==[[Herpes simplex transmission|Mode of Transmission]]==
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 [[Soma (biology)|cell body]]. HSV latency is static - no virus is produced - and is controlled by a number of viral genes including Latency Associated Transcript (LAT).<ref name="pmid12409612">{{cite journal |author=Stumpf MP, Laidlaw Z, Jansen VA |title=Herpes viruses hedge their bets |journal=Proc. Natl. Acad. Sci. U.S.A. |volume=99 |issue=23 |pages=15234–7 |year=2002 |pmid=12409612 |doi=10.1073/pnas.232546899}}</ref>
[[Herpes simplex transmission#Asymptomatic shedding|Asymptomatic shedding]] | [[Herpes simplex transmission#Recurrences and triggers|Recurrences and triggers]] | [[Herpes simplex transmission#Transmission and prevention|Transmission and prevention]]
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.<ref name="pmid11359358">{{cite journal |author=Sainz B, Loutsch JM, Marquart ME, Hill JM |title=Stress-associated immunomodulation and herpes simplex virus infections |journal=Med. Hypotheses |volume=56 |issue=3 |pages=348–56 |year=2001 |pmid=11359358 |doi=10.1054/mehy.2000.1219}}</ref> Local injury to the face, lips, eyes or mouth, trauma, surgery, wind, [[radiotherapy]], [[ultraviolet light]] or sunlight are well established triggers.<ref name="pmid18083428">{{cite journal |author=Chambers A, Perry M |title=Salivary mediated autoinoculation of herpes simplex virus on the face in the absence of "cold sores," after trauma |journal=J. Oral Maxillofac. Surg. |volume=66 |issue=1 |pages=136–8 |year=2008 |pmid=18083428 |doi=10.1016/j.joms.2006.07.019}}</ref><ref name="pmid2821086">{{cite journal |author=Perna JJ, Mannix ML, Rooney JF, Notkins AL, Straus SE |title=Reactivation of latent herpes simplex virus infection by ultraviolet light: a human model |journal=J. Am. Acad. Dermatol. |volume=17 |issue=3 |pages=473–8 |year=1987 |pmid=2821086 |doi=}}</ref><ref name="pmid1323616">{{cite journal |author=Rooney JF, Straus SE, Mannix ML, ''et al'' |title=UV light-induced reactivation of herpes simplex virus type 2 and prevention by acyclovir |journal=J. Infect. Dis. |volume=166 |issue=3 |pages=500–6 |year=1992 |pmid=1323616 |doi=}}</ref><ref name="pmid9377190">{{cite journal |author=Oakley C, Epstein JB, Sherlock CH |title=Reactivation of oral herpes simplex virus: implications for clinical management of herpes simplex virus recurrence during radiotherapy |journal=Oral Surg Oral Med Oral Pathol Oral Radiol Endod |volume=84 |issue=3 |pages=272–8 |year=1997 |pmid=9377190 |doi=}}</ref><ref name="pmid15603217">{{cite journal |author=Ichihashi M, Nagai H, Matsunaga K |title=Sunlight is an important causative factor of recurrent herpes simplex |journal=Cutis |volume=74 |issue=5 Suppl |pages=14–8 |year=2004 |pmid=15603217 |doi=}}</ref> Some studies suggest changes in the immune system during [[menstruation]] may play a role in HSV-1 reactivation.<ref name="pmid11022124">{{cite journal |author=Myśliwska J, Trzonkowski P, Bryl E, Lukaszuk K, Myśliwski A |title=Lower interleukin-2 and higher serum tumor necrosis factor-a levels are associated with perimenstrual, recurrent, facial Herpes simplex infection in young women |journal=Eur. Cytokine Netw. |volume=11 |issue=3 |pages=397–406 |year=2000 |pmid=11022124 |doi=}}</ref><ref name="pmid4526372">{{cite journal |author=Segal AL, Katcher AH, Brightman VJ, Miller MF |title=Recurrent herpes labialis, recurrent aphthous ulcers, and the menstrual cycle |journal=J. Dent. Res. |volume=53 |issue=4 |pages=797–803 |year=1974 |pmid=4526372 |doi=}}</ref> 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.<ref name="pmid18192785">{{cite journal |author=Martinez V, Caumes E, Chosidow O |title=Treatment to prevent recurrent genital herpes |journal=Curr Opin Infect Dis |volume=21 |issue=1 |pages=42–48 |year=2008 |pmid=18192785 |doi=10.1097/QCO.0b013e3282f3d9d3}}</ref>
==Transmission and prevention==
Herpes can be contracted through direct contact with an active lesion or body fluid of an infected person.<ref name="titleAHMF: Preventing Sexual Transmission of Genital Herpes">{{cite web |url=http://www.ahmf.com.au/health_professionals/guidelines/preventing_gh_transmission.htm |title=AHMF: Preventing Sexual Transmission of Genital Herpes |accessdate=2008-02-24 |format= |work=}}</ref> 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.<ref name="pmid16238897"/> 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.<ref name="pmid18156035"/> 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 [[monogamy|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.
