Herpes
Facts
The Herpes Virus Family
There are eight herpes viruses currently known to infect humans.
These include; herpes simplex virus type-1 (HSV-1), commonly associated
with cold sores or fever blisters; HSV-2, most commonly associated
with genital herpes; varicella zoster virus, which causes chickenpox
and shingles; cytomegalovirus (CMV), associated with retinitis
and pneumonia in immunocompromised people; Epstein-Barr virus,
which causes infectious mononucleosis; human herpes virus 6 (HHV6),
causing childhood roseola; HHV7, which results in infectious mononucleosis
in children; and HHV8, associated with Kaposi’s sarcoma.
Despite the extensive range of symptoms of herpes virus infections,
all are characterized by the establishment of latent infection
and all have the potential to reactivate from latency.
Herpes simplex virus type-1: commonly causes herpes labialis (also
called oral herpes, cold sores or fever blisters), which are highly
infectious open sores that crust over before healing. Although
less probable, HSV-1 can also cause genital herpes.
Herpes simplex virus type-2: a contagious sexually transmitted
viral infection primarily causing genital herpes in men and women.
The telltale signs of genital herpes include recurrent clusters
of blisters, bumps and rashes in the genital areas and rectal lesions.
HSV-2 can also be responsible for herpes labialis, although less
often than HSV-1.
Structure of the Virus
The HSV-1 and HSV-2 viruses look identical by the electron microscope.
The glycoprotein G (gG) protein is unique to HSV-1 and HSV-2.
Serologic tests that use glycoprotein G-based technology accurately
discriminate antibodies due to HSV-1 from antibodies due to HSV-2.
The gG protein should not be confused with immunoglobin G (IgG).
IgG and other antibody classes (e.g. IgA and IgM) are elicited
by gG.
Genital Herpes Symptoms
Most people with genital herpes are unaware that they have the
disease because they never have symptoms or do not recognize them.
When they do occur, the symptoms (and severity) of genital herpes
vary from person to person. First episode symptoms of genital herpes
can appear within 2 to 10 days of infection and last an average
of 2 to 3 weeks. In many people, the first infection may be so
mild that it goes unnoticed. In other people, painful sores may
appear at the site of infection.
Other symptoms can include:
- tingling
- itching or burning sensation
- pain in the thighs, buttocks, or genital area
- vaginal discharge
- a feeling of pressure in the abdominal area
- flu-like symptoms (which may include swollen glands, headache, muscle ache or fever;)
- and painful or difficult urination.
Genital herpes symptoms are sometimes mistaken for:
Female
- Vaginitis
- Yeast infection
- Ingrown hair
- UTI/Bladder infection
Male
- Zipper burn
- Jock itch
- Ingrown hair
- Hemorrhoids
Transmission
HSV-1 and HSV-2 is released from the sores that the viruses cause,
but they also are released between episodes from skin that does
not appear to be broken or to have a sore. A person almost always
gets HSV-2 infection during sexual contact with someone who has
a genital HSV-2 infection. A person can get HSV-1 by coming into
contact with the saliva of an infected person. HSV-1 infection
of the genitals is caused by oral-genital sexual contact with a
person who has the oral HSV-1 infection or genital contact with
a person who has genital HSV-1 infection.
Increased risk of HIV with HSV-2 infection
There is significant evidence that there is synergism between
HSV-2 and HIV-1. These findings are bringing about a fundamental
change in physicians views about the importance of Herpes testing.
The paradigm shift means that concerns of physicians and health
officials are in concert with those of patients with known genital
herpes infections who have been concerned about transmission of
the disease. Almost all new cases of genital herpes are transmitted
by a person who is unaware of their HSV-2 status. Type specific
testing is important so treatment can be instituted.
To date, there have been over 30 studies that
have determined the risk for HIV acquisition among persons with
HSV-2 is fairly high. In international studies, there is the
establishment of linkage.
HSV-2 has a different natural history among HIV-infected
persons. Those
individuals that have both infections have more frequent HSV-2 activations, at much higher rates of viral shedding. Finally,
there are some data that HSV-2 is associated with increased
HIV plasma levels in people who have both infections. HSV-2
may be one of the core factors to determine the progression and
natural history of HIV disease. There are some early indications
that suggest that treatment for HSV may be associated with reductions
in plasma HIV levels.
Pregnancy
Women with herpes can have healthy babies. However, the risk of
transmission of genital herpes from an infected mother to the baby
is high among women who acquire the infection near the time of
delivery. The risk is lower among women with recurrent herpes at
term or who acquire the infection during the first half of pregnancy.
Prevention of neonatal HSV infection depends on preventing the
mother from acquiring genital herpes infection during late pregnancy
and avoiding exposure of the baby to herpes lesions during delivery.
Type-specific serologic testing may be useful to identify women
at risk of acquiring HSV when their partner has known or suspected
genital herpes.
Recurrences
After infection, the herpes virus remains inside nerve cells in
an inactive, latent state. In most people, the virus reactivates
from time to time and can cause new lesions to appear near the
site of the original outbreak. The virus can also reactivate without
causing any visible symptoms. During this time, small amounts of
virus can be shed and can infect a partner (asymptomatic viral
shedding.) Symptoms of recurrent episodes are usually milder than
initial outbreaks and usually of shorter duration. The frequency
and severity of recurrences varies greatly.
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