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Herpes simplex

Commonly called Herpes

Description:
Herpes simplex is a viral infection caused by the herpes simplex virus. Infections are categorized based on the part of the body infected. Oral herpes involves the face or mouth. It may result in small blisters in groups often called cold sores or fever blisters or may just cause a sore throat. Genital herpes, often simply known as herpes, may have minimal symptoms or form blisters that break open and result in small ulcers. These typically heal over two to four weeks. Tingling or shooting pains may occur before the blisters appear. Herpes cycles between periods of active disease followed by periods without symptoms. The first episode is often more severe and may be associated with fever, muscle pains, swollen lymph nodes and headaches. Over time, episodes of active disease decrease in frequency and severity. Other disorders caused by herpes simplex include: herpetic whitlow when it involves the fingers, herpes of the eye, herpes infection of the brain, and neonatal herpes when it affects a newborn, among others.

There are two types of herpes simplex virus, type 1 (HSV-1) and type 2 (HSV-2). HSV-1 more commonly causes infections around the mouth while HSV-2 more commonly causes genital infections. They are transmitted by direct contact with body fluids or lesions of an infected individual. Transmission may still occur when symptoms are not present. Genital herpes is classified as a sexually transmitted infection. It may be spread to an infant during childbirth. After infection, the viruses are transported along sensory nerves to the nerve cell bodies, where they reside lifelong. Causes of recurrence may include: decreased immune function, stress, and sunlight exposure. Oral and genital herpes is usually diagnosed based on the presenting symptoms. The diagnosis may be confirmed by viral culture or detecting herpes DNA in fluid from blisters. Testing the blood for antibodies against the virus can confirm a previous infection but will be negative in new infections.

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Symptoms:
Symptoms of herpes simplex virus typically appear as a blister or as multiple blisters on or around affected areas — usually the mouth, genitals, or rectum. The blisters break, leaving tender sores.

Oral herpes infection is mostly asymptomatic, and most people with HSV-1 infection are unaware they are infected. Symptoms of oral herpes include painful blisters or open sores called ulcers in or around the mouth. Sores on the lips are commonly referred to as “cold sores.” Infected persons will often experience a tingling, itching or burning sensation around their mouth, before the appearance of sores. After initial infection, the blisters or ulcers can periodically recur. The frequency of recurrences varies from person to person.

Genital herpes caused by HSV-1 can be asymptomatic or can have mild symptoms that go unrecognized. When symptoms do occur, genital herpes is characterised by 1 one or more genital or anal blisters or ulcers. After an initial genital herpes episode, which can be severe, symptoms may recur. However, genital herpes caused by HSV-1 typically does not recur frequently, unlike genital herpes caused by herpes simplex virus type 2 (HSV-2; see below).

Genital herpes infections often have no symptoms, or mild symptoms that go unrecognised. Most infected people are unaware that they have the infection. Typically, about 10-20% of people with HSV-2 infection report a prior diagnosis of genital herpes. However, clinical studies following people closely for new infection demonstrate that up to a third of people with new infections may have symptoms.

When symptoms do occur, genital herpes is characterised by one or more genital or anal blisters or open sores called ulcers. In addition to genital ulcers, symptoms of new genital herpes infections often include fever, body aches, and swollen lymph nodes.

After an initial genital herpes infection with HSV-2, recurrent symptoms are common but often less severe than the first outbreak. The frequency of outbreaks tends to decrease over time but can occur for many years. People infected with HSV-2 may experience sensations of mild tingling or shooting pain in the legs, hips, and buttocks before the appearance of genital ulcers.

Causes:
Herpes simplex type 1, which is transmitted through oral secretions or sores on the skin, can be spread through kissing or sharing objects such as toothbrushes or eating utensils. In general, a person can only get herpes type 2 infection during sexual contact with someone who has a genital HSV-2 infection. It is important to know that both HSV-1 and HSV-2 can be spread even if sores are not present.

Pregnant women with genital herpes should talk to their doctor, as genital herpes can be passed on to the baby during childbirth.

