Herpes Simplex - Causes, Symptoms and Treatment

What is Herpes Simplex?

A widespread, recurrent viral infection, herpes simplex affects the skin and mucous membranes and commonly produces cold sores and fever blisters. There are two strains of herpes simplex, Type 1 and Type 2. Herpes Type 1 typically affects the oral mucous membranes, while herpes Type 2 primarily affects the genital area.

Herpes is equally common in males and females. It occurs worldwide and is most prevalent among children in lower socioeconomic groups who live in crowded environments. Primary Herpes virus hominis (HVH) is the leading cause of gingivostomatitis in children ages 1 to 3. it causes the most common non epidemic encephalitis and is the second most common viral infection in pregnant women. If viremia is present the virus can pass to the fetus transplacentally and, in early pregnancy, may cause spontaneous abortion or premature birth.

What are the Causes of Herpes Simplex?

Herpes simplex infection is caused by HVH. Herpes Type 1 is transmitted by oral and respiratory secretions; herpes Type 2 is transmitted by sexual contact. Cross infection may result from orogenital sex. Saliva, stool, urine, skin lesions, and purulent eye exudate are potential sources of infection.

What are the Signs and Symptoms of Herpes Simplex?

About 85% of all HVH infections are sub-clinical The others produce localized lesions and systemic reactions. After the first infection, a patient is a carrier susceptible to recurrent infections, which may be provoked by fever, menses, stress, heat, and cold. In recurrent infections, the patient usually has no constitutional signs and symptoms.

In neonates, HVH symptoms usually appear 1 to 2 weeks after birth. They range from localized skin lesions to a disseminated infection of such organs as the liver, lungs, and brain. Common complications include seizures, mental retardation, blindness, chorioretinitis, deafness, microcephaly, diabetes insipidus, and spasticity. Neonates with disseminated disease have a high mortality rate. Primary infection in childhood may be generalized or localized.

Generalized Infection:

After an incubation period of from 2 to 12 days, onset of generalized infection begins with fever, pharyngitis, erythema, and edema. After brief prodromal tingling and itching, typical primary lesions erupt as vesicles on an erythematous base, eventually rupturing and leaving a painful ulcer, followed by a yellowish crust. Healing begins 7 to 10 days after onset and is complete in 3 weeks.

Vesicles may form on any part of the oral mucosa, especially the tongue, gingiva, and cheeks. In generalized infection, vesicles occur with submaxillary lymphadenopathy, increased salivation, halitosis, anorexia, and a temperature as high as 105° F (40.6° C). Herpetic stomatitis may lead to severe dehydration in children.

A generalized infection usually runs its course in 4 to 10 days. In this form, virus reactivation causes cold sores-single or grouped vesicles in and around the mouth.

Localized Infection:

Genital herpes usually affects adolescents and young adults. Typically painful, the initial attack produces fluid-filled vesicles that ulcerate and heal in 1 to 3 weeks. Fever, regional lymphadenopathy, and dysuria may also occur.

HVH can also affect the eye. Usually, herpetic keratoconjunctivitis is unilateral and causes only local symptoms: conjunctivitis, regional adenopathy, blepharitis, and vesicles on the lid. Other ocular symptoms may be excessive lacrimation, edema, chemosis, photophobia, and purulent exudate.

Both types of HVH can cause acute sporadic encephalitis with an altered level of consciousness, personality changes, and seizures. Other effects include smell and taste hallucinations and neurologic abnormalities, such as aphasia.

Herpetic whitlow, an HVH finger infection, commonly affects health care workers. First the finger tingles and then it becomes red, swollen, and painful. Vesicles with a red halo erupt and may ulcerate or coalesce. Other effects may include satellite vesicles, fever, chills, malaise,and a red streak up the arm.

Diagnosis for Herpes Simplex

Typical lesions may suggest HVH infection. Confirmation requires isolation of the virus from local lesions in specialized culture tubes. As the lesions are often pathognomonic and frequently painful, a biopsy is rarely necessary. A rise in antibodies and moderate leukocytosis may support the diagnosis, although such testing is not generally required for diagnosis.

Treatment for Herpes Simplex

Symptomatic and supportive therapy is essential. Generalized primary infection usually requires an analgesic-antipyretic to reduce fever and relieve pain. Anesthetic mouthwashes such as viscous lidocaine may reduce the pain of gingivostomatitis, enabling the patient to eat and preventing dehydration. Topical lidocaine may relieve the pain of vulvovaginal herpes.

Refer patients with eye infections to an ophthalmologist. Topical corticosteroids are contraindicated in active infection, but idoxuridine, trifluridine, and vidarabine are appropriate.

Acyclovir and its variants may be useful for a primary herpetic outbreak by reducing viral shedding and decreasing the duration of the episode. It has not been shown to be beneficial for future outbreaks. For patients who suffer frequent outbreaks -- generally defined as more than 6 episodes annually-chronic suppression with oral acyclovir may be indicated.

A 5% acyclovir ointment may bring relief to patients with genital herpes or to immunosuppressed patients with HVH skin infections. Intravenous acyclovir helps treat more severe infections, such as herpetic encephalitis.

Special Considerations and Prevention Tips for Herpes Simplex

Below are some of the tips which will help to control the disease and also prevent it from getting more serious:

• Abstain from direct patient care if you have herpetic whitlow.
• Patients with central nervous system infection alone need no isolation.
• Teach patients to use warm compresses or take sitz baths several times a day, to increase fluid intake, and to avoid unprotected intercourse during the active stage.
• Instruct patients with herpetic whitlow not to share towels or utensils with uninfected people.
• Tell patients with cold sores not to kiss infants or people with eczema.
• Patients should not be made to feel guilty; herpes is a chronic but manageable disease in most instances.