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==[[Herpes simplex overview|Overview]]==
==[[Herpes simplex overview|Overview]]==
'''Herpes simplex''' is a [[viral disease]] caused by [[Herpes simplex virus]]es. Infection of the [[genital]]s is commonly known as ''herpes'' and predominantly occurs following sexual transmission of the type 2 strain of the virus (HSV-2).<ref name="pmid18156035">{{cite journal |author=Gupta R, Warren T, Wald A |title=Genital herpes |journal=Lancet |volume=370 |issue=9605 |pages=2127–37 |year=2007 |pmid=18156035 |doi=10.1016/S0140-6736(07)61908-4}}</ref> Oral herpes, colloquially called ''cold sores'', is usually caused by the type 1 strain of herpes simplex virus (HSV-1).<ref name="pmid15596324">{{cite journal |author=Bruce AJ, Rogers RS |title=Oral manifestations of sexually transmitted diseases |journal=Clin. Dermatol. |volume=22 |issue=6 |pages=520–7 |year=2004 |pmid=15596324 |doi=10.1016/j.clindermatol.2004.07.005}}</ref>  Both viruses cause periods of active disease—presenting as painful blisters containing infectious [[virus]] particles—that lasts 2-21 days and is followed by [[remission]] when the sores disappear. Most cases of genital herpes are [[asymptomatic]], although [[viral shedding]] may still occur.<ref name="pmid16238897">{{cite journal |author=Leone P |title=Reducing the risk of transmitting genital herpes: advances in understanding and therapy |journal=Curr Med Res Opin |volume=21 |issue=10 |pages=1577–82 |year=2005 |pmid=16238897 |doi=10.1185/030079905X61901}}</ref> HSV-1 and HSV-2 are transmitted by direct contact with a sore or body fluid of an infected individual.  After initial infection, these viruses move to [[Sensory neuron|sensory nerves]], where they reside as life-long, [[Virus latency|latent]] viruses. The viruses lie dormant in [[Trigeminal ganglion|trigeminal ganglia]] that provide sensation to the lips, lower mouth and neck, or in [[sacral ganglia|lumbrosacral]] that supply sensation to the genitals, [[perineum]] and upper legs.<ref name="pmid17939933">{{cite journal |author=Fatahzadeh M, Schwartz RA |title=Human herpes simplex virus infections: epidemiology, pathogenesis, symptomatology, diagnosis, and management |journal=J. Am. Acad. Dermatol. |volume=57 |issue=5 |pages=737–63; quiz 764–6 |year=2007 |pmid=17939933 |doi=10.1016/j.jaad.2007.06.027}}</ref>  Occasionally, these viruses reactivate and return to the area of skin infected during the primary infection.  Triggers for recurrences are uncertain but may include sunburn, [[ultraviolet light]], wind, trauma, surgery, and stress. Over time, episodes of active disease reduce and the frequency of recurrences is regulated by [[Adaptive immune system|specific immunity]] developed against the virus.<ref name="pmid18186706">{{cite journal |author=Koelle DM, Corey L |title=Herpes Simplex: Insights on Pathogenesis and Possible Vaccines |journal=Annu Rev Med |volume=59 |issue= |pages=381–395 |year=2008 |pmid=18186706 |doi=10.1146/annurev.med.59.061606.095540}}</ref>
Disorders such as [[herpetic whitlow]], herpes gladiatorum, and ocular herpes are caused by herpes simplex viruses. Infection of the [[central nervous system]] causes serious disorders - these include herpes [[encephalitis]], Mollaret's [[meningitis]], and possibly [[Bell's palsy]].<ref name="pmid15319091">{{cite journal |author=Tyler KL |title=Herpes simplex virus infections of the central nervous system: encephalitis and meningitis, including Mollaret's |journal=Herpes |volume=11 Suppl 2 |issue= |pages=57A–64A |year=2004 |pmid=15319091 |doi=}}</ref><ref name="pmid9393551">{{cite journal |author=Schirm J, Mulkens PS |title=Bell's palsy and herpes simplex virus |journal=APMIS |volume=105 |issue=11 |pages=815–23 |year=1997 |pmid=9393551 |doi=}}</ref>  In newborn babies, infection by herpes viruses (neonatal herpes) can be highly serious, resulting in brain damage or even death.<ref name="pmid15685144">{{cite journal |author=Kimberlin DW, Whitley RJ |title=Neonatal herpes: what have we learned |journal=Semin Pediatr Infect Dis |volume=16 |issue=1 |pages=7–16 |year=2005 |pmid=15685144 |doi=10.1053/j.spid.2004.09.006}}</ref> In [[Immunocompetence|immunocompetent]] people, herpes simplex is not typically life-threatening.  However, individuals with compromised immune systems can develop serious HSV infections such as [[encephalitis]].
Prevalence of HSV-1 and HSV-2 infections varies throughout the world.<ref name="pmid17939933"/>  Socioeconomic status appears to be an important factor associated with HSV-1 infection levels with developing countries, such as those in Sub-Saharan Africa, showing higher levels of HSV-1 and younger acquisition rates than industrialized countries like the [[United States]] and countries in Northern Europe. The risk of infection for HSV-1 is associated with lower income and a more crowded living environment. Levels of HSV-2 infections are much lower in the U.S. (20-30%), Australia (12%), the United Kingdom (4%) and Germany (14%).<ref name="pmid16926356">{{cite journal |author=Xu F, Sternberg MR, Kottiri BJ, ''et al'' |title=Trends in herpes simplex virus type 1 and type 2 seroprevalence in the United States |journal=JAMA |volume=296 |issue=8 |pages=964–73 |year=2006 |pmid=16926356 |doi=10.1001/jama.296.8.964}}</ref> Risk Factors for acquiring HSV-2 include: Female sex; black race; commencement of sexual activity at a younger age; higher number of sexual partners; and lower socioeconomic status.
Treatments are available to reduce the symptoms and speed up the healing process of herpes infections but there is currently no cure.<ref name="pmid18186706"/> Antiviral drugs, such as [[aciclovir]] and [[valaciclovir]], taken orally, reduce viral reproduction and shedding, and some topical creams, such as [[Docosanol]] and [[Tromantadine]] prevent the virus from entering the skin.  Some other drugs reduce herpetic symptoms by synergising with oral antiviral medication; [[Cimetidine]] and [[probenecid]] can reduce aciclovir clearance and [[aspirin]] can reduce [[inflammation]] associated with viral infection.  Some natural remedies may have potential benefits in reducing herpes outbreaks or their symptoms.  No [[vaccine]] is currently available to prevent or treat herpes.<ref name="pmid18186706"/>


==[[Herpes simplex pathophysiology|Pathophysiology]]==
==[[Herpes simplex pathophysiology|Pathophysiology]]==
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==[[Herpes simplex epidemiology and demographics|Epidemiology & Demographics]]==
==[[Herpes simplex epidemiology and demographics|Epidemiology & Demographics]]==


== Disorders ==
==Subtypes==
 
Several distinct disorders are caused by HSV infection of the skin or mucosa including those that affect the face and mouth (orofacial herpes), genitalia (genital herpes), or hands (herpes whitlow).  More serious problems arise when the virus infects and damages the eye (herpes keratitis) or invades the central nervous system to damage the brain (herpes encephalitis).  Newborn infants, with their under-developed immune systems, are also prone to serious complications due to HSV infection (neonatal herpes).
Several distinct disorders are caused by HSV infection of the skin or mucosa including those that affect the face and mouth (orofacial herpes), genitalia (genital herpes), or hands (herpes whitlow).  More serious problems arise when the virus infects and damages the eye (herpes keratitis) or invades the central nervous system to damage the brain (herpes encephalitis).  Newborn infants, with their under-developed immune systems, are also prone to serious complications due to HSV infection (neonatal herpes).


