Herpes Simplex Virus
The Herpes simplex virus (HSV) is a type of common contagious DNA virus that causes cold sores and sexually transmitted infection.
WHO estimates there are at least 500 million people living with genital herpes and few billion people living with oral herpes infection worldwide (as per WHO’s article, ‘Massive proportion of world’s population are living with herpes infection’.)
There are two types of herpes simplex viruses.
- Herpes Simplex 1 (HSV1)
- Herpes Simplex 2 (HSV2)
This type of virus is usually endemic all around the world. Herpes Simplex virus often can remain in the body without causing any symptoms and can be transmitted from person to person even when the patient is asymptomatic. However, it is most contagious when the symptoms manifest in the form of blisters or cold sores.
Stages of Infection
There are different stages of Infection in HSV.
- Primary stage, which occurs when you are first exposed to the disease and produce symptoms.
- Latent stage happens after the primary infection and frequently produces no symptoms. The viral particles during this stage spread to the nerves nearby and can remain in the body lifelong by lying dormant.
- Shedding of virus can occur during the asymptomatic period and spread via saliva, body fluids and semen.
These viral particles can get reactivated when the body’s immune system is weak and produces a re-infection during this time. Thus, the virus has the ability to produce infections recurrently throughout a person’s life. Hence, HSV remains incurable once a person contracts the infection.
HSV 1
Herpes Simplex 1 virus (HSV 1) commonly causes cold sores around the mouth, typically on one side of the face.
Oral herpes is more common in children than adults.
How does HSV 1 spread?
It spreads via close contact with infected persons, through saliva, kissing and through body fluids and sexual contact.
How do you identify the symptoms of HSV 1?
- Appearance of fluid filled blisters with crusting around the mouth, lips, tongue or face
- Fever may be present with enlarged lymph nodes in children
- Sensation of tingling pain and burning near the mouth
- Throat irritation and pain in adults
- Appearance of blisters on the genitalia or anal region (less common)
HSV 2
Herpes Simplex 2 virus (HSV 2) causes genital herpes.
HSV 2 infection, in particular, can increase the risk of acquiring HIV infection by three times as per research by the WHO, ‘Massive proportion of world’s population are living with herpes infection’.
How does HSV 2 spread?
This type of infection is spread as a sexually transmitted disease through saliva, vaginal fluid, semen and other body fluids.
How do you identify the symptoms of HSV 2?
- Appearance of ulcers in the female genitalia (labia, mons pubis, vagina and cervix)
- Appearance of ulcer in male genitalia (Shaft of the penis)
- Ulcers in the anal region
- Tingling sensation or pain in legs or back
HSV 1 and HSV 2 can also be transmitted during childbirth from mother to child and are called as neonatal herpes. Neonatal herpes affects the skin, eye and mucous membrane. In more severe cases, it also impacts the central nervous system causing Encephalitis or meningitis. This can be life-threatening; however, it is rare.
Herpes in other areas
Herpes Whitlow
Herpes Whitlow is an infection of the skin around the fingers due to contact with HSV 1 or HSV 2.
Herpes Gladiatorum
Herpes Gladiatorum occurs due to HSV 1 infection due to skin to skin contact.
Eczema Herpeticum
Eczema Herpeticum occurs in patients who already have pre-existing skin conditions with weakened skin barriers acquiring infection of HSV 1.
HSV 1 and HSV 2 can also cause eye infection called Keratoconjunctivitis Herpetica.
Meningitis and Encephalitis
Meningitis and Encephalitis can rarely result as a complication of severe HSV 1 or HSV 2 and is life-threatening if left untreated.
Investigations done to confirm HSV
- HSV PCR genital swab
- Herpes antibody test
- HSV culture genital swab
- HSV PCR of blood
Treatment for HSV
Most of the time, symptoms can resolve without any treatment.
- Painkillers and anti-inflammatory medications can help reduce pain.
- Keeping the area affected clean and dry
- Warm water soaks can help soothe pain and inflammation
- Antivirals medications and steroids can be used in more severe infections.
Prevention for HSV
- To avoid oral contact with symptomatic persons
- To avoid sharing of food and water
- Avoid sharing utensils, cosmetics, toiletries with symptomatic individuals
- Abstinence of sexual activity while symptomatic
- Using a condom to prevent the spread of infection
Currently, there are no vaccines for HSV and are still under research.
Conclusion
HSV infection remains to be a disease that once contracted is incurable and can be reactivated many times once infected. Hence, awareness and prevention with the help of safe sexual practices will help reduce the disease burden around the world.
