Herpes is any of a variety of conditions that are characterized by an eruption of small, usually painful, nlisters on the skin. The term “herpes” usually refers to an infection with the herpes simplex virus. Two forms of the virus, called HSV1 and HSV2, are generally responsible for cold sores and genital herpes, respectively. A closely related organism, the varicella zoster virus, is responsible for two other conditions in which skin blisters are a feature: chick-enpox and herpes zoster (shingles).

HERPES SIMPLEX

Herpes simplex is a common viral infection that is characterized by small, fluid-filled blisters. Herpes simplex infections are contagious and are usually spread by direct contact. Most infections are quite mild.

Types of herpes simplex

There are two forms of the virus: HSV1 (herpes simplex virus 1) and HSV2 (herpes simplex virus 2). Most people are infected with HSV1 at some time in their lives, usually during childhood. HSV1 is usually associated with infections of the lips, mouth, and face; HSV2 is often associated with infections of the genitals and infections acquired by babies at birth. There is considerable overlap between the two types; sometimes, conditions usually due to HSV1 are caused by HSV2, and vice versa.

Type 1 virus

The initial infection may be symptomless; alternatively, it may cause a flu like illness with mouth ulcers. There-after, the virus remains dormant in nerv cells in the facial area. In many people, the virus is periodically reactivated, causing cold sores that invariably erupt in the same site (usually around the lips).

Sometimes the virus can infect a finger after touching a cold sore, causing a painful eruption called herpetic with-low. HSV1 may also produce eczema herpeticum (an extensive rash of skin blisters) in a person with pre-existing skin disorder, such as eczema. Eczema herpeticum may require hospital admission. If the virus gets into an eye it may cause conjunctivitis, which usually lasts  only a few days; more seriously, it may cause a corneal ulcer.

Rarely, HSV1 spreads to the brain leading to encephalitis. The virus may cause a potentially fatal generalized infection in a person with immuno-deficiency disorder or in someone taking immunosuppressant drugs.

Type 2 virus

HSV2 is the usual case of sexually transmitted genital herpes, in which painful blisters erupt in the genital area. In some people, the blisters tend to recur.

Herpes Simplex treatment

Treatment of herpes simplex depends on its type, site, and severity of symptoms. Antiviral drugs, such as aciclovir, may be helpful, particularly if used early in an infection.

GENITAL HERPES

Genital herpes is a sezually transmitted bu oral contact with the genitals. After an incubation period of about a week, the virus produces soreness, burning, itching, and small blisters in the genital area. The blisters burst to leave small, painful ulcers, which heal in 10 to 14 days. The lymph nodes in the groin may become enlarged and painful, and the person may develop other symptoms such as headache, fever, and aching muscles.

Genital herpes treatment

Genital herpes cannot be cured, but early treatment can reduce the severity of symptoms. Antiviral drugs, such as aciclovir make ulcers less painful and also encourage healing. Other measures include taking analgesic drugs and bathing the genital area in a salt solution.

Genital herpes outlook

Once the virus has entered the body, it stays there for the rest of the person’s life. Recurrent attacks may occur, usually during periods when the person is feeling run down, anxious or depressed, or, in some cases, a few days before menstruation. The virus may be shed continuously and can be transmitted to others through sexual intercourse, even when the infected person has no symptoms. Recurrent attacks tend to become less frequent and less severe over time. Genital herpes may be passed from a pregnant woman to her baby during delivery. If the genital herpes develop in late pregnancy, delivery by caesarean section is usually recommended.

HERPES GESTATIONIS

Herpes gestiationis is a rare skin disorder of pregnant women that produces crops of tense, itchy blisters on the legs and abdomen. Herpes gestationis is an autoimmune disorder that is essentially a type of pemphigoid triggered by pregnancy.

Severe cases are treated with corticosteroid drugs. An affected woman may need to be monitored as there is an increased risk of fetal prematurity and low birth-weight. The disorder may initially worsen after delivery but then clears up. It tends to recur in subsequent pregnancies.

HERPES ZOSTER

Herpes zoster is an infection of the nerves supplying certain skin areas that is characterized by a painful rash of small crusting blisters. Also called shingles, herpes zoster is especially common among older people.

Herpes Zoster types

Herpes zoster usually affects only one side of the body, and follows the path of a nerve. It commonly develops on a strip of skin over the ribs, although the rash may also appear on the neck, arm, or lower part of the body. Sometimes the infection involves the face and eye; this form of the disorder is called herpes zoster ophtalmicus.

Herpes Zoster causes

Herpes zoster is caused by the varicella-zoster virus, which also causes chickenpox. After an attack of chickenpox, some of the viruses survive and lie dormant for many years in the nerve cells near the spinal cord. In some people, a decline in the efficiency of the immune system – especially in old age – because of disease or severe stress, allow the viruses to re-emerge and cause herpes zoster. The disorder is also common in peopl whose immune system is weakened by stress or by certain drugs, such as corticosteroid drugs or anticancer drugs.

Herpes Zoster symptoms

The first indication for herpes zoster is excessive sensitivity in the skin, followed by pain, which is often severe.  The infection can be difficult to diagnose at this stage and may be mistaken for a different condition; for example, pain in the chest wall may be mistaken for angina pectoris. After about five days, the rash appears as small, raised, red spots that soon turns into blisters. Within a few days, the blisters dry, the crusts drop off, sometimes leaving small pitted scars.

The most seriuos feature of herpes zoster is pain after the attack, known as postherpetic neuralgia, which affects about a third of all infected people. This pain is caused by nerve damage, and may last for months or years. Herpes zoster ophtalmicus may cause a corneal ulcer or uveitis (inflammation of the uvea: the iris, ciliary body and its muscle, and the choroid).

Herpes zoster treatment

If treatment is begun soon after the rash appears, antiviral drugs, such as aciclovir, will reduce the severity of the symptoms and minimize nerve damage. Analgesic drugs (painkillers) may also be helpful in relieving pain. If postherpetic neuralgia is a problem, anticonvulsant drugs, such as gabepentin, may be helpful.

Source: A-Z Family medical encyclopedia by BMA

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