[[Image:Kondom.jpg|thumb|left|200px|Barrier protection, such as a condom, can reduce the risk of herpes transmission in some cases]]
For genital herpes, [[condom]]s are a highly effective in limiting transmission of herpes simplex infection.<ref name=Wald>{{cite journal | author=Wald A, Langenberg AG, Link K, Izu AE, Ashley R, Warren T, Tyring S, Douglas JM Jr, Corey L. | title=Effect of condoms on reducing the transmission of herpes simplex virus type 2 from men to women | journal=JAMA | year=2001 | pages=3100-3106 | volume=285 | issue=24 | id=PMID 11427138}}</ref><ref name=Casper>{{cite journal | author=Casper C, Wald A. | title=Condom use and the prevention of genital herpes acquisition. | journal=Herpes | year=2002 | pages=10-14 | volume=9 | issue=1 | id=PMID 11916494}}</ref> 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,<ref name=Visser>{{cite journal | author=de Visser RO, Smith AM, Rissel CE, Richters J, Grulich AE. | title=Sex in Australia: safer sex and condom use among a representative sample of adults | journal=Aust. N. Z. J. Public Health. | year=2003 | pages=223-229 | volume=27 | issue=2 | id=PMID 14696715}}</ref> 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.<ref name="pmid18156035"/> Topical [[microbicide]]s contain chemicals that directly inactivate the virus and block viral entry are currently being investigated.<ref name="pmid18156035"/> [[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. <ref>{{cite news | last =Seppa | first =Nathan | title =One-Two Punch: Vaccine fights herpes with antibodies, T cells | pages =5 | language =English | publisher =Science News | date= 2005-01-05 | url =http://www.sciencenews.org/articles/20050101/fob6.asp | accessdate = 2007-03-29}}</ref>
As with almost all sexually transmited infections, women are more susceptible to acquiring genital HSV-2 than men.<ref> {{cite news | author=Carla K. Johnson | title=Percentage of people with herpes drops | url=http://www.newsobserver.com/150/story/477928.html | publisher=Associated Press | date= August 23, 2006}}</ref> 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. <ref name=Wald/> 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.<ref name="pmid18156035"/> 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.<ref name="pmid18156035"/>
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.<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>
==Asymptomatic shedding==
HSV asymptomatic [[viral shedding|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.<ref name="pmid16238897"/> Asymptomatic shedding is more frequent within the first 12 months of acquiring HSV, and concurrent infection with [[Human Immunodeficiency Virus|HIV]] also increases the frequency and duration of asymptomatic shedding.<ref>{{cite journal | author = Kim H, Meier A, Huang M, Kuntz S, Selke S, Celum C, Corey L, Wald A | title = Oral herpes simplex virus type 2 reactivation in HIV-positive and -negative men. | journal = J Infect Dis | volume = 194 | issue = 4 | pages = 420-7 | year = 2006 | id = PMID 16845624}}</ref> It can occur more than a week before or after a symptomatic recurrence in 50% of cases.<ref name="pmid16238897"/> 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.<ref name="pmid16238897"/>
The [[National Institutes of Health]] (NIH) in the United States is currently in the midst of [[Clinical trial|phase III trials]] of a vaccine against HSV-2, called Herpevac.<ref name="titleHerpevac Trial for Women">{{cite web |url=http://www.niaid.nih.gov/dmid/stds/herpevac/ |title=Herpevac Trial for Women |accessdate=2008-02-25 |format= |work=}}</ref> 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.<ref name="titleHerpevac Trial for Women">{{cite web |url=http://www.niaid.nih.gov/dmid/stds/herpevac/studyover_faqs.htm |title=Herpevac Trial for Women |accessdate=2008-03-04 |format= |work=}}</ref> 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.<ref name="titleHerpevac Trial for Women"/> 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.<ref name="titleHerpevac Trial for Women"/> 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.<ref name="titleHerpevac Trial for Women"/>