===Orofacial infection===
*[[Herpes simplex orofacial infection|Orofacial infection]]
{{Infobox_Disease |
*[[Herpes simplex anogenital infection|Anogenital infection]]
  Name          = Herpesviral vesicular dermatitis |
*[[Herpes simplex ocular infection|Ocular infection]]
  Image          = Herpes labialis - opryszczka wargowa.jpg |
*[[Herpes simplex encephalitis|Herpes Encephalitis]]
  Caption        = Herpes lesion on upper lip and face |
*[[Herpes simplex neonatorum|Neonatal herpes]]
  DiseasesDB    = |
*[[Herpetic whitlow]]
  ICD10          = {{ICD10|B|00|1|b|00}} |
*[[Herpes gladiatorum]]
  ICD9          = |
  ICDO          = |
  OMIM          = |
  MedlinePlus    = |
  eMedicineSubj  = |
  eMedicineTopic = |
  MeshID        = |
}}
 
Infection by HSV-1 is the most common cause of herpes that affects the face and mouth (orofacial herpes) although recent years are seeing an increase in oral HSV-2 infections.<ref name="pmid15596324"/> A majority of primary HSV-1 infections occur during childhood and, if the virus has come into contact with the mucosa or abraded skin, can cause acute herpetic [[gingivostomatitis]] (inflammation of the mucosa of the cheek and gums) within 5–10 days. Some other symptoms may also develop, including fever and sore throat, and painful [[ulcer]]s may appear.<ref name="pmid15596324"/> Primary HSV infection in adolescents frequently manifests as severe [[pharyngitis]] with lesions developing on the cheek and gums. Some individuals develop difficulty in swallowing ([[dysphagia]]) and swollen [[lymph node]]s ([[lymphadenopathy]]).<ref name="pmid15596324"/> Primary HSV infections in adults often presents as pharyngitis similar to that observed in glandular fever ([[infectious mononucleosis]]), but gingivostomatitis is less likely. The symptoms of primary HSV infection generally resolve within two weeks.<ref name="pmid15596324"/>
 
Once a primary oral HSV-1 infection has resolved, the HSV enters the nerves surrounding the primary lesion, migrates to the [[cell body]] of the neuron, and becomes latent in the [[trigeminal ganglion]].  In some people, the virus reactivates to cause recurrent infection - this is more common with HSV-1 than HSV-2 oral infection. [[Prodromal]] symptoms often precede a recurrence, which typically begins with reddening of the skin around the infected site, with eventual ulceration to form fluid-filled [[blister]]s that affect the lip (labial) tissue and the area between the lip and skin (vermilion border).  The recurrent infection is thus often called ''herpes simplex labialis''. Rare occasions of reinfections occur inside the mouth  (''intraoral HSV stomatitis'') affecting the gums, [[alveolar ridge]], [[hard palate]], and the back of the tongue - this may be accompanied with ''herpes labialis''.<ref name="pmid15596324"/> <ref>[http://www.ashastd.org/pdfs/HELPER_SPRING_05.pdf Herpes Online:  Exploring the "H" Community, pages 1-4 American Social Health Association 1996 Access date: 2007-03-29]</ref>
 
Oral herpes is spread by direct contact with an active sore in an infected person, for instance, during kissing. However virus can be transmitted through the skin in the absence of a lesion.  Oral herpes and cold sores can sometimes be confused with canker sores.
 
===Genital infection===
{{Infobox_Disease |
  Name          = Anogenital herpesviral infection |
  Image          = SOA-Herpes-genitalis-female.jpg|
  Caption        = Genital herpes in a female|
  DiseasesDB    = |
  ICD10          = {{ICD10|A|60||a|50}} |
  ICD9          = |
  ICDO          = |
  OMIM          = |
  MedlinePlus    = |
  eMedicineSubj  = |
  eMedicineTopic = |
  MeshID        = D006558 |
}}
[[Image:SOA-Herpes-genitalis-male.jpg|thumb|right|190px|Genital herpes in a male]]
 
Clusters of inflammed [[papule]]s and [[vesicle]]s on the outer surface of the genitals represent the typical symptoms of a primary HSV-1 or HSV-2 genital infection. These usually appear 4–7 days after sexual exposure to HSV for the first time,<ref name="pmid18156035"/> and may resemble cold sores.<ref name="titleSTD Facts - Genital Herpes">{{cite web |url=http://www.cdc.gov/std/Herpes/STDFact-Herpes.htm |title=STD Facts - Genital Herpes |accessdate=2008-02-22 |format= |work=}}</ref> In males, the lesions occur on the shaft of the [[penis]] or other parts of the genital region, on the inner thigh, buttocks, or [[anus]]. In females, lesions appear on or near the [[Mons pubis|pubis]], labia, [[clitoris]], [[vulva]], buttocks or anus.<ref name="titleSTD Facts - Genital Herpes"/> Other common symptoms include pain, itching, and burning. Less frequent, yet still common, symptoms include discharge from the penis or [[vagina]], [[fever]], [[headache]], muscle pain ([[myalgia]]),  swollen and enlarged lymph nodes and [[malaise]].<ref name="pmid18156035"/> Women often experience additional symptoms that include painful urination ([[dysuria]]) and [[cervicitis]], while herpetic [[proctitis]] (inflammation of the anus and rectum) is common for individuals participating in anal intercourse.<ref name="pmid18156035"/> After 2–3 weeks, existing lesions progress into ulcers and then crust and heal, although lesions on mucosal surfaces may never form crusts.<ref name="pmid18156035"/> The virus is not removed from the body by [[immune system]], but enters [[nerve]] [[ganglion|ganglia]] that serve the infected [[dermatomic area|dermatome]] where it becomes dormant.<ref name="pmid18156035"/>
 
Many HSV infected people experience a recurrence within the first year of infection, when the virus reactivates from its latent state.<ref name="pmid18156035"/>  Development of lesions follows [[prodrome]] - which warns of a recurrence and includes tingling ([[paresthesia]]), itching, and pain where lumbosacral nerves innervate the skin - by hours to days. In some individuals, starting to take antiviral treatment when prodrome is experienced can reduce the appearance and duration of lesions. Fewer lesions are likely to develop that cause less pain and heal faster (5–10 days without antiviral treatment) than during the primary infection.<ref name="pmid18156035"/>  Subsequent outbreaks tend to be periodic or episodic, occur on average four to five times a year when not using antiviral therapy, and may be triggered by [[stress (medicine)|stress]], [[illness]], [[fatigue]], [[menstruation]]. HSV-2 is widespread, affecting an estimated 1 in 4 females and 1 in 5 males in the United States. Although certain therapies can prevent outbreaks or reduce the risk of transmission to partners, no cure is yet available.<ref name="titleSTD Facts - Genital Herpes"/><ref name="pmid18156035"/>
 
===Herpes whitlow===
Herpes whitlow ([[herpetic whitlow]]) is a painful infection that typically manifest itself on fingers or thumbs and occasionally on the toes, or on the nail cuticle, and is caused by HSV-1 or HSV-2.<ref name="pmid14677662">{{cite journal |author=Clark DC |title=Common acute hand infections |journal=Am Fam Physician |volume=68 |issue=11 |pages=2167–76 |year=2003 |pmid=14677662 |doi=}}</ref> It is typically contracted by healthcare workers that come in contact with the virus; it is most commonly contracted by dental workers and medical workers exposed to oral secretions.<ref name="pmid15119801">{{cite journal |author=Lewis MA |title=Herpes simplex virus: an occupational hazard in dentistry |journal=Int Dent J |volume=54 |issue=2 |pages=103–11 |year=2004 |pmid=15119801 |doi=}}</ref><ref name="pmid12236568">{{cite journal |author=Avitzur Y, Amir J |title=Herpetic whitlow infection in a general pediatrician--an occupational hazard |journal=Infection |volume=30 |issue=4 |pages=234–6 |year=2002 |pmid=12236568 |doi=}}</ref> Again, the HSV seronegative person is at highest risk of acquiring this condition.  Herpes whitlow is also caused by [[autoinoculation]] of HSV into broken skin prior to an infected person developing antibodies against the virus (e.g. during primary infection before seroconversion).<ref name="pmid14677662"/>  It is often observed in thumb-sucking children with primary HSV-1 infection, and in adults aged 20 to 30 following contact with by HSV-2-infected genitals.<ref name="pmid17674583">{{cite journal |author=Wu IB, Schwartz RA |title=Herpetic whitlow |journal=Cutis |volume=79 |issue=3 |pages=193–6 |year=2007 |pmid=17674583 |doi=}}</ref>
 
Symptoms of herpetic whitlow include swelling, reddening and tenderness of the skin of infected finger. This may be accompanied by fever and swollen lymph nodes.  Small, clear vesicles initially form that merge and becomes cloudy. Associated pain often seems large relative to the physical symptoms. The herpes whitlow lesion usually heals in two to three weeks.<ref name="pmid5125276">{{cite journal |author= Anonymous|title=Herpetic whitlow: a medical risk |journal=Br Med J |volume=4 |issue=5785 |pages=444 |year=1971 |pmid=5125276 |doi=}}</ref>
 
