What is the herpes simplex virus?

Risk factors: Sexually active adolescents and adults are at risk of infection with HSV2. People with weakened immune systems, such as cancer patients, are at an increased risk of recurring HSV infection and disease.

Etiology and the disease process: Once a person is infected, the virus spreads to the nerve cells and remains in the body (in a latent form) for life.

The lesions in the genital area first look like red bumps but then turn into watery blisters that may open up, ooze fluid, or bleed. The lesions usually heal in seven to ten days but may take up to four weeks to heal. The lesions may reappear every now and then, usually after periods of stress, fever, or overexposure to sunlight.

Cancer, human immunodeficiency virus (HIV), acquired immunodeficiency syndrome (AIDS), and the use of medications (corticosteroids) that weaken the immune system may also trigger the reappearance of symptoms.

Some studies have suggested that women infected with both herpes simplex virus and a high-risk type of human papillomavirus (HPV) have a greater likelihood of developing cervical cancer than women who have only the HPV infection. However, HSV infection need not be present for cervical cancer to develop.

Incidence: Infections with herpes simplex virus are ubiquitous and are transmitted from person to person whether or not they have symptoms. Most children will acquire an HSV1 infection during their first few years of life, usually through contact with infected saliva. In the United States, 53.9 percent of Americans aged fourteen to forty-nine had antibodies to HSV1 and 15.7 percent had antibodies to HSV2 between 2005 and 2010, as reported by H. Bradley et al. in 2013.

Symptoms: HSV infections in children beyond the neonatal (newborn) period, adolescents, and adults usually have no symptoms. HSV1 may cause fever (especially during the first episode), mouth sores (fever blisters), and enlarged lymph nodes in the neck or groin. HSV2 may cause genital lesions with a burning and tingling sensation, muscle pain, vaginal discharge, and trouble urinating.

Screening and diagnosis: HSV infections can be diagnosed by the physical appearance of the skin lesions. There are, however, laboratory tests available to diagnose herpes simplex virus infections, including blood and cell culture tests. Other available tests include the following:

• Tzanck test: The sore on the skin is scraped and the sample stained for examination under a microscope.





• Direct fluorescent antibody (DFA) test: This uses a fluorescent antibody to detect the presence of the virus.

Treatment and therapy: Mild cases of the disease may not require treatment. For more severe cases, two types of therapies are usually recommended episodic and suppressive. The episodic therapy consists of taking medication at the first sign of recurrence to accelerate the healing process of the lesions. The medication is taken for a few days until the lesions disappear. Suppressive therapy consists of taking a medication daily to eliminate or reduce recurrence. Suppressive therapy is usually recommended for people who have six or more recurrences per year.

Cancer patients with severe cases and frequent infections may be treated with antiviral drugs, such as acyclovir (Zovirax), famciclovir (Famvir), and valacyclovir (Valtrex). Acyclovir is available in ointment and pill forms. Valacyclovir uses acyclovir as its active ingredient but is adsorbed better by the body than acyclovir, thus requiring fewer daily doses. Famciclovir stops the virus from replicating, using the active ingredient penciclovir. Like valacyclovir, it is well absorbed by the body.

Prognosis, prevention, and outcomes: Herpes has no cure. Recurrences, however, may be milder over time. HSV skin lesions usually heal on their own in seven to ten days, but they may take longer to heal in people with weakened immune systems. People with genital herpes may feel ashamed or guilty and may think that they can no longer have sex; however, herpes can be treated and transmission can be prevented. Genital HSV infection may be prevented by the use of condoms and by reducing the number of sexual partners. Condoms, however, do not always cover the whole infected area and infection may occur.

There is no licensed vaccine against herpes simplex virus, but several candidate vaccines have been studied.

American Academy of Pediatrics. “Varicella-Zoster Infections.” Red Book: 2012 Report of the Committee on Infectious Diseases. Ed. L. K. Pickering, C. J. Baker, D. W. Kimberlin, and S. S. Long. 29th ed. Elk Grove Village: AAP, 2012. Web. 13 Oct. 2014.

Bradley, H., et al. "Seroprevalence of Herpes Simplex Virus Types 1 and 2—United States, 1999–2010." Journal of Infectious Diseases 209.3 (2013): 325–33. Web. 14 Oct. 2014.

"Cervical Cancer Prevention." Cancer.gov. Natl. Cancer Inst., Natl. Inst. of Health, 27 Feb. 2014. Web. 14 Oct. 2014.

Ebel, Charles. Managing Herpes: How to Live and Love with a Chronic STD. Rev. ed. Research Triangle Park: American Social Health Assn., 2002. Print.

"Herpes Simplex." American Academy of Dermatology. Amer. Acad. of Dermatology, 2014. Web. 14 Oct. 2014.

"Infections in People with Cancer." Cancer.org. Amer. Cancer Soc., 6 Nov. 2013. Web. 14 Oct. 2014.

Stanberry, Lawrence. Understanding Herpes. 2nd ed. Jackson: UP of Mississippi, 2006. Print.