===Natural compounds===
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|Some individuals seek benefits in natural products and dietary supplements for treatment of herpes
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Certain [[dietary supplement]]s and [[Complementary and alternative medicine|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.<ref name="pmid16209859">{{cite journal |author=Perfect MM, Bourne N, Ebel C, Rosenthal SL |title=Use of complementary and alternative medicine for the treatment of genital herpes |journal=Herpes |volume=12 |issue=2 |pages=38–41 |year=2005 |pmid=16209859 |doi=}}</ref>
[[Aloe vera]] is available as cream or gel which makes an affected area heal faster, and may even prevent recurrences.<ref>{{cite journal | author=Vogler BK and Ernst E. | title=Aloe vera: a systematic review of its clinical effectiveness. | journal=British Journal of General Practice| volume=49| pages=823-828 | url=http://www.jr2.ox.ac.uk/bandolier/booth/alternat/AT125.html}}</ref>
[[Lemon balm]] (''Melissa officinalis''), has antiviral activity against HSV-2 in cell culture, and may reduce HSV symptoms in herpes infected people.<ref name=Allahverdiyev>
{{cite journal
| author=Allahverdiyev A, Duran N, Ozguven M, Koltas S. | title=Antiviral activity of the volatile oils of Melissa officinalis L. against Herpes simplex virus type-2. | journal=Phytomedicine. | year=2004 | pages=657-661 | volume=11 | issue=7-8 | id=PMID 15636181
}}</ref><ref name="pmid10589440">{{cite journal |author=Koytchev R, Alken RG, Dundarov S |title=Balm mint extract (Lo-701) for topical treatment of recurring herpes labialis |journal=Phytomedicine |volume=6 |issue=4 |pages=225–30 |year=1999 |pmid=10589440 |doi=}}</ref><ref name="pmid10589440"/> [[Carrageenan]]s - linear sulphated [[polysaccharide]]s extracted from red [[seaweed]]s - have been shown to have antiviral effects in HSV-infected cells and in mice.<ref name=Zacharopoulos>
}}</ref> 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.<ref name="pmid12357386">{{cite journal |author=Binns SE, Hudson J, Merali S, Arnason JT |title=Antiviral activity of characterized extracts from echinacea spp. (Heliantheae: Asteraceae) against herpes simplex virus (HSV-I) |journal=Planta Med. |volume=68 |issue=9 |pages=780–3 |year=2002 |pmid=12357386 |doi=10.1055/s-2002-34397}}</ref><ref name="pmid11231867">{{cite journal |author=Vonau B, Chard S, Mandalia S, Wilkinson D, Barton SE |title=Does the extract of the plant Echinacea purpurea influence the clinical course of recurrent genital herpes? |journal=Int J STD AIDS |volume=12 |issue=3 |pages=154–8 |year=2001 |pmid=11231867 |doi=}}</ref> [[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.<ref name=Docherty99>
{{cite journal
| author=Docherty JJ, Fu MM, Stiffler BS, Limperos RJ, Pokabla CM, DeLucia AL. | title=Resveratrol inhibition of herpes simplex virus replication | journal=Antiviral Res. | year=1999 | pages=145-155 | volume=43 | issue=3 | id=PMID 10551373
}}</ref><ref name=Docherty04>{{cite journal
| author=Docherty JJ, Smith JS, Fu MM, Stoner T, Booth T. | title=Effect of topically applied resveratrol on cutaneous herpes simplex virus infections in hairless mice | journal=Antiviral Res. | year=2004 | pages=19-26 | volume=61 | issue=1 | id=PMID 14670590