===Herpes gladiatorum===
Individuals that participate in contact sports such as wrestling, rugby, and soccer sometimes acquire a condition caused by HSV-1 known as herpes gladiatorum, ''[[scrumpox]]'', ''wrestler’s herpes'' or ''mat herpes''. Abraded skin caused by contacts sports provides an area of entry for HSV-1. Symptoms present within 2 weeks of direct skin-to-skin contact with an infected person, and include skin ulceration on the face, ears, and neck. This disorder may cause fever, headache, sore throat and swollen glands, and occasionally affects the eyes. Physical symptoms sometimes recur in the skin.<ref name="pmid17939933"/>
 
===Ocular herpes===
{{Infobox_Disease |
  Name          = Herpesviral ocular disease |
  Image          =Herpes2.JPG|
  Caption        =Herpes infection of the cornea |
  DiseasesDB    = |
  ICD10          = {{ICD10|B|00|5|b|00}} |
  ICD9          = |
  ICDO          = |
  OMIM          = |
  MedlinePlus    = |
  eMedicineSubj  = |
  eMedicineTopic = |
  MeshID        = D016849 |
}}
Ocular herpes is generally caused by HSV-1 and is a special case of facial herpes infection known as herpes keratitis.  It begins with infection of epithelial cells on the surface of the eye and retrograde infection of nerves serving the [[cornea]].<ref name="pmid11393165">{{cite journal |author=Carr DJ, Härle P, Gebhardt BM |title=The immune response to ocular herpes simplex virus type 1 infection |journal=Exp. Biol. Med. (Maywood) |volume=226 |issue=5 |pages=353–66 |year=2001 |pmid=11393165 |doi=}}</ref> Primary infection typically presents as swelling of the [[conjunctiva]] and eye-lids (blepharoconjunctivitis), accompanied by small white itchy lesions on the surface of the [[cornea]], which vary from minor damage to the [[epithelium]] (superficial punctate keratitis) to formation of [[Corneal ulcer|dendritic ulcers]].<ref name="pmid10858770">{{cite journal |author=Suresh PS, Tullo AB |title=Herpes simplex keratitis |journal=Indian J Ophthalmol |volume=47 |issue=3 |pages=155–65 |year=1999 |pmid=10858770 |doi=}}</ref> Infection is unilateral, affecting one eye at a time.  Additional symptoms include dull pain deep inside the eye, mild to acute dryness and [[sinusitis]]. Most primary infections resolve spontaneously in a few weeks or with the use of oral and topical [[antiviral]]s. However, the virus continues to inhabit the neurons of the eye and to multiply.
 
Subsequent recurrences may be more severe, with infected epithelial cells showing larger dendritic ulceration and lesions forming white plaques.<ref name="pmid10858770"/> The epithelial layer is sloughed off as the dendritic ulcer grows and mild inflammation ([[iritis]]) may occur in the underlying [[stroma of iris]]. Sensation loss occurs in lesional areas producing generalised corneal anaesthesia with repeated recurrences.<ref name="pmid10858770"/> This may be accompanied by chronic dry eye, low grade intermittent conjunctivitis or chronic unexplained sinusitis. When the concentration of viral DNA reaches a critical limit, the presence of the virus can trigger a massive [[autoimmune]] response in the eye, resulting in an individual's immune system destroying the [[Substantia propria|corneal stroma]].<ref name="pmid10858770"/> This usually results in loss of vision due to opacification of the cornea and is a result of an antibody responses against the viral [[antigen]] expression in the stroma following persistent infection.<ref name="pmid10858770"/> This is known as immune-mediated stromal keratitis.
 
Treatment with corneal transplants was once ineffective (with only 14%-61% rate of survival without antiviral therapy), as reinfection of the transplant is common when the virus reactivates. However, with concurrent use of antivirals the chance of graft acceptance has improved.<ref name="pmid12034687">{{cite journal |author=Halberstadt M, Machens M, Gahlenbek KA, Böhnke M, Garweg JG |title=The outcome of corneal grafting in patients with stromal keratitis of herpetic and non-herpetic origin |journal=Br J Ophthalmol |volume=86 |issue=6 |pages=646–52 |year=2002 |pmid=12034687 |doi=}}</ref>
 
===Herpes simplex encephalitis===
{{DiseaseDisorder infobox |
  Name        = Herpesviral encephalitis |
  ICD10      = {{ICD10|B|00|4|b|00}}, {{ICD10|G|05|1|g|00}} |
  ICD9        = {{ICD9|054.3}} |
}}
Herpes simplex [[encephalitis]] (HSE) is a very serious disorder and one of the most severe viral infections of the human [[central nervous system]]. It is estimated to affect at least 1 in 500,000 individuals per year.<ref name="pmid16675036">{{cite journal |author=Whitley RJ |title=Herpes simplex encephalitis: adolescents and adults |journal=Antiviral Res. |volume=71 |issue=2-3 |pages=141–8 |year=2006 |pmid=16675036 |doi=10.1016/j.antiviral.2006.04.002}}</ref> HSE is thought to be caused by the [[Retrograde infection|retrograde transmission]] of virus from a peripheral site on the face to the brain along a nerve [[axon]] following HSV-1 reactivation.<ref name="pmid16675036"/>  Approximately 50% of individuals that develop HSE are over 50 years of age.<ref name="pmid11853816">{{cite journal |author=Whitley RJ, Gnann JW |title=Viral encephalitis: familiar infections and emerging pathogens |journal=Lancet |volume=359 |issue=9305 |pages=507–13 |year=2002 |pmid=11853816 |doi=}}</ref>  About 1 in 3 cases of HSE result from primary HSV-1 infection predominantly occurring in individuals under the age of 18. Although 2 in 3 cases occur in seropositive persons, few of these individuals have history of recurrent orofacial herpes. The virus lies dormant in the [[ganglion]] of the trigeminal or fifth [[cranial nerve]] but the reason for reactivation, and its pathway to gain access to the brain, remains unclear.  The olfactory nerve may also be involved in HSE.<ref>{{cite journal | author = Dinn J | title = Transolfactory spread of virus in herpes simplex encephalitis. | journal = Br Med J | volume = 281 | issue = 6252 | pages = 1392 | year = 1980 | id = PMID 7437807}}</ref>
 
Without treatment, HSE results in rapid death in around 70% of cases.<ref name="pmid16675036"/>  Even with the best modern treatment, it is fatal in around 20% of cases treated, and causes serious long-term neurological damage in over half the survivors.  For unknown reasons the virus seems to target the [[temporal lobe]]s of the brain.  Only a small population of survivors (2.5%) regain completely normal brain function.<ref name="pmid11853816"/>  Most individuals with HSE show a decrease in their level of consciousness and an altered mental state presenting as [[Mental confusion|confusion]] and changes in personality.  Increased numbers of white blood cells can be found in their [[cerebrospinal fluid]] without the presence of [[pathogen]]ic [[bacteria]] and [[fungi]], and they typically have a fever.<ref name="pmid16675036"/> Some patients with HSE will have seizures.  The electrical activity of the brain (detected using [[Electroencephalography|EEG]], [[Computed tomography|CT]], or [[Magnetic resonance imaging|MRI]] scans) changes as the disease progresses, first showing abnormalities in one [[temporal lobe]] of the brain, which spread to the other temporal lobe 7–10 days later.<ref name="pmid16675036"/>
 
===Neonatal herpes simplex===
{{DiseaseDisorder infobox |
  Name        = Congenital herpesviral (herpes simplex) infection |
  Image          = SOA-Herpes-neonatorum.jpg|
  Caption        = HSV disease in a newborn child|
  ICD10      = {{ICD10|P|35|2|p|35}} |
  ICD9        = {{ICD9|771.2}} |
}}
 
