Oral and genital herpes are well known viral infections caused by two types of the same virus known as the herpes simplex virus. There is no cure for this viral infection and it affects people throughout the world. However, antiviral drugs can manage the condition in terms of duration and severity.
What is herpes simplex?
Herpes simplex is a virus that is known for causing sores on the mouth, lips, genital or rectum. There are two types – one that is more likely to affect the mouth and face area while the other tends to involve the genitals and rectum. It is commonly referred to as oral herpes or genital herpes. The infection may not always cause visible signs and symptoms. It may fluctuate between periods of acute infection and latency where the virus is still present but not as active on the skin and mucosal surfaces.
Contact with open sores and even secretions such as saliva can transmit the infection from one person to another. Although people in lower socioeconomic groups are more frequently exposed to the virus (about 80% are seropositive), it almost as common among higher socioeconomic groups (about 50% seropositive). HSV infection is not usually fatal but people with weak immune systems like in HIV/AIDS are risk of deadly complications.
Types of Herpes Simplex
There are two types of herpes simplex virus (HSV) known as HSV-1 and HSV-2.
- HSV-1 usually affects the mouth and face to cause cold sores or fever blisters.
- HSV-2 usually affects the genitalia and most of the time it is sexually transmitted.
However, it is important to note that location does not necessarily indicate the type of herpes simplex virus that is responsible for the infection. HSV-2 can cause mouth and face lesions while HSV-1 in some rare instances causes genital lesions.
Causes and Spread of HSV
Both type 1 and 2 herpes simplex are double-stranded DNA viruses. The virus is typically limited to the region where the infection occurs. In people with weakened immune systems the virus may spread to other parts of the body. Although the viral infection is limited to surface tissues at the site of infection it can sometimes spread to nerves in the region (neurovirulence) such as the trigeminal nerve with mouth and face infections or the sacral nerves with genital infections.
When the virus infects a person there is a primary infection stage. The infection can then become latent only to re-emerge at later periods. This latency period can last for months or even years. Reactivation may occur at any time. A recurrence is more common with HSV-2 than it is with HSV-1. There are certain triggers for recurrences, such as fever, sunburn and stress. It is important to note that these triggers do not cause the symptoms but simply trigger conditions where the viral activity leads to symptoms.
The herpes simplex virus (HSV) is spread through close personal contact. It is transmitted from one person to another and humans are the only natural reservoir for the virus. Usually the virus is spread by entering small cracks in the skin or tin breaks in mucosal surfaces within the mouth or genitals. It can also be transmitted through secretions like saliva. Since the virus is is inactivated at room temperature or with drying, it is rarely spread through fomites (contaminated objects with which an infected person has made contact).
Herpes simplex virus type 1 (HSV-1) can therefore be spread by kissing, sharing personal items such as a toothbrush or eating utensils with an infected person and so on. HSV-2 is usually spread only through sexual contact. It is also possible for pregnant women with genital herpes to transmit the virus to a newborn baby during childbirth as the child passes through the birth canal. Although contact with open sores are more likely to spread the infection, it can also be transmitted from an infected person without any evident sores.
HSV-1 is common among adults and children. Usually HSV-2 is only seen in adolescents and adults due to it mainly being transmitted by sexual contact. When HSV-2 is seen in children, particularly in the genital region, then sexual abuse must be considered as a possibility.
Signs and Symptoms
A person with HSV infection may present without any notable signs or symptoms. It is therefore difficult to identify a person with HSV infection simply by looking at the face, lips, mouth or genitals. The first-episode symptoms start to appear within a few days after infection. It usually starts with pain and tingling in the infected area and tiny bumps or blisters then erupt. The lesions last for about 1 to 2 weeks and then rupture to form shallow ulcers (open sores).
There is usually generalized symptoms with the primary infection. This includes fever, loss of appetite, muscle aches and a general feeling of being unwell (malaise). These symptoms do not usually appear with recurrences. HSV-2 infections are more likely than HSV-1 to recur. Typically these recurrences last for a few days to a week and can occur several times in a year. As time passes the recurrences become less frequent on a yearly basis but the possibility of passing on the infection is still present.
People living with HIV/AIDS and other conditions where the immune system is severely weakened are at a high risk of fatal complications form HSV infection.
Pictures of HSV Infection
Images sourced from Dermatology Atlas Brazil
Treatment for Herpes Simplex Virus
Herpes simplex virus infection is treated with antiviral drugs. However, this does not mean that the infection can be cured. Instead it reduces the duration and severity of the symptomatic period. These drugs, which may be administered orally or topically, include:
In severe cases the medication may be administered by an injection. Other medication may also be used to relieve symptoms like pain and fever. The virus remains in the body for a lifetime and while it cannot be cured, it can be effectively managed. Apart from avoiding triggers like stress and sunburn where possible, it is also important to maintain a healthy immune system. The degree of immune protection not only decreases the frequency of recurrences but also the severity.