Herpes Simplex

Herpes simplex virus (HSV) is a common infection that occurs subclinically in about 85% of patients. In the rest, it causes localized lesions. HSV may be latent for years, but after the initial infection, the patient becomes a carrier susceptible to recurrent attacks. The outbreaks may be provoked by fever, menses, stress, heat, cold, lack of sleep, sun exposure, and contact with reactivated disease (for example, by kissing or by sharing cosmetics). In recurrent infections, the patient usually has no constitutional signs and symptoms.

HSV infection generally isn't serious in an otherwise healthy adult; in a neonate or an immunocompromised patient, such as one with acquired immunodeficiency syndrome (AIDS), it can produce severe illness. In fact, serious HSV infections occur commonly in patients with AIDS.

HSV infection occurs worldwide and equally in males and females. Lower socioeconomic groups are infected more often, probably because of crowded living conditions.

Causes

Herpes labialis is an extremely common disease caused by infection of the mouth area with herpes simplex virus, most often type 1.

The initial infection may cause no symptoms. The virus remains in the nerve tissue of the face. In few people, the virus reactivates and produces recurrent cold sores that are usually in the same area, but are not serious. Herpes virus type 2 causes genital herpes and infection of babies at birth, but may also cause herpes labialis.

Herpes viruses are contagious. Contact may occur directly, or through contact with infected razors, towels, dishes, and other shared articles. Occasionally, oral-to-genital contact may spread oral herpes to the genitals. For this reason, people with active herpes lesions on or around the mouths or on the genitals should avoid oral sex.

Symptoms and Signs

• Mouth sores
• Blisters or ulcers -- most frequent on the mouth, lips and gums or genitalia
• Fever blisters
• Fever -- may be present especially during the first episode
• Enlargement of lymph nodes in the neck or groin
• Viral culture of lesion  
• Genital lesions (male) -- may be preceded by burning or tingling sensation
• Genital lesions (female) -- may be preceded by burning or tingling sensation

Diagnostic tests

Confirmation of HSV infection requires isolating the virus from local lesions and a histologic biopsy. In primary infection, an increase in antibodies and moderate leukocytosis may support the diagnosis.

Treatment

Symptomatic and supportive therapy is the rule. Generalized primary infection usually requires antipyretic and analgesic medications to reduce fever and pain. Anesthetic mouthwashes, such as viscous lidocaine,
may reduce the pain of gingivostomatitis, enabling the patient to consume food and fluids and thus promote hydration. (Avoid offering alcohol-based mouthwashes, which can increase discomfort.) A bicarbonate-based mouth rinse may be used for oral care. Drying agents, such as calamine lotion, may soothe labial and skin lesions. Avoid using petrolatum-based salves or dressings because they promote viral spread and slow healing.

Refer patients with eye infections to an ophthalmologist. Topical cortico steroids are contraindicated in active infection, but ophthalmic medications, such as idoxuridine, trifluridine, and vidarabine, may be effective.

Acyclovir is a major agent for combating genital herpes, particularly primary infection. Other medications include ganciclovir, famiciclovir, and valacyclovir. The drug may reduce symptoms, viral shedding, and healing time. And although it's mostly ineffective in treating recurrent attacks, it may be prescribed to treat and suppress HSV in immunocompromised patients and those with severe and frequent recurrences. The drug is available in topical, oral, and I.V. form (usually reserved for severe infection).

Prevention

Avoiding direct contact with an open lesion will lower the risk of infection.

People with genital herpes should avoid sexual contact when active lesions are present. Safer sex behaviors, including the use of condom, may also lower the risk of infection.

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