[[Infant|Neonatal]] HSV disease is a rare but serious condition, usually the consequence of [[vertical transmission]] of the virus from mother to newborn child, although an estimated 10% of cases may be acquired [[postnatal]]ly from a parent, caretaker, or sibling. From 1/3,000 to 1/20,000 of live births are infected with neonatal herpes. Approximately 22% of pregnant women have had a previous exposure HSV-2, and a further 2% or more women acquire the virus during pregnancy.<ref name="pmid16199646">{{cite journal |author=Brown ZA, Gardella C, Wald A, Morrow RA, Corey L |title=Genital herpes complicating pregnancy |journal=Obstet Gynecol |volume=106 |issue=4 |pages=845–56 |year=2005 |pmid=16199646 |doi=10.1097/01.AOG.0000180779.35572.3a}}</ref> Particularly among young adults, genital herpes infections are increasing caused by HSV-1.<ref name="pmid17197885">{{cite journal |author=Baker DA |title=Consequences of herpes simplex virus in pregnancy and their prevention |journal=Curr. Opin. Infect. Dis. |volume=20 |issue=1 |pages=73–6 |year=2007 |pmid=17197885 |doi=10.1097/QCO.0b013e328013cb19}}</ref> The risk of transmission is 30-57% in cases of primary infection acquisition by the mother in the [[Pregnancy#physiology|third trimester]] of pregnancy. Risk of transmission by a mother with existing antibodies for both HSV-1 and HSV-2 has a much lower (1-3%) transmission rate. This in part is due to the presence of significant titer of protective maternal antibodies in the fetus from about the seventh month of pregnancy.<ref name="pmid12517231">{{cite journal |author=Brown ZA, Wald A, Morrow RA, Selke S, Zeh J, Corey L |title=Effect of serologic status and cesarean delivery on transmission rates of herpes simplex virus from mother to infant |journal=JAMA |volume=289 |issue=2 |pages=203–9 |year=2003 |pmid=12517231 |doi=}}</ref> However, shedding of HSV-1 from both primary genital infection and reactivation is associated with high transmission from mother to infant.<ref name="pmid12517231"/>
 
HSV-1 neonatal herpes is extremely rare in developing countries because primary exposure to HSV-1 (and therefore development of HSV-1 specific antibodies) usually occurs in childhood or adolescence, precluding a genital HSV-1 infection; HSV-2 infections are much more common in these countries. In industrialized nations the adolescent HSV-1 seroprevalance has been dropping steadily for the last 5 decades as a result of better hygiene, less over-crowding, and smaller family size. The resulting increase in the number of young women entering the sexually active/child bearing years as HSV-1 seronegative, has been a harbinger of increased HSV-1 genital herpes, and as a result, increased HSV-1 neonatal herpes in developed nations.  A recent three year study in Canada revealed neonatal HSV infections in 5.9 per 100,000 live births. HSV-1 was the cause of 62.5% of cases of neonatal herpes, and 98.7% of transmission was asymptomatic.<ref name=Kropp>{{cite journal
| author=Kropp RY., Wong T, et al | title=Neonatal Herpes Simplex Virus Infections in Canada: Results of a 3-Year National Prospective Study | journal=Pediatrics  | year=2006 | pages=1955-1962 | volume=117 | issue=61 | id=PMID 16740836 |  |doi= |url=http://pediatrics.aappublications.org/cgi/content/abstract/117/6/1955
}}</ref> Asymptomatic genital HSV-1 has been shown to be more infectious to the neonate and is more likely to produce neonatal herpes than HSV-2. <ref name=ZA_Brown>{{cite journal
| author=Brown ZA, Wald A, Morrow RA, Selke S, Zeh J, Corey L | title=Effect of Serologic Status and Cesarean Delivery on Transmission Rates of Herpes Simplex Virus From Mother to Infant | journal=JAMA  | year=2003 | pages=203-209 | volume=289 | issue=2 | id=PMID 12517231 |  |doi= |url=http://jama.ama-assn.org/cgi/reprint/289/2/203
}}</ref><ref name=EL_Brown>{{cite journal
| author=Brown ZA, Gardella C, Malm G, Prober CG, Forsgren M, Krantz EM, Arvin AM, Yasukawa LL, Mohan K, Brown Z, Corey L, Wald A  | title=Effect of maternal herpes simplex virus (HSV) serostatus and HSV type on risk of neonatal herpes | journal=Acta Obstet et Gynecol Scand
| year=2007 | pages=523-529 | volume=86 | issue=5 | id=PMID 17564578 |  |doi= |url=http://www.informaworld.com/smpp/content~content=a777727985~db=all
}}</ref>
 
Neonatal herpes manifests itself in three forms: skin, eyes and mouth (SEM) herpes, disseminated (DIS) herpes, and central nervous system (CNS) herpes.<ref name="pmid15685144"/>  SEM herpes is characterized by external lesions but no internal organ involvement, and has the best prognosis. Lesions are likely to appear on trauma sites such as the attachment site of fetal scalp electrodes, forceps or vacuum extractors that are used during delivery, in the margin of the eyes, the [[nasopharynx]], and in areas associated with trauma or surgery (including circumcision).<ref name="pmid12517231"/> DIS herpes affects internal organs, especially the liver. CNS herpes is an infection of the nervous system and the brain that can lead to encephalitis. Infants with CNS herpes present with [[seizure]]s, [[tremor]]s, [[lethargy]], and irritability, they feed poorly, have unstable temperatures, and their [[fontanelle]] (soft spot of the skull) may bulge.<ref name="pmid12517231"/>  CNS herpes is associated with highest [[morbidity]], and DIS herpes has a higher [[mortality]] rate.  Untreated, SEM herpes may spread to the internal organs and cause DIS or CNS herpes resulting in increased mortality and morbidity. Death from neonatal HSV disease in the US is currently decreasing; as high as 85% of HSV infected neonates died a few decades ago whereas the current death rate is about 25%. Reduction in mortality is due to the use of antiviral treatments such as [[vidarabine]] and [[acyclovir]].<ref name="pmid15685144"/><ref name="pmid11269641">{{cite journal |author=Kesson AM |title=Management of neonatal herpes simplex virus infection |journal=Paediatr Drugs |volume=3 |issue=2 |pages=81–90 |year=2001 |pmid=11269641 |doi=}}</ref><ref>[http://www.merck.com/mmpe/sec19/ch279/ch279h.html The Merck Manual, Neonatal Herpes Simplex Virus (HSV) Infection]</ref><ref name=neonatal>
{{cite journal | author=Brocklehurst P, Kinghorn GA et al. | title=randomised placebo controlled trial of suppressive acyclovir in late pregnancy in women with recurrent genital herpes infection | Journal= Br J Obstet Gynaecol| Year= 1998|volume=105| issue=3| pages=275-80  }}</ref> However, morbidity and mortality still remain high due to diagnosis of DIS and CNS herpes coming too late for effective antiviral administration; early diagnosis is difficult in 20-40% of infected neonates that have no visible lesions.<ref name="pmid9523400">{{cite journal |author=Jacobs RF |title=Neonatal herpes simplex virus infections |journal=Semin. Perinatol. |volume=22 |issue=1 |pages=64–71 |year=1998 |pmid=9523400 |doi=}}</ref> Herpes simplex virus infection in the newborn "carries high mortality and morbidity rates from central nervous system involvement," according to [[Harrison's Principles of Internal Medicine]], which recommends that pregnant women with active genital herpes lesions at the time of labor be delivered by [[cesarean section]]. Women whose herpes is not active can be managed with acyclovir.<ref>Ch. 6, "Medical Disorders during Pregnancy," in Harrison's Principles of Internal Medicine, 17th ed., 2008</ref>


=== Viral meningitis ===
=== Viral meningitis ===

Revision as of 18:05, 15 September 2011

For patient information on congenital herpes, click here

For patient information on genital herpes, click here

Herpes simplex
Electron micrograph of Herpes simplex virus.
ICD-10 A60, B00, G05.1, P35.2
ICD-9 054.0, 054.1, 054.2, 054.3, 771.2
DiseasesDB 5841 Template:DiseasesDB2
MeSH D006561

Sexually transmitted diseases Main Page

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Patient Information

Genital Herpes
Congenital Herpes

Overview

Classification

Orofacial Infection
Anogenital Infection
Ocular Infection
Herpes Encephalitis
Neonatal Herpes
Herpetic Whitlow
Herpes Gladiatorum
Mollaret's Meningitis

Pathophysiology

Epidemiology and Demographics

Asymptomatic Shedding

Recurrences and Triggers

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Direct detection of Genital Lesions

Treatment

Antiviral Therapy

Overview
Antivirals for First Episode of Genital Herpes
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Overview

Pathophysiology

Epidemiology & Demographics

Subtypes

Several distinct disorders are caused by HSV infection of the skin or mucosa including those that affect the face and mouth (orofacial herpes), genitalia (genital herpes), or hands (herpes whitlow). More serious problems arise when the virus infects and damages the eye (herpes keratitis) or invades the central nervous system to damage the brain (herpes encephalitis). Newborn infants, with their under-developed immune systems, are also prone to serious complications due to HSV infection (neonatal herpes).

