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Herpes simplex Causes and Risks:
There are two strains of herpes viruses. Herpes simplex virus type 1 (HSV-1) is usually associated with infections of the lips, mouth, and face. It is common in children between 1 and 3 years old and may cause lesions inside the mouth and inflamed gums. It causes cold sores or fever blisters and is transmitted by oral and respiratory secretions (for example, sneezing or coughing can transmit the virus). Herpes simplex virus 2 (HSV-2) is usually associated with genital lesions and is transmitted by sexual contact. Cross-infection of type 1 and 2 viruses may occur from oral-genital sex. Both viruses are contagious and the first symptoms usually appear 1 or 2 weeks after contact with an infected person.
Most people have been affected with the type 1 virus by the age of 20. In addition to oral and genital lesions, the virus can also cause an infection of the eye involving the eyelid, conjunctiva , and cornea. A finger infection, called herpetic whitlow, affects health care providers (because of exposure to lung and mouth secretions during procedures) and young children. The herpes virus can also infect the fetus and cause congenital abnormalities. Herpes virus type 2 can be transmitted to a newborn during vaginal delivery if the mother is actively infected at the time of delivery. Encephalitis (rarely) may occur as a result of herpes infection.
Infection occurs after exposure to the virus through a break in the skin, or through mucus membranes. There is strong evidence that the virus may be transmitted even when symptoms are not present. The virus spreads to nerve cells within the body, and then to other mucosal skin surfaces. The virus remains dormant in the body after an active infection and recurrences of the symptoms can take place at a later time. Recurrences may be precipitated by overexposure to sunlight, fever, stress , or certain foods and drugs.
Prevention:
Prevention is difficult since the virus can be spread to others when the infected person has no evidence of a current outbreak; however, avoiding direct contact with an open lesion will lower the risk of infection.
In people with recurrent oral lesions, the use of sunscreen during sun exposure may reduce the frequency of outbreaks.
People with genital herpes should avoid sexual contact when active lesions are present. Safer sex behaviors including the use of condoms may also lower the risk of infection.
Pregnant women with herpes simplex infection should receive weekly viral cultures of the cervix and external genitalia as the delivery date approaches. At the time of delivery, if active lesions are present, or the viral culture is positive for herpes, a cesarean delivery ( C-section ) is recommended to avoid infecting the newborn.
Symptoms:
Additional symptoms that may be associated with this disease:
Signs and Tests:
Physical findings of blisters may be sufficient to diagnose herpes simplex.
The following tests may (occasionally) be performed:
Treatment:
Some cases are relatively mild and may not require treatment. Anesthetic mouthwashes such as 2% lidocaine or baking soda rinses may reduce the pain of lesions inside the mouth. Alcohol-based mouthwashes should not be used.
Gentle cleansing of skin lesions with soap and water is recommended. Warm baths may relieve the pain of genital lesions. Drying lotions such as calamine may relieve the pain of skin lesions. Petroleum based ointments should not be used because they promote viral spread and delay healing.
Oral acyclovir (Zovirax) may be prescribed to suppress recurrent eruptions of genital herpes .
If secondary infection of the skin lesions occur, topical antibiotics such as neomycin-bacitracin ointment, or oral antibiotics, are indicated.
Prognosis:
The lesions generally heal on their own in 7 to 10 days.
Once infected, the virus stays in the body for the rest of a person's life and recurrences of active infection may happen. Some people never have another episode, and some have 4 or 5 recurrences a year. Subsequent infections tend to occur after exposure to the sun and stressful events.
Complications:
Call Your Healthcare Provider:
Call for an appointment with your health care provider if herpes symptoms do not resolve in 7 to 10 days, or if there are frequent recurrences of symptoms.
This individual has a small herpetic lesion on the upper lip at the corner of the mouth and new blisters (vesicles) that are forming on the cheek.
This individual has a fairly extensive herpetic lesion on the upper lip and below the nose. Note the swelling and distortion of the left half of his upper lip (right side of picture).
This child has a herpes simplex infection around his eye. These lesions will go through the same evolutionary stages as the typical cold sore: burning and pain, vesicle formation, ulceration, crusting, and clearing. One complication is infection of the cornea, which could cause corneal scarring and vision loss.