For many people with the herpes virus, which can go through periods of being dormant, attacks (or outbreaks) can be brought on by the following conditions:

*General illness (from mild illnesses to serious conditions)

*Fatigue

*Physical or emotional stress

*Immunosuppression due to AIDS or such medications as chemotherapy or steroids

*Trauma to the affected area, including sexual activity

*Menstruation

Complications:
Severe disease:
In immunocompromised people, such as those with advanced HIV infection, HSV-1 can have more severe symptoms and more frequent recurrences. Rarely, HSV-1 infection can also lead to more severe complications such as encephalitis (brain infection) or keratitis (eye infection).

HSV-2 and HIV have been shown to influence each other. HSV-2 infection increases the risk of acquiring a new HIV infection by approximately three-fold. In addition, people with both HIV and HSV-2 infection are more likely to spread HIV to others. HSV-2 is amongst the most common infections in people living with HIV, occurring in 60-90% of HIV-infected persons.

Infection with HSV-2 in people living with HIV (and other immunocompromised individuals) can have a more severe presentation and more frequent recurrences. In advanced HIV disease, HSV-2 can lead to more serious, but rare, complications such as meningoencephalitis, esophagitis, hepatitis, pneumonitis, retinal necrosis, or disseminated infection.

Diagnosis:
Often, the appearance of herpes simplex virus is typical and no testing is needed to confirm the diagnosis. If a health care provider is uncertain, herpes simplex can be diagnosed with lab tests, including DNA — or PCR — tests and virus cultures.

Treatment:
Antiviral medications, such as acyclovir, famciclovir, and valacyclovir, are the most effective medications available for people infected with HSV. These can help to reduce the severity and frequency of symptoms, but cannot cure the infection.

WHO guidelines for the treatment of Genital Herpes Simplex Virus

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Prevention:
HSV-1 is most contagious during an outbreak of symptomatic oral herpes, but can also be transmitted when no symptoms are felt or visible. People with active symptoms of oral herpes should avoid oral contact with others and sharing objects that have contact with saliva. They should also abstain from oral sex, to avoid transmitting herpes to the genitals of a sexual partner. Individuals with symptoms of genital herpes should abstain from sexual activity whilst experiencing any of the symptoms.

People who already have HSV-1 infection are not at risk of getting it again, but they are still at risk of acquiring herpes simplex virus type 2 (HSV-2) genital infection (see below).

The consistent and correct use of condoms can help to prevent the spread of genital herpes. However, condoms can only reduce the risk of infection, as outbreaks of genital herpes can occur in areas not covered by a condom.

People who already have HSV-1 infection are not at risk of getting it again, but they are still at risk of acquiring HSV-2 genital infection (see below).

Pregnant women with symptoms of genital herpes should inform their health care providers. Preventing acquisition of a new genital herpes infection is particularly important for women in late pregnancy, as this is when the risk for neonatal herpes is greatest.

Additional research is underway to develop more effective prevention methods against HSV infection, such as vaccines. Several candidate HSV vaccines are currently being studied.

Individuals with genital HSV infection should abstain from sexual activity whilst experiencing symptoms of genital herpes. HSV-2 is most contagious during an outbreak of sores, but can also be transmitted when no symptoms are felt or visible.

People with symptoms suggestive of genital HSV infection should also receive HIV testing, and those in settings or populations with high HIV incidence might benefit from more focused HIV prevention efforts, such as pre-exposure prophylaxis.

The consistent and correct use of condoms can help reduce the risk of spreading genital herpes. However, condoms only provide partial protection, as HSV can be found in areas not covered by a condom. Medical male circumcision can provide men life-long partial protection against HSV-2, in addition to HIV and human papillomavirus (HPV).

Pregnant women with symptoms of genital herpes should inform their health care providers. Preventing acquisition of a new genital herpes infection is particularly important for women in late pregnancy, as this is when the risk for neonatal herpes is greatest.

Additional research is underway to develop more effective prevention methods against HSV infection, such as vaccines or topical microbicides (compounds which can be applied inside the vagina or rectum to protect against sexually transmitted infections).

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
https://en.wikipedia.org/wiki/Herpes_simplex
https://www.webmd.com/genital-herpes/pain-management-herpes#1
https://www.who.int/news-room/fact-sheets/detail/herpes-simplex-virus

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