Viral meningitis

HSV-2 is the most common cause of recurrent viral meningitis called Mollaret's meningitis.[1][2] This condition was first described in 1944 by French neurologist Pierre Mollaret. Recurrences usually last a few days or a few weeks, and resolve without treatment. They may recur weekly or monthly for approximately 5 years following primary infection.[3]

Bell's palsy

A type of facial paralysis called Bell's palsy has been linked to the presence and reactivation of latent HSV-1 inside the sensory nerves of the face known as geniculate ganglia, particularly in a mouse model.[4][5] This is supported by findings that show the presence of HSV-1 DNA in saliva at a higher frequency in patients with Bell's palsy relative to those without the condition.[6] However, since HSV can also be detected in these ganglia in large numbers of individuals that have never experienced facial paralysis, and high titers of antibodies for HSV are not found in HSV-infected individuals with Bell's palsy relative to those without, this theory has been contested.[7] Other studies, which fail to detect HSV-1 DNA in the cerebrospinal fluid of Bell's palsy sufferers, also question whether HSV-1 is the causative agent in this type of facial paralysis.[8][9] The potential effect of HSV-1 in the etiology of Bell's palsy has prompted the use of antiviral medication to treat the condition. The benefits of acyclovir and valacyclovir have been studied.[10]

Alzheimer's disease

Scientists discovered a link between Herpes Simplex Type I and Alzheimer’s Disease in 1979.[11] In the presence of a certain gene variation (APOE-epsilon4 allele carriers), HSV type 1 appears to be particularly damaging to the nervous system and increases one’s risk of developing Alzheimer’s disease. The virus interacts with lipoproteins, their components, and their receptors in the brain which may lead to the development of the disease.[12] This now makes the virus the pathogen most clearly linked to the establishment of Alzheimer’s.[13] It is important to note, however, that without the presence of the gene allele, HSV type 1 does not appear to cause any neurological damage and thus increase the risk of Alzheimer’s.[14]

Recurrences and triggers

Following active infection, herpes viruses become quiescent to establish a latent infection in sensory and autonomic ganglia of the nervous system. The double-stranded DNA of the virus is incorporated into the cell physiology by infection of the cell nucleus of a nerve's cell body. HSV latency is static - no virus is produced - and is controlled by a number of viral genes including Latency Associated Transcript (LAT).[15]

The causes of reactivation from latency are uncertain but several potential triggers have been documented. Physical or psychological stress can trigger an outbreak of herpes.[16] Local injury to the face, lips, eyes or mouth, trauma, surgery, wind, radiotherapy, ultraviolet light or sunlight are well established triggers.[17][18][19][20][21] Some studies suggest changes in the immune system during menstruation may play a role in HSV-1 reactivation.[22][23] In addition, concurrent infections, such as viral upper respiratory tract infection or other febrile diseases, can cause outbreaks, hence the historic terms "cold sore" and "fever blister".

The frequency and severity of recurrent outbreaks may vary greatly depending upon the individual. Outbreaks may occur at the original site of the infection or in close proximity to nerve endings that reach out from the infected ganglia. In the case of a genital infection, sores can appear near the base of the spine, the buttocks, back of the thighs, or they may appear at the original site of infection. Immunocompromised individuals may experience episodes that are longer, more frequent and more severe. The human body is able to build up an immunity to the virus over time and antiviral medication has been proven to shorten the duration and/or frequency of the outbreaks.[24]

Transmission and prevention

Herpes can be contracted through direct contact with an active lesion or body fluid of an infected person.[25] Infected people that show no visible symptoms may still shed and transmit virus through their skin, and this asymptomatic shedding may represent the most common form of HSV-2 transmission.[26] There are no documented cases of infection via an inanimate object (e.g. a towel, toilet seat, drinking vessels). To infect a new individual, HSV travels through tiny breaks in the skin or mucous membranes in the mouth or genital areas. Even microscopic abrasions on mucous membranes are sufficient to allow viral entry. Herpes transmission occurs between discordant partners; a person with a history of infection (HSV seropositive) can pass the virus to an HSV seronegative person.[27] Antibodies that develop following an initial infection with that type of HSV prevents reinfection with the same herpes type - a person with a history of a cold sore caused by HSV-1 cannot contract a herpes whitlow or genital infection caused by HSV-1. In a monogamous couple, a seronegative female runs a >30% per year risk of contracting an HSV-1 infection from a seropositive male partner. If an oral HSV-1 infection is contracted first, seroconversion will have occurred after 6 weeks to provide protective antibodies against a future genital HSV-1 infection.

Barrier protection, such as a condom, can reduce the risk of herpes transmission in some cases

For genital herpes, condoms are a highly effective in limiting transmission of herpes simplex infection.[28][29] However, condoms are by no means completely effective. The virus cannot get through latex, but their effectiveness is somewhat limited on a public health scale by the limited use of condoms in the community,[30] and on an individual scale because the condom may not completely cover blisters on the penis of an infected male, or base of the penis or testicles not covered by the condom may come into contact with free virus in vaginal fluid of an infected female. In such cases, abstinence from sexual activity, or washing of the genitals after sex, is recommended. The use of condoms or dental dams also limits the transmission of herpes from the genitals of one partner to the mouth of the other (or vice versa) during oral sex. When one partner has herpes simplex infection and the other does not, the use of antiviral medication, such as valaciclovir, in conjunction with a condom, further decreases the chances of transmission to the uninfected partner.[27] Topical microbicides contain chemicals that directly inactivate the virus and block viral entry are currently being investigated.[27] Vaccines for HSV are currently undergoing trials. Once developed, they may be used to help with prevention or minimize initial infections as well as treatment for existing infections. [31]

As with almost all sexually transmited infections, women are more susceptible to acquiring genital HSV-2 than men.[32] On an annual basis, without the use of antivirals or condoms, the transmission risk of HSV-2 from infected male to female is approximately 8-10%. This is believed to be due to the increased exposure of mucosal tissue to potential infection sites. Transmission risk from infected female to male is approximately 4-5% annually. Suppressive antiviral therapy reduces these risks by 50%. Antivirals also help prevent the development of symptomatic HSV in infection scenarios by about 50%, meaning the infected partner will be seropositive but symptom free. Condom use also reduces the transmission risk by 50%. Condom use is much more effective at preventing male to female transmission than vice-versa. [28] The effects of combining antiviral and condom use is roughly additive, thus resulting in approximately a 75% combined reduction in annual transmission risk. These figures reflect experiences with subjects having frequently-recurring genital herpes (>6 recurrences per year). Subjects with low recurrence rates and those with no clinical manifestations were excluded from these studies.

To prevent neonatal infections, seronegative women are recommended to avoid unprotected oral-genital contact with an HSV-1 seropositive partner and conventional sex with a partner having a genital infection during the last trimester of pregnancy. Mothers infected with HSV, are advised to avoid procedures that would cause trauma to the infant during birth (e.g. fetal scalp electrodes, forceps and vacuum extractors) and, should lesions be present, to elect caesarean section to reduce exposure of the child to infected secretions in the birth canal.[27] The use of antiviral treatments, such as aciclovir, given from the 36th week of pregnancy limits HSV recurrence and shedding during childbirth, thereby reducing the need for caesarean section.[27]

HSV seropositive individuals practising unprotected sex with HIV positive persons pose a high risk of HIV transmission, and are even more susceptible to HIV during an outbreak with active sores.[33]

Asymptomatic shedding

HSV asymptomatic shedding occurs at some time in most individuals infected with herpes. It is believed to occur on 2.9% of days while on antiviral therapy, versus 10.8% of days without and is estimated to account for one third of the total days of viral shedding.[26] Asymptomatic shedding is more frequent within the first 12 months of acquiring HSV, and concurrent infection with HIV also increases the frequency and duration of asymptomatic shedding.[34] It can occur more than a week before or after a symptomatic recurrence in 50% of cases.[26] There are some indications that some individuals may have much lower patterns of shedding, but evidence supporting this is not fully verified - no significant differences are seen in the frequency of asymptomatic shedding when comparing persons with 1 to 12 annual recurrences to those that have no recurrences.[26]

Diagnosis

Primary orofacial herpes is readily identified by clinical examination in persons without a previous history of lesions, and with reported contact with an individual with known HSV-1 infection. The appearance and distribution of sores, in these individuals, typically presents as multiple, round, and superficial oral ulcers, accompanied by acute gingivitis.[35] Adults with non-typical presentation are more difficult to diagnose. However, prodromal symptoms that occur before the appearance of herpetic lesions helps to differentiate HSV symptoms from the similar symptoms of, for example, allergic stomatitis. Occasionally, when lesions do not appear inside the mouth, primary orofacial herpes is mistaken for a bacterial infection known as impetigo. Common mouth ulcers (aphthous ulcer), also resemble intraoral herpes, but do not present a vesicular stage.[35]

