Herpes simplex - Wikipedia. Herpes simplex. Synonyms. Cold sores, fever blisters. Herpes labialis of the lower lip. Note the blisters in a group marked by an arrow. Specialty. Infectious disease.
Symptoms. Blisters that break open and form small ulcers, fever, swollen lymph nodes. Oral herpes involves the face or mouth. It may result in small blisters in groups often called cold sores or fever blisters or may just cause a sore throat.
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These typically heal over two to four weeks. Tingling or shooting pains may occur before the blisters appear. Herpes cycles between periods of active disease followed by periods without symptoms.
The first episode is often more severe and may be associated with fever, muscle pains, swollen lymph nodes and headaches. Over time, episodes of active disease decrease in frequency and severity. Transmission may still occur when symptoms are not present. Genital herpes is classified as a sexually transmitted infection. It may be spread to an infant during childbirth. Testing the blood for antibodies against the virus can confirm a previous infection but will be negative in new infections. Condom use decreases the risk somewhat.
Daily antiviral medication taken by someone who has the infection can also reduce spread. There is no available vaccine and once infected, there is no cure. However, each may cause infections in all areas. Common infection of the skin or mucosa may affect the face and mouth (orofacial herpes), genitalia (genital herpes), or hands (herpetic whitlow). More serious disorders occur when the virus infects and damages the eye (herpes keratitis), or invades the central nervous system, damaging the brain (herpes encephalitis). People with immature or suppressed immune systems, such as newborns, transplant recipients, or people with AIDS, are prone to severe complications from HSV infections.
HSV infection has also been associated with cognitive deficits of bipolar disorder. Following a primary infection, the virus enters the nerves at the site of primary infection, migrates to the cell body of the neuron, and becomes latent in the ganglion. In HSV- 1- infected individuals, seroconversion after an oral infection prevents additional HSV- 1 infections such as whitlow, genital herpes, and herpes of the eye. Prior HSV- 1 seroconversion seems to reduce the symptoms of a later HSV- 2 infection, although HSV- 2 can still be contracted.
Many people infected with HSV- 2 display no physical symptoms—individuals with no symptoms are described as asymptomatic or as having subclinical herpes. It is of greater severity than herpes labialis, which is often the subsequent presentations. Herpes labialis. Infection occurs when the virus comes into contact with oral mucosa or abraded skin. Herpes genitalis. When symptomatic, the typical manifestation of a primary HSV- 1 or HSV- 2 genital infection is clusters of inflamed papules and vesicles on the outer surface of the genitals resembling cold sores. Herpetic whitlow and herpes gladiatorum.
Herpes whitlow is a painful infection that typically affects the fingers or thumbs. On occasion, infection occurs on the toes or on the nail cuticle. Individuals who participate in contact sports such as wrestling, rugby, and football(soccer), sometimes acquire a condition caused by HSV- 1 known as herpes gladiatorum, scrumpox, wrestler's herpes, or mat herpes, which presents as skin ulceration on the face, ears, and neck. Symptoms include fever, headache, sore throat, and swollen glands.
It occasionally affects the eyes or eyelids. Herpesviral encephalitis and herpesviral meningitis. A herpetic infection of the brain thought to be caused by the transmission of virus from a peripheral site on the face following HSV- 1 reactivation, along the trigeminal nerveaxon, to the brain. HSV is the most common cause of viral encephalitis. When infecting the brain, the virus shows a preference for the temporal lobe.
It is often associated with impaired immune function (e. HIV/AIDS, immunosuppression in solid organ transplants). Other. Neonatal herpes simplex is a HSV infection in an infant. It is a rare but serious condition, usually caused by vertical transmission of HSV- 1 or - 2) from mother to newborn.
During immunodeficiency, herpes simplex can cause unusual lesions in the skin. One of the most striking is the appearance of clean linear erosions in skin creases, with the appearance of a knife cut. The virus interacts with the components and receptors of lipoproteins, which may lead to its development. Herpes simplex virus 2 is typically contracted through direct skin- to- skin contact with an infected individual, but can also be contracted by exposure to infected saliva, semen, vaginal fluid, or the fluid from herpetic blisters. Even microscopic abrasions on mucous membranes are sufficient to allow viral entry.