A herpetic whitlow is an infection of the herpes virus around the fingernail. In children, this is often caused by thumbsucking or finger sucking while they have a cold sore. It is seen in adult healthcare workers such as dentists because of increased exposure to the herpes virus. The use of rubber gloves prevents herpes whitlow in healthcare workers.
A herpetic whitlow is an infection of the herpes virus around the fingernail. In children, this is often caused by thumbsucking or finger sucking while they have a cold sore. It is seen in adult healthcare workers such as dentists because of increased exposure to the herpes virus.
Herpes is generally a localized infection. In immunocompromised individuals such as this one, the lesions are seen on the chin and neck. In people who have AIDS, herpes can spread rampantly. It is extremely difficult to treat in the absence of a competent immune system.
Herpes labialis is a form of herpes simplex virus that appears on the lips (also known as cold sores). This child has an extensive herpetic lesion on the upper lip and cheek. This may represent the initial infection for this child, which is often more severe than subsequent infections.
A herpetic whitlow is an infection by the herpes virus around the fingernail. In children, this is often caused by thumbsucking or finger sucking while they have a cold sore. Adult healthcare workers may be exposed to the herpes virus if protective gloves aren't worn.
Herpes simplex around the mouth is also known as cold sores. This is a representation of an extensive infection of the herpes simplex virus.
A severe infection with the herpes simplex virus. Note the multiple fluid-filled blisters (vesicles). These vesicles will break, ooze, crust, and finally scab-over during the process of healing. These lesions can be quite painful.
Herpes lesions on the face: Although usually seen on the lips and immediate surrounding skin, herpes outbreaks can occur anywhere on the face or other areas of the body if those areas become infected. In this photograph, the blisters (vesicles) of early herpes infection are very apparent. This appearance is easy to confuse with early shingles (herpes zoster) on the face.
This close-up view of early herpes outbreak shows small, grouped blisters (vesicles) and lots of inflammation (erythema).
Herpes simplex, whitlow: A herpetic whitlow is an infection by the herpes virus around the fingernail. In children, this is often caused by thumb sucking or finger sucking while they have a cold sore. Health care workers, such as dentists, have increased exposure to patients with active herpes lesions on the lips, but the spread can be prevented with the use of gloves.
Herpetic whitlow is an infection of the finger (or fingers) by the herpes virus. It begins with stinging tingling, followed by the appearance of blisters (vesicles) which rupture and crust over, followed by healing. This is frequently a recurrent process. This photograph demonstrates severe involvement of the 3rd finger.
A herpetic whitlow is an infection of the finger (or fingers) by the herpes virus. It begins with stinging tingling, followed by the appearance of blisters (vesicles) that rupture and crust over, followed by healing. This is frequently a recurrent process. This photograph demonstrates the early stage of infection.
A herpetic whitlow is an infection of the finger (or fingers) by the herpes virus. It begins with stinging tingling, followed by the appearance of blisters (vesicles) that rupture and then crust over, and then healing. This is frequently a recurrent process. This photograph demonstrates a slightly later stage of infection, with ulcers just developing.
A herpetic whitlow is an infection of the finger (or fingers) by the herpes virus. It begins with stinging tingling, followed by the appearance of blisters (vesicles) that rupture and crust over, followed by healing. This is frequently a recurrent process. This photograph demonstrates severe involvement of the 3rd finger.
A herpetic whitlow is an infection of the finger (or fingers) by the herpes virus. It begins with stinging tingling, followed by the appearance of blisters (vesicles) that rupture and crust over, followed by healing. This is frequently a recurrent process.
Herpes virus, the cause of cold sores, can also infect the membranes of the eye. Herpes simplex keratitis causes inflammation of the white of the eye and can damage the cornea. Corneal damage has occurred, and is stained green (about 12:00 o'clock on the iris) with a dye called fluorscein. Some of the dye is pooled along the lower lid margin. Herpes infection in the eye can cause corneal scarring with vision loss.
Herpes simplex virus normally infects mucous membranes. In people with weakened immune systems (immunocompromised) it may infect many areas including the skin. A large are of tissue has been damaged with some tissue death (necrosis). These infections are difficult to treat.
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