Genital herpes can be more difficult to diagnose than oral herpes since most HSV-2-infected persons have no classical signs and symptoms.[35] To confuse diagnosis, several other conditions resemble genital herpes, including lichen planus, atopic dermatitis, or urethritis.[35] Laboratory testing is, therefore, often used to confirm genital herpes. Laboratory tests include culture of the virus, direct fluorescent antibody (DFA) studies to detect virus, skin biopsy, polymerase chain reaction (PCR) to test for presence of viral DNA. A Tzanck test (or smear), can also be performed although this cannot differentiate between herpes simplex or varicella (chicken pox) (the primary infection of varicella zoster virus (VZV or shingles). Although these procedures produce highly sensitive and specific diagnoses, their high costs and time constraints discourage their regular use in clinical practice.[35] Serological tests for antibodies to HSV are rarely useful to diagnosis but are important in epidemiological studies. Serologic assays cannot differentiate between antibodies generated in response to a genital versus an oral HSV infection and as such cannot confirm the site of infection. Absence of antibody to HSV-2 does not exclude gential infection because of the increasing incidence of genital infections caused by HSV-1. For these reasons and the diagnostic delay; serology is not routinely used in clinical practice[35]

Physical Examination

Skin

Herpes simplex [36]

Eyes

Herpes Simplex Keratitis [37]

Treatment

Currently, there is no treatment that can eradicate any of the herpes viruses from the body. Non-prescription analgesics can reduce pain and fever during initial outbreaks. Topical anesthetic treatment (such as prilocaine, lidocaine or tetracaine) can relieve itching and pain.[38][39]

Antiviral Medication

Antiviral medications used against herpes viruses work by interfering with viral replication, effectively slowing the replication rate of the virus and providing a greater opportunity for the immune response to intervene. All drugs in this class depend on the activity of the viral enzyme, thymidine kinase, to convert the drug sequentially from its prodrug form to a monophosphate (with one phosphate group), diphosphate (with two phosphate groups) and, finally, triphosphate (with three phosphate groups) form that interferes with viral DNA replication.[40]

The antiviral medication acyclovir

There are several prescription antiviral medications for controlling herpes simplex outbreaks, including aciclovir (Zovirax), valaciclovir (Valtrex), famciclovir (Famvir), and penciclovir. Aciclovir was the original and prototypical member of this drug class and is now available in generic brands at a greatly reduced cost. Valaciclovir and famciclovir are prodrugs of aciclovir and penciclovir respectively, which have improved solubility in water and better bioavailability when taken orally.[40] Aciclovir is the recommended antiviral for suppressive therapy in the last months of pregnancy to prevent transmission of herpes simplex to the neonate.[41] The use of valaciclovir and famciclovir, while potentially improving treatment compliance and efficacy, are still undergoing safety evaluation in this context. There is evidence in mice that treatment with famciclovir, rather than aciclovir, during an initial outbreak can help lower the incidence of future outbreaks by reducing the amount of latent virus in the neural ganglia. This potential effect on latency over aciclovir drops to zero a few months post-infection.[42] Antiviral medications are also available as topical creams for treating recurrent outbreaks on the lips although their effectiveness is disputed.[43] Penciclovir cream has a far longer cellular half-life than aciclovir cream – 10-20 hours for penciclovir versus 3 hours for aciclovir - increasing its effectiveness relative to aciclovir when topically applied.[44]

Topical treatments

Docosanol is available as a cream for direct application to the affected area of skin. It prevents HSV from fusing to cell membranes, thus barring the entry of the virus into the skin. Docosanol was approved for use after clinical trials by the FDA in July 2000.[45] Marketed by Avanir Pharmaceuticals under the brand name Abreva, it was the first over-the-counter antiviral drug approved for sale in the United States and Canada and was the subject of a US nationwide class-action suit in March, 2007 due to the misleading claim that it cut recovery times in half.[46] Tromantadine is available as a gel that inhibits entry and spreading of the virus by altering the surface composition of skin cells and inhibiting release of viral genetic material. Zilactin is a topical analgesic barrier treatment, which forms a "shield" at the area of application to prevents a sore from increasing in size and decrease viral spreading during the healing process.

Other drugs

Cimetidine, a common component of heartburn medication, has been shown to lessen the severity of herpes zoster outbreaks in several different instances, and offered some relief from herpes simplex.[47][48][49] This is an off-label use of the drug. It and probenecid have been shown to reduce the renal clearance of aciclovir.[50] These compounds also reduce the rate, but not the extent, at which valaciclovir is converted into aciclovir.

Limited evidence suggests that low dose aspirin (125 mg daily) might be beneficial in patients with recurrent HSV infections. Aspirin (also called acetylsalicylic acid) is an non-steroidal anti-inflammatory drug, which reduces the level of prostaglandins - naturally occurring lipid compounds - that are essential in creating inflammation.[51] A recent study in animals showed inhibition of thermal (heat) stress-induced viral shedding of HSV-1 in the eye by aspirin, and a possible benefit in reducing the frequency of recurrences.[52]

Vaccines

The National Institutes of Health (NIH) in the United States is currently in the midst of phase III trials of a vaccine against HSV-2, called Herpevac.[53] The vaccine has only been shown to be effective for women who have never been exposed to HSV-1. Overall, the vaccine is approximately 48% effective in preventing HSV-2 seropositivity and about 78% effective in preventing symptomatic HSV-2.[53] Assuming FDA approval, a commercial version of the vaccine is estimated to become available around 2008. During initial trials, the vaccine did not exhibit any evidence in preventing HSV-2 in males.[53] Additionally, the vaccine only reduced the acquisition of HSV-2 and symptoms due to newly acquired HSV-2 among women who did not have HSV-2 infection at the time they got the vaccine.[53] Because about 20% of persons in the United States have HSV-2 infection, this further reduces the population for whom this vaccine might be appropriate.[53]

Natural compounds

Some individuals seek benefits in natural products and dietary supplements for treatment of herpes

Certain dietary supplements and alternative remedies are believed beneficial in the treatment of herpes when used in conjunction with conventional antiviral therapy. However, there is currently insufficient scientific and clinical evidence to support the safe or effective use of these compounds to treat herpes in humans.[54]

Aloe vera is available as cream or gel which makes an affected area heal faster, and may even prevent recurrences.[55] Lemon balm (Melissa officinalis), has antiviral activity against HSV-2 in cell culture, and may reduce HSV symptoms in herpes infected people.[56][57][57] Carrageenans - linear sulphated polysaccharides extracted from red seaweeds - have been shown to have antiviral effects in HSV-infected cells and in mice.[58]However, there is no evidence for efficacy of this compound in humans.[59] There are conflicting reports about the effectiveness of extracts from the plant echinacea in treating herpes infections, suggesting a possible benefit for treating oral, but not genital, herpes.[60][61] Resveratrol, a compound naturally produced by plants and a component of red wine, prevents HSV replication in cultured cells and reduces cutaneous HSV lesion formation in mice although, used alone, it is not considered potent enough to be an effective treatment.[62][63] Extracts from garlic have shown antiviral activity against HSV in cell culture experiments, although the extremely high concentrations of the extracts required to produce an antiviral effect was also toxic to the cells.[64] The plant Prunella vulgaris, commonly known as "selfheal", also prevents expression of both type 1 and type 2 herpes in cultured cells.[65]

Lactoferrin, a component of whey protein, has been shown to have a synergistic effect with aciclovir against HSV in vitro.[66] Lysine supplementation has been proposed for the prophylaxis and treatment of herpes simplex when used at high doses (exceeding 1000 mg per day) but not low doses.[67][68][69] Some dietary supplements have been suggested to positively treat herpes. These include vitamin C, vitamin A, vitamin E, and zinc.[70][71] Butylated hydroxytoluene (BHT), commonly available as a food preservative, has been shown in cell culture and animal studies to inactivate herpes virus.[72] [73] However BHT has not been clinically tested and approved to treat herpes infections in humans.

