HERPES INFECTIONS

DEFINITION

Herpes infections are a group of diseases caused by a herpes virus. There are eight different herpes viruses that can infect humans. Two of these, herpes simplex type 1 and herpes simplex type 2, occur commonly. They cause cold sores and genital herpes.

DESCRIPTION

Cold sores are a very common health problem. More than 60 percent of Americans have had a cold sore. Nearly 25 percent of these individuals have repeated outbreaks of cold sores. Cold sores are also known as fever blisters or oral herpes. They are usually caused by herpes simplex virus 1 (HSV1).

Herpes Infections: Words to Know

Latency:

A period of time during which a virus is not active.

Prodrome:

A period of time during which certain symptoms signal the beginning of a disease.

Ulcer:

An open wound in the skin or mucous membrane that is usually sore and painful.

Most people are first infected with HSV1 before the age of ten. Once the virus enters the body, it remains there for life. Cold sores are painful blisters filled with fluid. They usually occur on the lips. By contrast, canker sores usually occur on the tongue, inside the cheeks, or elsewhere inside the mouth.

Genital herpes are also painful blisters filled with fluid. They are caused by a close relative of HSV1, herpes simplex virus 2 (HSV2). A common rule of thumb is that HSV1 causes infections above the waist and HSV2 causes infections below the waist. But that rule is not completely true. Either virus can cause infections above or below the waist. Still, the rule is a good general guideline as to where each virus is most likely to be active.

Viruses that enter the body often go through a latency period. A latency period is a stage during which the virus goes into hiding. It can be found in cells, but it is not active. There are no external symptoms that the virus is in the body.

At some point, however, the virus becomes active again. Any number of factors can cause reactivation of the virus. Physical or emotional shock is a common cause. When the virus becomes active again, symptoms of the infection reappear.

This pattern explains why cold sores and genital herpes commonly appear and then disappear. Each new appearance does not mean a new infection. It means that the virus has emerged from its latency period and become active again.

CAUSES

Both HSV1 and HSV2 are transmitted directly between people. Cold sores are spread, for example, when an uninfected person touches an infected person. A common means of transmission is by kissing. The greatest risk for spreading the virus occurs when blisters are present on the lips. But it can also be spread when there are no blisters.

Genital herpes is spread only through sexual contact. When an uninfected person comes into contact with the blisters on another person's body, the virus may be transmitted. Genital herpes is spread between genital areas in most cases, but it can also be spread to the mouth during oral sex.

NEONATAL HERPES

Pregnant women with genital herpes can pass the infection to their newborn babies. The babies are infected as they pass through the birth canal. The infection that occurs in babies is known as neonatal herpes. About 1 in 3,000 to 5,000 babies born each year in the United States will develop neonatal herpes. The infection can be avoided by having the baby delivered by cesarean section. A cesarean section is a procedure in which an incision (cut) is made in the stomach wall. The baby is then removed through the incision. Babies born with herpes can become very ill and die from the disease.

SYMPTOMS

Not everyone who is infected with the herpes virus will develop symptoms. Among those who do, the symptoms first appear within two to twenty days of infection. Symptoms that develop after the original infection are generally severer than those that appear in later episodes of the disease.

The first stage of infection often involves a set of symptoms called a prodrome. The prodrome is a warning sign that an infection has begun to develop in the body. Some symptoms of a herpes prodrome include pain, burning, itching, or tingling at the site where the blisters will form. The prodrome lasts anywhere from a few hours to a few days.

Following the prodrome, the characteristic herpes blisters begin to appear. Cold sore blisters first appear in the form of small red bumps that quickly fill with fluid. The blisters are very painful. They may either burst and form a scab or dry up and form a scab. The skin heals without scarring within six to ten days.

The appearance of genital herpes is somewhat different. The blisters formed in the genital area also begin as small red bumps that fill with liquid. In dry areas, the blisters form a scab and heal within two to three weeks. In moist areas, the blisters usually break and form painful ulcers before healing. New blisters may form over a period of a week or longer. They may then join to form very large ulcers (open sores). The pain usually disappears after about two weeks. The blisters and ulcers heal without scarring in three to four weeks.

Both forms of herpes tend to recur on a regular basis. In the case of cold sores, most people experience fewer than two outbreaks each year. This pattern varies considerably, however. Some people never have a second episode of cold sores, while others have many such episodes. Those who do have further outbreaks usually get blisters in the same area each time. They also tend to be triggered by the same factors, such as stress or exposure to sun.

Genital herpes tends to recur more often than cold sores. About 40 percent of persons infected with HSV2 will experience six or more outbreaks per year. The vast majority of patients with genital herpes will have at least one outbreak every year. Reoccurrences of HSV2 infections tend to be less severe than the initial outbreak. Patients usually have fewer blisters and less pain. The time between outbreak and healing may also get shorter with each outbreak.

DIAGNOSIS

Cold sores and genital herpes both have a very distinctive appearance. Simple observation of a patient's symptoms often provides a strong indication of the problem. However, the symptoms of the two diseases are somewhat similar to those of other infections. Cold sores, for example, look something like a bacterial infection known as impetigo. There may also be some confusion between cold sores in the mouth and canker sores.

