Herpes Simplex Infections (HSV)

Herpes simplex infections are caused by 2 different viruses simply called HSV-1 and HSV-2. HSV-1 causes infection of the oral area (cold sores and fever blisters) while HSV-2 causes blisters or sores on the cervix, vagina or penis. Both illnesses are characterized by repeated cycles of healing and recurrences.

One can rarely see neurologic complications of encephalitis with HSV-1 and meningitis with HSV-2.

In newborns, ingestion of viruses during delivery can lead to infections of skin, eyes and oral areas. Life-threatening infection can also develop involving the lung, liver, brain and meninges.

Where does it occur?

It occurs worldwide, however it is more prevalent in lower-socioeconomic groups.

How is it transmitted?

Transmission of HSV-1 is through contact with saliva, while HSV-2 is transmitted through sexual intercourse. Newborn contract the infection as it is coming through the birth canal of infected mothers.

Is it contagious from person to person?

It is contagious from person to person through intimate contact with infected areas. HSV 1 is typically contracted through contact with saliva of an infected individual through activities of kissing, while HSV 2 is typically contracted through sexual intercourse with an infected individual.

However if there is oral-genital contact, both viruses can be involved in oral and genital areas.

It is important to note that infected individuals without visible sores can still shed the virus and be contagious.

What is the risk for travelers?

The risk is generally low unless engaged in unprotected sexual intercourse with infected individuals even if they have no visible sores.

How soon after exposure will one develop symptoms?

Symptoms develop anywhere from 2-14 days after exposure.

What are the signs and symptoms?

HSV-1 is characterized by onset of small blisters on lips, mouth and throat that can erode into painful ulcers. HSV-1 involvement of the eye can result in pink eye with excessive tearing, pain with bright lights, etc. If the infection spreads to the brain and meninges one can see confusion, agitation, fever, headache and seizures.

HSV-2 is characterized by blisters with a red base that are painful and erode to form shallow ulcers. This may be associated with fever and painful lymph nodes in the groin. Very rarely one can develop infection of the nervous system with symptoms of headache and neck stiffness suggesting meningitis. Alternatively one can have pain shooting down the legs with difficulty urinating or defecating if nerves in the pelvis are involved. This can be life-threatening.

Are there any lab tests to diagnose the illness?

The virus can be detected on swabs of blisters and ulcers with antibody tests. The virus can be cultured from these blisters and ulcers. Spinal fluid can be tested by PCR for HSV to diagnose central nervous system involvement.

Newer blood antibody tests may help differentiate between HSV-1 from HSV -2 infections if done in specialized and reputable labs.

Is there any treatment?

Medications like acyclovir, famciclovir, valacyclovir are available and effective. Central nervous system involvement requires intravenous treatment.

What preventive measures can be taken?

Avoid unprotected sexual activity. In health care settings wear gloves when in contact with known infected patients.

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