Psychological and social effects

Since there is currently no cure for herpes, some people experience negative feelings related to the condition following diagnosis, particularly if they have acquired the genital form of the disease. Though these feelings lessen over time, they can include depression, fear of rejection, feelings of isolation, fear of being found out, self-destructive feelings, and fear of masturbation.[74] In order to improve the well-being of people with herpes, support groups have been formed in the United States and the UK, providing supporting communities and information about herpes of message forums and dating websites.[75][76][77][78][79]

People with the herpes virus are often hesitant to divulge to other people, including friends and family, that they are infected. This is especially true of new or potential sexual partners that they consider 'casual'.[80] A perceived reaction is sometimes taken into account before making a decision about whether to inform new partners and at what point in the relationship. Many people choose not to disclose their herpes status when they first begin dating someone, but wait until it later becomes clear that they are moving towards a sexual relationship. Other people disclose their herpes status upfront. Still others choose only to date other people who already have herpes.

Legal redress

Whether the law can help a person who catches herpes depends on the jurisdiction where it was contracted as legal jurisdictions define their own rules regarding the transmission of STIs such as herpes.[81] There can be both criminal and civil possibilities. For example, in the criminal case of R. v. Sullivan heard in England and Wales, an attempt was made to prosecute Sullivan for sexual assault after his partner experienced a primary outbreak of genital herpes, on the basis that he had failed to reveal the fact that he had herpes. The presiding judge dismissed the prosecution case during preliminary hearings, citing inability to prove prior knowledge and the trial did not take place.[82] Civil claims for transmission of herpes are, for their part, usually based on negligence if transmission was accidental and battery if deliberate. The first successful case to allow such a claim in the United States was Kathleen K. v. Robert B., decided by the California Court of Appeals.[83]

