Herpes

Cause

When the body is infected with HSV, we speak of a primary (first occurring) infection. The virus enters the body through mucosa or through the skin. It usually takes three to nine days before the symptoms develop. The virus replicates in the infected skin or infected mucosa and spreads to the lymph nodes in the vicinity of the infection site. These lymph nodes may temporarily become bigger and painful.
Characteristic for a herpes infection is that the virus remains lifelong in the body in a dormant form. At an early stage of the primary infection, the virus penetrates the local nerve endings and travels through the nerve to the corresponding ganglion. Due to various circumstances, including fever, sunlight, menstruation or stress, the virus can become active again and move from the ganglion to the initially infected area of the skin or mucosa. Here, an inflammation can reoccur.
Most people are infected with HSV type 1 at a young age. Primary herpes infections in children are usually less severe than in adults. The severity increases with age. The virus has only a short life span outside the human body. Infection mostly occurs via direct contact with a carrier of the virus.

Symptoms

Both virus types can in principle affect any area of the skin and adjacent mucosa.
The signs and symptoms are:

• Often a painful, itchy, tingling sensation during and just before a herpes outbreak.
• First, one sees small red spots. These will eventually become painful vesicles and, at the end of the herpes-cycle, leave a yellowish scab, which then falls off so that the skin may heal again. The vesicles are one to three millimeters in size and are often clustered.
• Headache.
• Muscle pain.
• Fever.
• The spots and vesicles may also appear on the genitals. In women, they can occur, for example, in the vagina. Peeing hurts in that case and the genitals feel burning and itchy.

Diagnosis

The diagnosis of a herpes infection of skin and mucosa is usually made on the basis of the existing symptoms. By means of laboratory tests, such as microscopic examination, viral culture and DNA techniques, the diagnosis can be confirmed.

Treatment

Normally, herpes infections don’t require treatment. After all, the symptoms disappear naturally. When treatment of a herpes infection is necessary, an antiviral agent may be prescribed. This drug inhibits multiplication of the virus. There are no drugs available that kill the virus. The infection can thus regularly come back again after the treatment. For herpes to the lips, an antiviral cream can be used. When there is often recurrent herpes, people with many symptoms can be given a long-term treatment with antiviral tablets.

Prognosis

Anyone who has once been infected with the herpes virus, carries the virus with him for life. In most people, this causes no problems. For some, the virus is occasionally active, making the symptoms come back. In a very small group, this happens so often and so intense, that they are really bothered. Eventually, however, even in those people the attacks decrease in severity and number.

Considerations

• Avoid self-contamination. Never touch herpes sites with the fingers, so don’t scratch the scabs. When a cream or ointment is applied at the herpes, preferably use a cotton swab. When applying or removing facial cosmetics, avoid any contact with herpes. Don’t use lipstick as long as herpes is present on the lips. When washing, avoid any contact between herpes and washcloth or towel. Wash hands immediately after contact with herpes.
• Prevent infection to others. When a person has cold sores, keep toiletries and consumption utensils strictly for private use. Make sure no one else uses them and wash them thoroughly, immediately after use. Avoid direct contact with the lips of others, so don’t kiss or hug babies. In case of herpes around the genitals, one should not have sexual contact until all the defects are completely healed. After complete healing, however, the infectiousness isn’t gone. Prevention is better than cure. Herpes to the genitals is usually not a serious, but a nasty venereal disease. Using a condom reduces the risk of contamination.
• Prevent herpes in newborns. It’s important that a pregnant woman reports to her doctor or obstetrician that she or her partner has had herpes to the genitals. If a pregnant woman has repeatedly herpes infections to the genitals, the delivery can take place in a normal manner. If a primary herpes occurs during the last six weeks of pregnancy, a ceasarean section will be recommended. After birth, make sure that people with active herpes infection to the lips don’t come close to the newborn (and especially don’t kiss).

Facts

• The term ‘herpes’ is derived from the Greek word herpès (festering wound).
• The prevalence of herpes infection is 90%.