}}</ref> 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.<ref name="pmid1470664">{{cite journal |author=Weber ND, Andersen DO, North JA, Murray BK, Lawson LD, Hughes BG |title=In vitro virucidal effects of Allium sativum (garlic) extract and compounds |journal=Planta Med. |volume=58 |issue=5 |pages=417–23 |year=1992 |pmid=1470664 |doi=}}</ref> The plant ''[[Prunella vulgaris]]'', commonly known as "selfheal", also prevents expression of both type 1 and type 2 herpes in cultured cells.<ref name=saritamackita> {{cite journal
| author=Chiu LC, Zhub W, Oo VE | title=A polysaccharide fraction from medicinal herb Prunella vulgaris downregulates the expression of herpes simplex virus antigen in Vero cells | journal=Journal of Ethnopharmacology | year=2004 | pages=63-68 | volume=93 | issue=1 }}</ref>
[[Lactoferrin]], a component of whey protein, has been shown to have a synergistic effect with aciclovir against HSV ''in vitro''.<ref name=Andersen>
{{cite journal
| author=Andersen JH, Jenssen H, Gutteberg TJ. | title=Lactoferrin and lactoferricin inhibit Herpes simplex 1 and 2 infection and exhibit synergy when combined with acyclovir | journal=Antiviral Res. | year=2003 | pages=209-215 | volume=58 | issue=3 | id=PMID 12767468
}}</ref> [[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.<ref name=McCune>
{{cite journal
| author=McCune MA, Perry HO, Muller SA, O'Fallon WM. | title=Treatment of recurrent herpes simplex infections with L-lysine monohydrochloride | journal=Cutis. | year=2005 | pages=366-373 | volume=34 | issue=4 | id=PMID 6435961
}}</ref><ref name=Griffith>
{{cite journal
| author=Griffith RS, Walsh DE, Myrmel KH, Thompson RW, Behforooz A. | title=Success of L-lysine therapy in frequently recurrent herpes simplex infection. Treatment and prophylaxis | journal=Dermatologica. | year=1987 | pages=183-190 | volume=175 | issue=4 | id=PMID 3115841
}}</ref><ref name=Griffith2>
{{cite journal
| author=Griffith RS, Norins AL, Kagan C. | title=A multicentered study of lysine therapy in Herpes simplex infection | journal=Dermatologica. | year=1978 | pages=257-267 | volume=156 | issue=5 | id=PMID 640102
}}</ref>
Some dietary supplements have been suggested to positively treat herpes. These include [[vitamin C]], [[vitamin A]], [[vitamin E]], and [[zinc]].<ref name="pmid16813459">{{cite journal |author=Gaby AR |title=Natural remedies for Herpes simplex |journal=Altern Med Rev |volume=11 |issue=2 |pages=93–101 |year=2006 |pmid=16813459 |doi=}}</ref><ref name="pmid16405618">{{cite journal |author=Yazici AC, Baz K, Ikizoglu G |title=Recurrent herpes labialis during isotretinoin therapy: is there a role for photosensitivity? |journal=J Eur Acad Dermatol Venereol |volume=20 |issue=1 |pages=93–5 |year=2006 |pmid=16405618 |doi=10.1111/j.1468-3083.2005.01358.x}}</ref> [[Butylated hydroxytoluene]] (BHT), commonly available as a food preservative, has been shown in cell culture and animal studies to inactivate herpes virus.<ref>Snipes W, Person S, Keith A, Cupp J. "Butylated hydroxytoluene inactivates lipid-containing viruses" Science. 1975;188(4183):64-6</ref> <ref>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</ref> However BHT has not been clinically tested and approved to treat herpes infections in humans.
==Psychological and social effects==
==Psychological and social effects==
Revision as of 18:49, 15 September 2011
For patient information on congenital herpes, click here
For patient information on genital herpes, click here
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).
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.[1] 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.[2][3][4][5][6]
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'.[7] 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.[8] 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.[9] 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.[10]
References
↑Vezina C, Steben M. (2001). "Genital Herpes: Psychosexual Impacts and Counselling". The Canadian Journal of CME (June): 125–134.