HSV asymptomatic shedding occurs at some time in most individuals infected with herpes. It can occur more than a week before or after a symptomatic recurrence in 5. Concurrent infection with HIV increases the frequency and duration of asymptomatic shedding. Herpes simplex is a double- stranded DNA virus.
The appearance and distribution of sores in these individuals typically presents as multiple, round, superficial oral ulcers, accompanied by acute gingivitis. Prodromal symptoms that occur before the appearance of herpetic lesions help differentiate HSV symptoms from the similar symptoms of other disorders, such as allergicstomatitis. When lesions do not appear inside the mouth, primary orofacial herpes is sometimes mistaken for impetigo, a bacterial infection. Common mouth ulcers (aphthous ulcer) also resemble intraoral herpes, but do not present a vesicular stage. Laboratory tests include culture of the virus, direct fluorescent antibody (DFA) studies to detect virus, skin biopsy, and polymerase chain reaction to test for presence of viral DNA. Although these procedures produce highly sensitive and specific diagnoses, their high costs and time constraints discourage their regular use in clinical practice.
However, a glycoprotein G- specific (Ig. G) HSV test introduced in the 1. HSV- 1 from HSV- 2. The differential diagnosis includes hand, foot and mouth disease due to similar lesions on the skin. Prevention. Barrier protection, such as a condom, can reduce the risk of herpes transmission. As with almost all sexually transmitted infections, women are more susceptible to acquiring genital HSV- 2 than men. Transmission risk from infected female to male is around 4–5% annually.
Condom use also reduces the transmission risk significantly. In many infections, the first symptom people will have of their own infections is the horizontal transmission to a sexual partner or the vertical transmission of neonatal herpes to a newborn at term. Since most asymptomatic individuals are unaware of their infection, they are considered at high risk for spreading HSV. Neither type of condom prevents contact with the scrotum, anus, buttocks, or upper thighs, areas that may come in contact with ulcers or genital secretions during sexual activity.
Protection against herpes simplex depends on the site of the ulcer; therefore, if ulcers appear on areas not covered by condoms, abstaining from sexual activity until the ulcers are fully healed is one way to limit risk of transmission. When one partner has a herpes simplex infection and the other does not, the use of antiviral medication, such as valaciclovir, in conjunction with a condom, further decreases the chances of transmission to the uninfected partner.
In contrast, the risk falls to 3% if the infection is recurrent. To prevent neonatal infections, seronegative women are recommended to avoid unprotected oral- genital contact with an HSV- 1- seropositive partner and conventional sex with a partner having a genital infection during the last trimester of pregnancy.
Mothers infected with HSV are advised to avoid procedures that would cause trauma to the infant during birth (e. The use of valaciclovir and famciclovir, while potentially improving compliance, have less- well- determined safety in pregnancy. Management. No method eradicates herpes virus from the body, but antiviral medications can reduce the frequency, duration, and severity of outbreaks.
Analgesics such as ibuprofen and paracetamol (acetaminophen) can reduce pain and fever. Topical anesthetic treatments such as prilocaine, lidocaine, benzocaine, or tetracaine can also relieve itching and pain. Acyclovir was the first discovered and is now available in generic. The double- stranded DNA of the virus is incorporated into the cell physiology by infection of the nucleus of a nerve's cell body. HSV latency is static; no virus is produced; and is controlled by a number of viral genes, including latency- associated transcript. Prodromal symptoms include tingling (paresthesia), itching, and pain where lumbosacral nerves innervate the skin.
Prodrome may occur as long as several days or as short as a few hours before lesions develop. Beginning antiviral treatment when prodrome is experienced can reduce the appearance and duration of lesions in some individuals.
During recurrence, fewer lesions are likely to develop and are less painful and heal faster (within 5–1. A 2. 00. 9 study showed the protein VP1. Reactivation due to other infections is the likely source of the historic terms 'cold sore' and 'fever blister'. Other identified triggers include local injury to the face, lips, eyes, or mouth; trauma; surgery; radiotherapy; and exposure to wind, ultraviolet light, or sunlight. Some individuals' outbreaks can be quite debilitating, with large, painful lesions persisting for several weeks, while others experience only minor itching or burning for a few days. Some evidence indicates genetics play a role in the frequency of cold sore outbreaks. An area of human chromosome 2.
An immunity to the virus is built over time. Most infected individuals experience fewer outbreaks and outbreak symptoms often become less severe.