak of genital herpes can have positive blood tests for antibodies to herpes and can shed the virus. Taking antiviral medications daily reduces both viral shedding and disease transmission.

Other Serious Implications of HSV

Eye Infections - HSV infection of the eye can lead to herpes keratitis with pain, light sensitivity, a discharge, and a gritty sensation in the eye. Without prompt treatment, scarring of the eye may result. Fortunately, there are drugs available to eliminate infection and prevent severe scarring in the cornea.
lnfections in Pregnancy - A pregnant woman who has genital herpes at the time of childbirth may transmit the virus to her baby as it passes through the birth canal. If the birth occurs during the mother's first episode of genital herpes, the baby may suffer severe damage. Women who know that they have had genital herpes or think they might have it during their pregnancy should tell their physicians so the baby can be protected.

Pregnant women should avoid sexual contact with a partner who has active genital herpes, especially late in the pregnancy, or they must routinely use condoms.

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 a newborn child.

HSV can be life-threatening to a person who has cancer, an individual with AIDS, a person who has had an organ transplant, or anyone who has some other major illness, because their immunity to infection has been reduced.

Can herpes be cured?

While there are no known cures for herpes, there are several safe medications to reduce outbreaks. Studies to improve treatment methods or eliminate outbreaks entirely, continue. See your dermatologist for more information.

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