References

  1. ↑
  2. ↑ "Recurring viral meningitis & herpes II". Med Help International. Retrieved 2006-11-21.
  3. ↑ Sendi P, Graber P (2006). "Mollaret's meningitis". CMAJ. 174 (12): 1710. doi:10.1503/cmaj.051688. PMID 16754896.
  4. ↑ Takasu T, Furuta Y, Sato KC, Fukuda S, Inuyama Y, Nagashima K (1992). "Detection of latent herpes simplex virus DNA and RNA in human geniculate ganglia by the polymerase chain reaction". Acta Otolaryngol. 112 (6): 1004–11. PMID 1336296.
  5. ↑ Sugita T, Murakami S, Yanagihara N, Fujiwara Y, Hirata Y, Kurata T (1995). "Facial nerve paralysis induced by herpes simplex virus in mice: an animal model of acute and transient facial paralysis". Ann. Otol. Rhinol. Laryngol. 104 (7): 574–81. PMID 7598372.
  6. ↑ Lazarini PR, Vianna MF, Alcantara MP, Scalia RA, Caiaffa Filho HH (2006). "[Herpes simplex virus in the saliva of peripheral Bell's palsy patients]". Rev Bras Otorrinolaringol (Engl Ed) (in Portuguese). 72 (1): 7–11. PMID 16917546.
  7. ↑ Linder T, Bossart W, Bodmer D (2005). "Bell's palsy and Herpes simplex virus: fact or mystery?". Otol. Neurotol. 26 (1): 109–13. PMID 15699730.
  8. ↑ Kanerva M, Mannonen L, Piiparinen H, Peltomaa M, Vaheri A, Pitkäranta A (2007). "Search for Herpesviruses in cerebrospinal fluid of facial palsy patients by PCR". Acta Otolaryngol. 127 (7): 775–9. doi:10.1080/00016480601011444. PMID 17573575.
  9. ↑ Stjernquist-Desatnik A, Skoog E, Aurelius E (2006). "Detection of herpes simplex and varicella-zoster viruses in patients with Bell's palsy by the polymerase chain reaction technique". Ann. Otol. Rhinol. Laryngol. 115 (4): 306–11. PMID 16676828.
  10. ↑ Tiemstra JD, Khatkhate N (2007). "Bell's palsy: diagnosis and management". Am Fam Physician. 76 (7): 997–1002. PMID 17956069.
  11. ↑ Middleton PJ, Peteric M, Kozak M, Rewcastle NB, McLachlan DR. (1980). "Herpes simplex viral genome and senile and presenile dementias of Alzheimer and Pick". Lancet: 1038.
  12. ↑ Dobson, C.B. (1999). "Herpes simplex virus type 1 and Alzheimer's disease". Neurobiol Aging. 20 (4): 457–65. Retrieved 2008-03-15. Unknown parameter |coauthors= ignored (help)
  13. ↑ Pyles, R.B. (2001). "The association of herpes simplex virus and Alzheimer's disease: a potential synthesis of genetic and environmental factors" (PDF). Herpes. 8 (3): 64–68. Retrieved 2008-03-15.
  14. ↑ Itzhaki, R.F. (1997). "Herpes simplex virus type 1 in brain and risk of Alzheimer's disease". Lancet. 349 (9047): 241–4. Retrieved 2008-03-15. Unknown parameter |coauthors= ignored (help)
  15. ↑ Stumpf MP, Laidlaw Z, Jansen VA (2002). "Herpes viruses hedge their bets". Proc. Natl. Acad. Sci. U.S.A. 99 (23): 15234–7. doi:10.1073/pnas.232546899. PMID 12409612.
  16. ↑ Sainz B, Loutsch JM, Marquart ME, Hill JM (2001). "Stress-associated immunomodulation and herpes simplex virus infections". Med. Hypotheses. 56 (3): 348–56. doi:10.1054/mehy.2000.1219. PMID 11359358.
  17. ↑ Chambers A, Perry M (2008). "Salivary mediated autoinoculation of herpes simplex virus on the face in the absence of "cold sores," after trauma". J. Oral Maxillofac. Surg. 66 (1): 136–8. doi:10.1016/j.joms.2006.07.019. PMID 18083428.
  18. ↑ Perna JJ, Mannix ML, Rooney JF, Notkins AL, Straus SE (1987). "Reactivation of latent herpes simplex virus infection by ultraviolet light: a human model". J. Am. Acad. Dermatol. 17 (3): 473–8. PMID 2821086.
  19. ↑ Rooney JF, Straus SE, Mannix ML; et al. (1992). "UV light-induced reactivation of herpes simplex virus type 2 and prevention by acyclovir". J. Infect. Dis. 166 (3): 500–6. PMID 1323616.
  20. ↑ Oakley C, Epstein JB, Sherlock CH (1997). "Reactivation of oral herpes simplex virus: implications for clinical management of herpes simplex virus recurrence during radiotherapy". Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 84 (3): 272–8. PMID 9377190.
  21. ↑ Ichihashi M, Nagai H, Matsunaga K (2004). "Sunlight is an important causative factor of recurrent herpes simplex". Cutis. 74 (5 Suppl): 14–8. PMID 15603217.
  22. ↑ Myśliwska J, Trzonkowski P, Bryl E, Lukaszuk K, Myśliwski A (2000). "Lower interleukin-2 and higher serum tumor necrosis factor-a levels are associated with perimenstrual, recurrent, facial Herpes simplex infection in young women". Eur. Cytokine Netw. 11 (3): 397–406. PMID 11022124.
  23. ↑ Segal AL, Katcher AH, Brightman VJ, Miller MF (1974). "Recurrent herpes labialis, recurrent aphthous ulcers, and the menstrual cycle". J. Dent. Res. 53 (4): 797–803. PMID 4526372.
  24. ↑ Martinez V, Caumes E, Chosidow O (2008). "Treatment to prevent recurrent genital herpes". Curr Opin Infect Dis. 21 (1): 42–48. doi:10.1097/QCO.0b013e3282f3d9d3. PMID 18192785.
  25. ↑ "AHMF: Preventing Sexual Transmission of Genital Herpes". Retrieved 2008-02-24.
  26. ↑ 26.0 26.1 26.2 26.3
  27. ↑ 27.0 27.1 27.2 27.3 27.4
  28. ↑ 28.0 28.1 Wald A, Langenberg AG, Link K, Izu AE, Ashley R, Warren T, Tyring S, Douglas JM Jr, Corey L. (2001). "Effect of condoms on reducing the transmission of herpes simplex virus type 2 from men to women". JAMA. 285 (24): 3100–3106. PMID 11427138.
  29. ↑ Casper C, Wald A. (2002). "Condom use and the prevention of genital herpes acquisition". Herpes. 9 (1): 10–14. PMID 11916494.
  30. ↑ de Visser RO, Smith AM, Rissel CE, Richters J, Grulich AE. (2003). "Sex in Australia: safer sex and condom use among a representative sample of adults". Aust. N. Z. J. Public Health. 27 (2): 223–229. PMID 14696715.
  31. ↑ Seppa, Nathan (2005-01-05). "One-Two Punch: Vaccine fights herpes with antibodies, T cells". Science News. p. 5. Retrieved 2007-03-29.
  32. ↑ Carla K. Johnson (August 23, 2006). "Percentage of people with herpes drops". Associated Press.
  33. ↑ Koelle DM, Corey L (2008). "Herpes Simplex: Insights on Pathogenesis and Possible Vaccines". Annu Rev Med. 59: 381–395. doi:10.1146/annurev.med.59.061606.095540. PMID 18186706.
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  45. ↑ "Drug Name: ABREVA (docosanol) - approval". centerwatch.com. July 2000. Retrieved 2007-10-17.
  46. ↑ "California Court Upholds Settlement Of Class Action Over Cold Sore Medicationl". BNA Inc. July 2000. Retrieved 2007-10-17.
  47. ↑ Another treatment, if not very medical, is the use of vaseline, or any other type of fat. This will ban water, or saliva, from reaching the cold sore. as the cold sore "feeds" itself from water, this will end its existence in a day or two. Kapinska-Mrowiecka M, Toruwski G (1996.). "Efficacy of cimetidine in treatment of herpes zoster in the first 5 days from the moment of disease manifestation". Pol Tyg Lek. 51 (23–26): 338–339. PMID 9273526. Check date values in: |year= (help)
  48. ↑ Hayne ST, Mercer JB (1983). "Herpes zoster:treatment with cemetidine". Can Med Assoc J. 129 (12): 1284–1285. PMID 6652595.
  49. ↑ Komlos L, Notmann J, Arieli J, et.al. (1994). "In vitro cell-mediated immune reactions in herpes zoster patients treated with cimetidine". Asian Pac J Allelrgy Immunol. 12 (1): 51–58. PMID 7872992.
  50. ↑ De Bony F, Tod M, Bidault R, On NT, Posner J, Rolan P. (2002). "Multiple interactions of cimetidine and probenecid with valaciclovir and its metabolite acyclovir". Antimicrob. Agents Chemother. 46 (2): 458–463. PMID 11796358.
  51. ↑ Karadi I, Karpati S, Romics L. (1998). "Aspirin in the management of recurrent herpes simplex virus infection". Ann. Intern. Med. 128 (8): 696–697. PMID 9537952.
  52. ↑ Gebhardt BM, Varnell ED, Kaufman HE. (2004). "Acetylsalicylic acid reduces viral shedding induced by thermal stress". Curr. Eye Res. 29 (2–3): 119–125. PMID 15512958.
  53. ↑ 53.0 53.1 53.2 53.3 53.4 "Herpevac Trial for Women". Retrieved 2008-02-25.
  54. ↑ Perfect MM, Bourne N, Ebel C, Rosenthal SL (2005). "Use of complementary and alternative medicine for the treatment of genital herpes". Herpes. 12 (2): 38–41. PMID 16209859.
  55. ↑ Vogler BK and Ernst E. "Aloe vera: a systematic review of its clinical effectiveness". British Journal of General Practice. 49: 823–828.
  56. ↑ Allahverdiyev A, Duran N, Ozguven M, Koltas S. (2004). "Antiviral activity of the volatile oils of Melissa officinalis L. against Herpes simplex virus type-2". Phytomedicine. 11 (7–8): 657–661. PMID 15636181.
  57. ↑ 57.0 57.1 Koytchev R, Alken RG, Dundarov S (1999). "Balm mint extract (Lo-701) for topical treatment of recurring herpes labialis". Phytomedicine. 6 (4): 225–30. PMID 10589440.
  58. ↑ Zacharopoulos VR, Phillips DM. (1997). "Vaginal formulations of carrageenan protect mice from herpes simplex virus infection". Clin. Diagn. Lab. Immunol. 4 (4): 465–468. PMID 9220165.
  59. ↑ Carlucci MJ, Scolaro LA, Damonte EB. (1999). "Inhibitory action of natural carrageenans on Herpes simplex virus infection of mouse astrocytes". Chemotherapy. 45 (6): 429–436. PMID 10567773.
  60. ↑ Binns SE, Hudson J, Merali S, Arnason JT (2002). "Antiviral activity of characterized extracts from echinacea spp. (Heliantheae: Asteraceae) against herpes simplex virus (HSV-I)". Planta Med. 68 (9): 780–3. doi:10.1055/s-2002-34397. PMID 12357386.
  61. ↑ Vonau B, Chard S, Mandalia S, Wilkinson D, Barton SE (2001). "Does the extract of the plant Echinacea purpurea influence the clinical course of recurrent genital herpes?". Int J STD AIDS. 12 (3): 154–8. PMID 11231867.
  62. ↑ Docherty JJ, Fu MM, Stiffler BS, Limperos RJ, Pokabla CM, DeLucia AL. (1999). "Resveratrol inhibition of herpes simplex virus replication". Antiviral Res. 43 (3): 145–155. PMID 10551373.
  63. ↑ Docherty JJ, Smith JS, Fu MM, Stoner T, Booth T. (2004). "Effect of topically applied resveratrol on cutaneous herpes simplex virus infections in hairless mice". Antiviral Res. 61 (1): 19–26. PMID 14670590.
  64. ↑ Weber ND, Andersen DO, North JA, Murray BK, Lawson LD, Hughes BG (1992). "In vitro virucidal effects of Allium sativum (garlic) extract and compounds". Planta Med. 58 (5): 417–23. PMID 1470664.
  65. ↑ Chiu LC, Zhub W, Oo VE (2004). "A polysaccharide fraction from medicinal herb Prunella vulgaris downregulates the expression of herpes simplex virus antigen in Vero cells". Journal of Ethnopharmacology. 93 (1): 63–68.
  66. ↑ Andersen JH, Jenssen H, Gutteberg TJ. (2003). "Lactoferrin and lactoferricin inhibit Herpes simplex 1 and 2 infection and exhibit synergy when combined with acyclovir". Antiviral Res. 58 (3): 209–215. PMID 12767468.
  67. ↑ McCune MA, Perry HO, Muller SA, O'Fallon WM. (2005). "Treatment of recurrent herpes simplex infections with L-lysine monohydrochloride". Cutis. 34 (4): 366–373. PMID 6435961.
  68. ↑ Griffith RS, Walsh DE, Myrmel KH, Thompson RW, Behforooz A. (1987). "Success of L-lysine therapy in frequently recurrent herpes simplex infection. Treatment and prophylaxis". Dermatologica. 175 (4): 183–190. PMID 3115841.
  69. ↑ Griffith RS, Norins AL, Kagan C. (1978). "A multicentered study of lysine therapy in Herpes simplex infection". Dermatologica. 156 (5): 257–267. PMID 640102.
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  71. ↑ Yazici AC, Baz K, Ikizoglu G (2006). "Recurrent herpes labialis during isotretinoin therapy: is there a role for photosensitivity?". J Eur Acad Dermatol Venereol. 20 (1): 93–5. doi:10.1111/j.1468-3083.2005.01358.x. PMID 16405618.
  72. ↑ Snipes W, Person S, Keith A, Cupp J. "Butylated hydroxytoluene inactivates lipid-containing viruses" Science. 1975;188(4183):64-6
  73. ↑ Richards JT, Katz ME, Kern ER. "Topical butylated hydroxytoluene treatment of genital herpes simplex virus infections of guinea pigs" Antiviral Res 1985;5(5):281-90
  74. ↑ Vezina C, Steben M. (2001). "Genital Herpes: Psychosexual Impacts and Counselling". The Canadian Journal of CME (June): 125–134.
  75. ↑ Herpes Support Groups & Clinics
  76. ↑ Herpes Viruses Association - a patient run group
  77. ↑ Herpes message forum with over 4000 members
  78. ↑ H-Date, a dating site for persons with either or both of HSV-1 or HSV-2
  79. ↑ MPwH - Meeting People with Herpes, a dating site with over 65000 members
  80. ↑ Green J, Ferrier S, Kocsis A, Shadrick J, Ukoumunne OC, Murphy S, Hetherton J. (2003). "Determinants of disclosure of genital herpes to partners". Sex. Transm. Infect. 79 (1): 42–44. PMID 12576613.
  81. ↑ Webpage on social aspects of genital herpes
  82. ↑ "The transmission of HIV as a criminal offence". Retrieved 2008-03-05.
  83. ↑ Gold-bikin, L.Z. [?hl=en&lr=&ie=UTF-8&q=info:5smAUslPm8sJ:scholar.google.com/&output=viewport "Herpes Breeds New Legal Epidemic: Fraud and Negligence Suits"] Check |url= value (help). Family Advocate. 7: 26. Retrieved 2008-03-05.

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