Herpes Symptoms and Treatment
Herpes simplex is a virus that causes infections of moist membranes and skin. The most common areas affected are around the nose, lips, vulva, vagina and penis, but the surface anywhere on the body may be involved. The herpes virus is widely distributed in the community, and infections are very common.
The herpes simplex virus comes in two main types, labeled simply 1 and 2. Herpes simplex 1 tends to cause infections around the nose and mouth (cold sores) and herpes simplex 2 tends to cause genital infections, but they are interchangeable and not mutually exclusive. A distantly related virus, Herpes zoster, is responsible for shingles and chickenpox.
Cold sores (herpes simplex 1)
Approximately 60% of the population are infected with herpes simplex 1 and remain carriers of the virus for the rest of their lives. The virus is passed from one person to another by direct contact (such as kissing).
Cold sores are rare before six months of age, but as the immunity passed on by the mother at birth and through breastfeeding has worn off, the infection can develop on the lips, inside the mouth or around the nostrils. Serious infection before five years of age is uncommon, and the incidence also seems to decrease in old age.
Cold sores are characterized by redness and soreness of the affected area, followed a day or two later by an eruption of small blisters, which rapidly burst to leave a shallow, weeping, painful ulcer. In severe cases, there may be a mild fever, and the glands in the neck may become tender and enlarged. After about a week, the sore heals and the pain eases.
Infections with herpes simplex 1 can also develop on the ringers, particularly at the edge of the nail, when it is given the name whitlow. Herpes simplex 1 infections occasionally occur on the genitals, where the herpes simplex 2 infection is more common, and vice versa. In rare cases, the infection can spread into the throat and lungs, and these patients become extremely ill.
Recurrences of cold sores tend to develop at the same spot time after time. They occur when the patient is under stress, run-down or has an infection (e.g. a cold - hence the name, cold sores), or when the skin is damaged by drying, sun burn or wind burn. At these times, the virus is able to overcome the body's defense mechanisms, start multiplying and cause the typical sore. After an attack, the virus lies dormant in the nerve cells under the skin until the opportunity to cause a further infection arises.
The diagnosis can be confirmed by taking special swabs from the sore and identifying the virus in a laboratory. Normally no investigations are required, and the diagnosis can be made on the appearance of the sore.
If treatment of a particular cold sore infection is undertaken immediately the redness and discomfort is felt and before the blisters form, it may be possible to stop it progressing further. Creams or lotions containing idoxuridine are used for this purpose. Once the cold sore is established, a cure is not possible, but drying, antiseptic and anesthetic creams or lotions may be used to control the symptoms and prevent any secondary infection from developing.
A bacterial infection, in addition to the original herpes viral infection, is the only common complication. Antibiotic creams or ointments are then necessary.
Some patients have only one attack of cold sores in their lives, while others are unlucky enough to become a victim every month (it may follow a woman's menstrual cycle). There appears to be no obvious reason why some people are affected more than others.
Genital herpes (herpes simplex 2)
Herpes simplex 2 is the technical name for a disease that is second only to AIDS in its effect upon the sexual mores of the world. Genital herpes is not a new disease, but it has become more widely spread in the past two decades.
It is sometimes possible to develop a genital form of herpes sore from a herpes simplex 1 virus. The blisters from both types of herpes infection are identical. The majority of cases of genital herpes are caught by sexual contact with someone, male or female, who already has the disease. It is possible, but unlikely, for the virus to be caught in hot spa baths and from a shared wet towel, but these and similar incidents are not common.
Once a person is infected with the virus, it settles in the nerve endings around the vulva or penis. It remains there for the rest of that person's life. At times of stress, illness or reduced resistance, the virus starts reproducing and causes the painful blisters and ulcers that characterize the disease. The first attack may occur only a week, or up to some years, after the initial infection. Blisters and ulcers may develop anywhere on the penis or scrotum (sac) in the male; and on the vulva (vaginal lips), and in the vagina and cervix (opening into the womb) of the female. When they occur internally on the cervix or high in the vagina, the symptoms are reduced, and the woman may pass on the infection without being aware of its presence.
The attack will last for two to four weeks and then subside. After weeks, months or years, a further attack may occur, but the usual pattern is for the attacks to become less severe and to occur further apart. Some victims have only one attack in their lives, others who are less fortunate may have repeated attacks for long periods of time that seriously affect their lifestyle. Herpes infection can also in rare cases cause an encephalitis. Genital herpes appears to affect women more severely and frequently than men.
The infection can be definitely diagnosed by taking a swab from the ulcer and having this examined in a laboratory. This is sometimes necessary to exclude other causes of ulcers on the genitals, and for legal reasons.
Until the early 90s, herpes was incurable. Medications were available to shorten an attack and reduce its severity, but they were not always effective. Soothing anesthetic creams and lotions are still the mainstay of treatment and control until an attack passes. While expensive anti-viral tablets will cure an attack of genital herpes and, if taken for several months, will prevent further attacks and possibly cure the disease. It is also available as an ointment.
If sores are present, there is a very good chance of passing the disease on to your sexual partner. A victim is also infectious for several days before a new crop of sores develop, as the virus is rapidly reproducing at this stage. An absence of sores does not guarantee that the infection will not be transmitted, but condoms will give some protection (but not 100%) against spreading the disease.
The most serious side of this normally distressing but not life-threatening disease is the effect it may have on the babies of women who develop an attack at the end of their pregnancy. If a baby catches the infection during delivery, it can cause severe brain damage in the child. For this reason, if a woman has a history of repeated herpes infections, she may be delivered by cesarean section so that the baby does not come into contact with the virus particles that may be present in the birth canal.
There is also evidence that the incidence of gynecological cancer is increased in women with genital herpes. All women should have regular smear tests, but particularly so if they have this annoying, but rarely serious disease.
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