Herpes

Herpes is a very common virus. As many as 1 in 3 people carry the virus that causes herpes. Of those carrying the virus, around 80% of people are not aware that they have the condition as they show very mild symptoms or none at all. Herpes simplex viruses are prevalent all over the world and even in the most remote human populations.

What is Herpes?

Herpes is caused by the Herpes Simplex Virus (HSV) that spreads from one person to the other through direct contact. It is a common viral infection that manifests in the form of painful blisters or ulcers at the site of infection that heal over time on their own.

There are two types of Herpes Simplex Virus (HSV):

• Herpes Simplex Virus type 1 (HSV-1)
  HSV-1 is highly contagious, spreads easily from one person to another and is found all over the world. HSV-1 infection tends to occur during childhood and the virus lives in the body lifelong with no permanent cure. HSV-1 generally causes oral herpes, which is an infection in and around the mouth region. Oral herpes is also known as oro-labial, oral-labial or oral-facial herpes. HSV-1 can also cause genital herpes, which is herpes in the genital or the anal area of the body.
• Herpes Simplex Virus type 2 (HSV-2)
  HSV-2 infection is found all over the world and is almost always transmitted through sexual activity. It causes a condition known as genital herpes, which is a lifelong condition having no permanent cure.

The symptoms depend on the type of herpes virus causing it. Most of the time, herpes does not cause any symptoms and most people with HSV infection are not aware that they have it.

HSV-1

• Oral Herpes
  The symptoms of oral herpes, if they occur, are in the form of painful sores or blisters or ulcers inside and around your mouth. When these sores appear on or around the lips they are commonly known as cold sores. People experience a sensation of tingling, itching, or burning in the area before the sores appear. After the first time, the sores may appear again in the future. The number of times they reoccur varies from person to person. (Read more - Mouth ulcers causes and treatment)
• Genital Herpes
  Genital herpes may be asymptomatic or symptomatic. If the symptoms occur, they are characterized by the presence of one or more sores or blisters or ulcers in the genital area. Symptoms of genital herpes, when caused by HSV-1, do not tend to recur frequently.

HSV-2

The HSV-2 virus causes genital infections which do not show any symptoms or show symptoms that are not obvious and are not noticed by most people. Around 10 to 20% of the people who get infected with HSV-2 report that they have had the condition before.

• The symptoms of genital infection due to HSV-2, when they do occur, are in the form of one or more blisters or sores or ulcers in the genital area. People infected with HSV-2 may experience mild tingling or a shooting pain in the legs, hips, and buttocks before the symptoms show up.
• When the infection occurs for the first time, it may be accompanied by fever, body ache, and swollen lymph nodes.
• After the initial episode of the infection, recurrence is common when the virus becomes active again, but, the symptoms are less severe than those of the initial infection. 
• Recurrent outbreaks tend to occur more frequently in the first year and slowly tend to become less frequent. This is because the body’s natural defence system makes antibodies against the virus.

Causes

• The main source of contracting a Herpes Simplex infection is from the skin surface of an infected person, especially through the moist skin of the mouth, anus and the genitals. Infection can also be passed through other areas of the skin and through the eyes. It should be noted that the infection cannot spread by touching objects, workspaces, washbasins or towels that have been in contact of an infected person.
• Genital infection can occur while having unprotected sex - anal or vaginal, sharing sex toys and having genital contact.
• HSV can be passed on from one person to another even when there are no visible sores present.  It is usually passed on just before the appearance of a blister, while the blister is present and before it is completely healed.
• A pregnant mother can pass on her genital herpes to her baby while giving birth.

Risk Factors

• Children are more prone to catching Herpes Simplex Virus- type 1. They generally contract it from an adult who has the virus through the skin-to-skin contact. An adult carrying the virus usually has no sores or symptoms that indicate that he/she has the infection.
• Some common characteristics that put a person at a greater risk of contracting Herpes Simplex Virus- type 2 are as follows:
  • Having multiple sex partners.
  • Being sexually active since a young age.
  • A medical history of sexually transmitted infections.
  • Weak immune system due to certain diseases or medications.
  • Being a female.

