Herpes simplex virus (HSV) type 1 and type 2 are frequent causes of primary and recurrent infections on the skin and mucous membranes of the oral cavity, lips and genitals.
Herpes simplex viruses are widespread around the world. They can lead to primary, latent and recurrent infections.
Primary infection means that a person has not previously been in contact with the virus and hasn’t developed specific antibodies to this virus. In latent infections, the virus is present in sensory ganglia in a dormant state without visible changes on the skin and mucous membranes. In case the immunity weakens due to some other diseases, use of immunosuppressive drugs, intense emotional stress, exposure to ultraviolet radiation or surgical interventions, the virus may reactivate and cause recurrent visible infection.
What does Herpes simplex viral infection look like?
Herpes simplex virus can have different clinical pictures, that partly depend on whether the infection is primary or recurrent, from the location of the infection, as well as on the immunity of the infected person.
Primary infections are characterised by more intense lesions, as well as more pronounced pain. Symptoms occur 5 to 7 days after exposure to the virus. Initially, malaise, enlargement of regional lymph glands, increased body temperature are present. In the area where lesions appear, the skin is red, swollen and painful, later small clustered vesicles (blisters) develop and break, leaving erosions covered with scabs. The lesions recede in a period of 2 to 6 weeks.
Similar problems are also observed in recurrent infections, but their intensity is less stronger and the duration is shorter. Sometimes in recurrent infections, only clustered vesicles on a red base appear, followed by a pain or burning sensation.
In oral cavity and in lip area, primary infections are often asymptomatic. Usually they are caused by Herpes simplex virus type 1. If they manifest, gingivostomatitis develops, which is an inflammation of the buccal mucosa and gums characterised by numerous, extremely painful erosions, making eating extremely difficult.
People with latent infection often develop recurrent herpes labialis, lesions on the lips in the form of tiny blisters, grouped on a red base. Less commonly lesions are observed on the skin around the lips, on the cheek or on the mucous membrane of the nose.
On the genitals, primary and recurrent infections are most often asymptomatic (without problems and visible lesions) and they are caused by Herpes simplex virus type 2 and type 1. Sometimes lesions appear as erosive balanitis (the appearance of spotted erosions on the penis), vulvitis or vaginitis (the appearance of erosions on the labia minora and labia majora, and on the vaginal mucosa). Clustered vesicles and scabs on the gluteus or on the hips are less common.
What other infections Herpes simplex virus causes?
Eczema herpeticum is a form of Herpes simplex virus infection that develops in children, less often adults, with atopic dermatitis. Widespread erosions covered with hemorrhagic (bloody) scabs with some blisters develop. The general condition of a patient is poor with malaise, high fever, dehydration and enlargement of the lymph glands. Bacterial superinfection, pneumonia and encephalitis may also appear. This condition requires immediate treatment, most often hospital care.
Herpetic whitlow — most commonly observed in adolescents or children. The causative agent is usually Herpes simplex virus type 1. It is characterised by swelling, redness and clustered blisters on a finger, accompanied by a feeling of pain. The diagnosis is most often made based on recurrent lesions in the same location.
In immunodeficient people and people who have HIV infection, receive immunosuppressive therapy or have advanced malignancies, a severe, widespread Herpes simplex virus infection may develop with many complications.
In newborns, the Herpes simplex virus can cause eye infection (unilateral or bilateral keratoconjunctivitis), as well as herpetic meningoencephalitis (inflammation of the brain and meninges).
How is Herpes simplex virus infection treated?
In local therapy of herpes labialis, most often topical preparations are used:
* Acyclovir 5% ointment 5 times daily for 7 to 10 days;
* Penciclovir 1% cream several times throughout the day for 4 days in a row or a combination of Acyclovir and Hydrocortisone ointment 5 times daily for 5 days.
In case a bacterial superinfection develops, then antibiotic ointments should be used.
Herpetic infection of the oral mucosa is treated with oral antiseptics with/without systemic antiviral therapy.
Recurrent episodes of orolabial herpes can be treated with valacyclovir 2 times daily for 1 day or with a single dose of famciclovir of 1.5 g with an adequate topical therapy.
With genital herpes infections, primary and recurrent, it is recommended to use oral antiviral drugs during the first 24h to 48h from the appearance of lesions. Acyclovir, valacyclovir or famciclovir can be used.
If a person has 6 or more episodes of acute HSV infection during one year, oral antiviral therapy should be administered: Acyclovir 400 mg 2 times daily, Famciclovir250 mg 2 times daily or Valacikovir500 mg daily.
It is also important to act preventively in terms of boosting the immune system and the organism as a whole, which involves a healthy lifestyle, sufficient sleep, adequate nutrition and avoidance of stress. Supplements such as zinc, probiotics and vitamins C and D may be used.