Know the disease- Herpes simplex. Herpes simplex is one of the oldest diseases known to mankind. Personal hygiene and sexual hygiene are very important to prevent.
Herpes simplex is one of the oldest diseases known to mankind. Von Hebra wrote the meaning of herpes in 1886. Herpes means to creep, to crawl. The skin lesions spread slowly to surrounding area. Herpes simplex is popularly called as “Fever blister”. The meaning of fever blister is, every time person gets fever, vesicles and ulcer appear on lips, and around the nostrils. Fever may be of any origin, it may be malaria or an enteric fever. Herpes simplex is also called as “Cold sore”. Every time person gets common cold, the vesicles and ulcer appear on lips, and around the nostrils. In one year, if person gets common cold twice, he will get herpes simplex twice. If person gets common cold 4 times, he will get herpes simplex also 4 times. Once fever subsides, or common cold subsides, herpes simplex also subsides.
What causes herpes simplex?
Herpes simplex is caused by a virus, called “Human Herpes virus 1 (HHV1)” and “Human Herpes virus 2 (HHV 2)”. Both belong to DNA group, and family Human Hepesvirdae family. HHV 1 usually causes vesicles and ulcers around mouth, it is called “Herpes labialis”. HHV 2 usually causes vesicles and ulcers around genitals, it is called “Herpes genitalis”. When a person’s defense mechanism is lowered for any reason, either due to simple disease, or serious diseases like cancer, AIDS, or on steroids and anti-metabolites, person is more prone to develop herpes simplex. When a person with lower immunity comes in intimate contact with a person suffering from herpes simplex infection, the virus enters mucous membrane, or small cuts in skin. They start multiplying in the skin or mucous membrane and take rest. Then slowly find nerve filaments and climb along the nerve filaments and reach “Nerve ganglion”. They settle in nerve ganglion and stay permanently in nerve ganglion. As and when person’s immunity lowers, herpes virus gets activated and start multiplying in nerve ganglion, descends down the nerve filament and reach skin or mucous membrane, and initiate inflammation in the form of pain, redness, vesicles, and ulcers. After few days, ulcer heal, if second time or again and again, if person develop fever or common cold, viruses in nerve ganglion climb down along the nerve filaments, and reach skin or mucous membrane, and initiate inflammation in the form of pain, redness, vesicles, and ulcers, called second attack of herpes or “Recurrent herpes”.
How many days necessary to produce clinical symptoms?
Once virus enters a person it will take 1 week to 2 weeks to produce clinical signs. If it is first attack, it may take 2 weeks; second or recurrent lesions may take 2 to 4 days.
How many people suffer from Herpes in the World?
World Health Organization estimated 3.7 billion people under the age of 50 years have HSV-1 infection globally. WHO estimated 417 billion people aged between 15-49 Worldwide have HSV-2 infection.
What are the symptoms of first attack?
First attack is called primary attack. Primary attack of HHV 1 occurs in childhood. Primary attack is severe, person suffer from fever, body ache, head ache, irritation in the throat. On the lip, patient feels burning sensation and discomfort, redness and edema develop, small bumps will erupt. In 1 or 2 days, these bumps will change to water filled lesions called blisters or vesicles. In 2 more days, pus cells called neutrophils enter and change the vesicles to pustules. These vesicles and pustules are present in groups. They burst open leaving painful ulcers. Local lymph nodes enlarge and become painful. Slowly fever subsides, ulcer start forming crust and heals. Most of the time ulcer heals without producing a scar.
What are the symptoms of second or recurrent attack?
Symptoms of secondary attack are comparatively mild. Fever and body aches are mild. In the same area, where the primary attack has produced blisters and ulcers, blisters and ulcers develop in and around the same area during recurrent attack.
What are the common sites for herpes attack?
Most of the time herpes lesions are found on the upper lip, lower lip, or around the nostrils in children. Herpes lesions are found on genitals in adults. Herpes lesions are also found on tongue, esophagus, and finger tips.
What are the investigations?
Simple clinical examination is sufficient. Sometimes fluid of blisters is to be examined for giant cells, or taken for virus culture. Serum antibodies also can be examined. It is wise to investigate for underlying disease. All sexually active people are to be screened for HIV and other STDs.
Possible Complications of herpes simplex – Usually people adjust and try to live with attacks. Sometimes it will become problematic. The complications are:
- Severe disease in people with reduced immunity, especially in advanced HIV/AIDS cases. The ulcer may extend deep into cheeks and gums, and destroy parts of the lips and cheeks.
- Psychological impact – person will develop inferiority complex and depression in life. If herpes lesions start recurring on genitals, his sex life is disturbed, quality of life is disturbed and family life also gets disturbed.
- When a mother with herpes genitalis deliver, the baby while coming out of birth canal, will get infected, and the baby will suffer severely. The brain and spinal cord will also get infected.
What is treatment?
Simple local application of calamine lotion and antibiotic cream is advised till the ulcer heals. For fever and body ache paracetamol tablets are better. Antiviral drugs like Acyclovir to be taken under the guidance of doctors.
Prevention
HSV-1 is most contagious during an outbreak of symptomatic oral herpes, but can also be transmitted when no symptoms are felt or visible. People with active symptoms of oral herpes should avoid oral contact with others and sharing objects that have contact with saliva. They should also abstain from oral sex, to avoid transmitting herpes to the genitals of a sexual partner. Individuals with symptoms of genital herpes should abstain from sexual activity whilst experiencing any of the symptoms. Personal hygiene and sexual hygiene are important.
Dr Aarudhra Premchander,
Vydehi Institute of Medical Sciences & Research Centre
Bangalore- 560066
Ph: 080 28413381/2/3/4