Oral herpes

People with Herpes Simplex Virus (HSV-1) infection should take preventive measures to ensure that they do not spread the disease to others.

• In case of infection of the lips, avoid kissing, sharing glasses and constantly touching the lips until the sores on the lips have completely healed.
• Oral sex should be avoided to ensure that the infection doesn't spread to the genitals of your partners.
• A high level of personal hygiene should be maintained. Hands should be thoroughly washed every time after touching a sore.
• A fresh cotton-tipped swab should be used to apply medication on the cold sore.

Genital herpes

People with genital herpes are advised to use a condom at all times to protect their partners from an infection. This precaution needs to be taken irrespective of the presence of symptoms or visible blisters because the virus can be present on the genitals in its latent form and can spread to the partner. Be aware that use of a condom does not guarantee that the virus will not spread to your partner.

If at any time, you or your partner have been infected with genital herpes, it is important that this is informed to your doctor when you get pregnant. This is because when you carry the virus in its latent form, there are chances that you may pass it on to your baby. Your doctor may prescribe medicines during the end of your pregnancy to prevent it.

Herpes is often diagnosed by the appearance of characteristic lesions on the skin. Your doctor may collect a sample from the lesion by taking a swab and send it to the laboratory for diagnosis to confirm the presence of the virus. When lesions are not present, medical tests such as blood tests may be carried out to detect the presence of HSV.

Medication

Once a person is infected with HSV, there is no cure for the infection. Prevention against infection is also difficult as the disease is quite widespread.

The sores or lesions caused by the infection tend to clear up by themselves without any treatment most of the time. Treatments help to manage the symptoms, give relief from the pain and shorten the duration of the herpes episode.

The standard line of treatment is the use of antivirals. Antiviral creams and lotions help with the symptoms such as itching, burning and tingling of the skin and the mucosal surfaces. Antiviral pills, tablets and injections help to reduce the time the infection takes to heal.

Some of the common prescription medicines are Acyclovir, Famciclovir, and Valacyclovir. Remember that self-medication can be dangerous and doctors prescribe different medications based on the specific signs and symptoms and requirements of the patients. Hence, always consult a doctor before taking any medicine.

Anti-viral medicines help to reduce both the intensity and the duration of the viral outbreak and may also help to control the spread of infection.

Lifestyle management

Herpes is a lifelong viral condition and once a person is infected, there is no way to get rid of the virus from the body. However, care can be taken to ensure that friends and family members around the person do not get infected with the virus. In the case of genital herpes, certain lifestyle changes to protect partners from infection and avoiding sex during the outbreak of herpes may be required. Open and honest communication is important to maintain your relationship. Talk to your doctor about the concerns you may have.

Prognosis

Herpes has no medical treatment. The disease manifests itself from time to time in the form of eruptions and exists in its latent form in most people. Recurrences are more common in the first year and tend to lessen in intensity, duration and frequency with the passage of time. This is because, with time, the body's natural defence mechanism tends to develop antibodies against the virus. Medication for a herpes outbreak is aimed at reducing the symptoms and associated discomforts such as itchiness. People who have a good immunity have lesser problems while those who have a compromised immune system tend to develop severe complications.

Complications

Generally, HSV does not cause any major complications. HSV-1 infection in the eyes can lead to blindness if not treated on time.  Other complications of herpes oral infection (HSV-1) may include bacterial infection of the skin, recurrence of sores and blisters in the mouth. People with a weak immune system due to conditions like HIV, cancer or atopic dermatitis may develop a widespread body infection which can be dangerous. Complications may also occur to unborn babies, newborn babies, people who have a long-term illness or had an organ transplant. If you have any such medical conditions and notice any symptoms of herpes, it is advised that you seek immediate medical attention.