A variety of diseases cause sores in the genital area also. Some examples include syphilis, chancroid, herpes zoster (another infection caused by the herpes virus), and inflammatory bowel disease. In some cases, it is difficult to distinguish the blisters and ulcers caused by genital herpes and sores produced by other diseases.

To confirm a diagnosis, a doctor can do a culture of cells taken from the infected area by wiping a clean cotton swab over the infected area. The material collected on the swab is then kept in a warm, moist environment for a few days. The organisms responsible for the infection can be identified when examined under a microscope.

TREATMENT

There is no cure for herpes virus infections. However, there are antiviral drugs that can relieve some symptoms of these infections. Antiviral drugs interfere with the growth of viruses. They work best when used as early in an infection as possible. For the best results, treatment should begin during the prodrome stage of infection. Antiviral drugs may also prevent future outbreaks of cold sores or genital herpes.

The preferred antiviral for treatment of herpes infections is acyclovir (trade name Zovirax). The drug is most effective when injected directly into the bloodstream or taken orally (by mouth). It can also be used as a lotion and applied directly to sores, but it is less effective when used this way.

Treatments are also available to relieve the symptoms of herpes infections. Patients with cold sores should avoid salty foods, citrus foods, and other foods that irritate the sores. The sores can be washed once or twice a day with warm, soapy water. Over-the-counter medications that contain the chemical phenol can provide some relief too. Blistex Medicated Lip Ointment is an example of this kind of medication. Aspirin, acetaminophen, or ibuprofen can also be used to relieve the pain of cold sores. Children, however, should not take aspirin as it can cause Reye's syndrome (see Reye's syndrome entry).

There are several things a patient can do to reduce the pain of genital sores. Wearing loose-fitting clothing and cotton underwear is helpful. Soaking in a tub of warm water and using a blow-dryer set on the cool setting to dry the infected area may help. Putting an ice pack on the infected area for 10 minutes may also help relieve pain. A zinc sulfate ointment may help heal sores. Applying a baking soda compress to sores may be soothing.

Alternative Treatment

Some people believe that a contributing factor in herpes infections is an imbalance in amino acids. Amino acids are the building blocks from which proteins are made. The two amino acids thought to be involved in a herpes infection are lysine and arginine. Based on this theory, some practitioners recommend a diet rich in lysine to prevent the reoccurrence of cold sores. Foods rich in lysine include most vegetables, legumes (peas and beans), fish, turkey, and chicken.

Herbalists recommend a variety of herbs to protect against herpes infections. Echinacea and garlic are thought to strengthen the immune system. Members of the red algae family are believed to be effective in treating HSV1 and HSV2 infections. Some ointments and salves that may relieve the pain of herpes include zinc sulfate, lithium succinate, licorice, lemon balm, and peppermint.

Stress is thought to be one of the factors that bring on an attack of herpes. Some methods for relieving stress include acupressure, massage, meditation, yoga, tai chi, and hypnotherapy.

PROGNOSIS

There is no cure for any type of herpes infection. Most such infections are painful and sometimes embarrassing. However, they generally get better on their own without any permanent scarring or damage to the body. In many cases, infections become less frequent and severe as a person grows older.

In relatively rare cases, both types of infection can have more serious complications. For example, the spread of HSV1 to the eyes can cause damage, which may impair vision. The spread of HSV2 to the cervix, urinary system, anal opening, and nervous system can produce more dangerous infections of these areas.

PREVENTION

The only way to prevent a herpes infection is by avoiding contact with an infected person. While good advice, that policy may be difficult to follow. Many infected people do not know that they carry the virus. Or they may not be concerned because the virus is in a latent stage. In the case of genital herpes, some people may choose not to tell their sexual partners that they are infected.

Having a man use a condom during sexual intercourse can provide partial protection against genital herpes. The condom reduces, but does not eliminate, the chance of spreading HSV2.

A number of suggestions have been made for reducing the risk of having a reoccurrence of oral herpes. These include:

• Avoid exposure to the sun, which appears to trigger outbreaks of oral herpes.
• Avoid touching cold sores, since doing so may spread the virus to other parts of the face or body.
• Wash hands thoroughly and frequently, so that an infected person is less likely to transfer HSV1 to other persons.
• Avoid physical contact with other people when one has an active infection.
• Wear gloves when applying ointment to a child's sore.
• Be especially careful in handling young babies by not kissing their eyes or mouth if you are infected.
• Monitor children with cold sores so that they do not transmit the virus to other children by way of toys.
• Maintain good general health to reduce the risk of contracting a cold or the flu, which are known to bring on cold sores.

See also: Sexually transmitted diseases.

FOR MORE INFORMATION

Books

Ebel, Charles. Managing Herpes: How to Live and Love with a Chronic STD. Research Triangle Park, NC: American Social Health Association, 1998.

Harknett, Philippa. Herpes Simplex: The Self-Help Guide to Managing the Herpes Virus. London: Thorsons Publications, 1995.

Sacks, Stephen L. The Truth about Herpes. Seattle, WA: Gordon Soules Book Publishers, 1997.

Periodicals

Kott, Andrea. "The Common Cold Sore." Parents (November 1997): pp. 101–05.

Web sites

JAMA Women's Health Information Center. [Online] http://www.ama-assn.org/special/std/std.htm (accessed on April 8, 1998).

Mayo Health Oasis. [Online] http://www.mayohealth.org (accessed on March 3, 1998).