Herpes

Herpes is a chronic disease caused by viruses of the Herpesviridae family. Pathogens are widely spread 
among people. Entering the human body once, they penetrate the tissues of the nervous system and 
remain there forever. According to some data, up to 80% of people aged 20 years are already infected by a 
herpes. 

The reproduction of herpes viruses is minimal, when the immune system is working normally. Many infected people do not even know that they are infected. Unfortunately, pathogens often overcome immune defenses, resulting in an exacerbation of the process with unpleasant, painful, and sometimes dangerous consequences. 

Kinds 

There are defined 8 types of herpes viruses that can harm human health. They differ by diseases they  lead to: 

1. Herpes simplex virus type 1 (HSV-1). It is usually manifested by rashes on the skin of the face and lips (orofacial type).
2. HSV type 2 is called urogenital, it is characterized by damage to the genital area.
3. HSV type 3 is the causative agent of chickenpox. Over time, HSV type 3 can cause shingles (herpes zoster).
4. The Epstein-Barr virus (HCV type 4)  provokes the development of chronic fatigue syndrome, infectious mononucleosis and an extremely dangerous tumor - nasopharyngeal carcinoma.
5. Cytomegalovirus (HSV type 5)  causes CMV mononucleosis.
6. HSV type 6 is considered one of the most dangerous type  of the Herpesviridae family. Affects brain tissue, causes encephalopathy in children, can cause lymphoma and lymphogranulomatosis.
7. HSV type 7 virus is poorly investigated, but it is considered one of the causes of cerebral palsy.
8. HSV type 8 leads to the development of Kaposi's sarcoma (in case a person has   immunodeficiency) 

Most often, people suffer from HSV types 1 and 2. Moreover, these pathogens can replace each other. As an example, herpes on the lip can be caused by a pathogen of type 2 and a rash on the genitals can be caused by HSV type  1.

Signs and symptoms

Most cases of herpes infection  are caused by HSV types 1 and 2.

Typical symptoms of the herpes simplex virus:

•  burning, pain and discomfort in some part of the body without visible skin lesion at first;
• In a few hours (up to a day) a vesicular rash appears in this place in the form of small blisters filled with a clear liquid;
• within 1–2 days, the number of vesicles may increase;
• the content of the rash become turbid in a few hours;
•  1–3 days the rash open by themselves, a spot of erosion is formed in this place;
• the wetting area quickly dries up and becomes covered with crusts, which fall off after 5–10 days;
• after the crusts fall off, a pigment spot remains, which soon acquires the color of normal skin.

A similar course is characteristic of the disease with localization on the mucous membranes of the mouth, in the area of the lips, nose, near the eyes, on the genitals and in the groin. There is one more feature that herpes manifests itself on the body: during each exacerbation, burning, pain and rashes appear on different areas of the skin, which is why the Greeks called the disease herpes - creeping.

Temperature and general well-being during a typical herpetic attack, as a rule, remain normal.

There are also atypical forms of infection, for example, when a spot is formed instead of vesicles, which quickly disappears. But the main symptom of herpes - pain and burning - is always noted. This is due to the fact that viruses leave the cells and move to the surface of the skin along sensitive nerve endings and irritate them.

Risks and consequences

In people with preserved immunity, an episode of dermatitis herpetiformis usually lasts 10–14 days. If the body's defenses are weakened, new rashes form every few days and the attack lasts for 1-2 months or longer.

Against this background, erosions can become infected, leaving behind unattractive deep scars. There is also evidence that frequent recurrences of herpes can increase the risk of skin cancer.

We recommend turn to  a Universum clinic’s dermatologist if HSV symptoms occur every year or more often. Consultation, diagnosis and treatment will help protect the patient himself, protect other people and family members from infection.

Transmission of infection

• contact-domestic, through a towel, washcloth, body contact;
• airborne during conversation, coughing, sneezing;
• sexually transmitted (typical for the urogenital form of viral infection);
• intrauterine, from a virus-infected mother to a child, both during pregnancy and during childbirth.

If the disease is in an active phase, the risk of infection increases many times. Pathogens remain infectious on tissues for about an hour, so herpes on the face and other parts of the body often appear as a result of using a common towel. On  average he incubation period for herpes is 7–10 days from the moment of infection, but it can be prolonged for several months or years.

Provocative factors

Once on the skin, the causative agents enter the nerve nodes of the spinal cord, trigeminal and facial nerves along the nerve fibers. And they accumulate there (remission period) until a situation favorable for an exacerbation occurs.

As a rule, recurrences of rashes occur after:

• stress;
• hypothermia, where the term ‘cold on the lips’ came from;
• taking drugs that weaken immunity;
• severe bacterial infections, such as pneumonia.

A serious factor that provokes protracted and severe attacks of herpes is HIV. Such people need consultation with an infectious disease specialist and treatment of immunodeficiency.

Diagnostics

• polymerase chain reaction (PCR);
• method of direct immunofluorescence (PIF);
• enzyme immunoassay (ELISA)

Treatment

• relieve symptoms of an acute process (itching, pain, burning);
• prevent complications of the disease;
• put the disease into remission and prolong it as much as possible;
• reduce the risk of transmitting pathogens to other people.

In the acute phase of the disease, the following can be prescribed:

• ointments and creams with an antiviral component on the foci of rashes;
• antiviral agents internally in the form of tablets, injections;
• immunomodulatory drugs, inducers of endogenous interferon;
• anti-inflammatory and wound healing therapy;
• medicine for the prevention of bacterial complications.

Control of the effectiveness of the treatment is carried out regularly, while not only assessing the condition of the skin, but also the level of immunoglobulins in the blood.

After clinical recovery, the Universum clinic’s  doctor provides recommendations for anti-relapse treatment: courses should be taken 1-2 times a year.

Vaccination is often relevant

Prevention

Unfortunately, it is very difficult to avoid infection with herpes viruses. To reduce the risk, it is necessary to:

• strictly follow the rules of personal hygiene;
• regularly use soap;
• do not drink from other people's dishes, do not take other people's cutlery;
• thoroughly wash dishes and laundry after guests;
• avoid casual sexual contacts, kisses;
• lead a healthy lifestyle and strengthen the immune system.

The most important point is to avoid contact with potentially sick people who have a rash resembling herpes on the hands, lips, and face.

If suspicious symptoms appear, contact an experienced dermatologist for treatment. At an early stage: when the skin already hurts, but there are no rashes yet.

Литература

1. Widener RW, Whitley RJ. Herpes simplex virus. Handb Clin Neurol. 2014;123:251-63. doi: 10.1016/B978-0-444-53488-0.00011-0. PMID: 25015489.
2. Fatahzadeh M, Schwartz RA. Human herpes simplex virus infections: epidemiology, pathogenesis, symptomatology, diagnosis, and management. J Am Acad Dermatol. 2007 Nov;57(5):737-63; quiz 764-6. doi: 10.1016/j.jaad.2007.06.027. PMID: 17939933.
3. Jensen LA, Hoehns JD, Squires CL. Oral Antivirals for the Acute Treatment of Recurrent Herpes Labialis. Annals of Pharmacotherapy. 2004;38(4):705-709. doi:10.1345/aph.1D285
4. Chi CC et al. Interventions for prevention of herpes simplex labialis (cold sores on the lips). Cochrane Database Syst Rev. 2015 Aug 7;2015(8):CD010095. doi: 10.1002/14651858.CD010095.pub2. PMID: 26252373; PMCID: PMC6461191.