Herpes simplex is an infectious disease caused by viruses. The disease is divided into 2 subtypes. While type 1 (HSV-1) is predominantly localized on the lip, type 2 (HSV-2) occurs primarily on the genitals. Normally, this disease is harmless, but in individual cases it can become dangerous.
What is herpes simplex?
The word “herpes” is derived from the ancient Greek language from “herpein” (= “creep”). This refers to the creeping spread of the individual skin lesions. “Simplex” means “the simple form.” This addition distinguishes the disease from herpes zoster, the causative agent of chickenpox and shingles. In most cases, both types of herpes occur as a skin disease. Occasionally, a generalized form can also develop in immunocompromised individuals. This usually occurs as a result of herpes sepsis or inflammation of internal organs, such as on the retina (herpes simplex retinitis) of the eye or in the esophagus (herpes simplex esophagitis). About 90% of all adults are affected by HSV-1, compared with only 5% to 30% for HSV-2.
Causes
In a person who has been infected with the herpes virus once during his or her lifetime, the disease remains latent in the nerve ganglia (nodes) of the body. The initial infection may be asymptomatic. The virus remains dormant in the body for life, which is called persistent infection. In fact, the disease is transmissible even in this state. HSV-1, which primarily appears as cold sores, is passed on during childhood. This occurs either through direct mucosal contact (e.g., kissing) or as droplet infection through the air (e.g., sneezing, breathing on someone). Infection with HSV-2 occurs predominantly during sexual intercourse. The infection therefore counts as a sexually transmitted disease.
Symptoms, complaints, and signs
Herpes simplex is typically manifested by itchy, burning blisters around the mouth, lips, face, and genitals. The blisters are usually filled with water or pus and burst open after several days to weeks. A painful crust then forms on the affected area, which usually falls off after a few days. In the course of time, the disease can spread to other parts of the body and affect, for example, the cheeks, eye area, nasal cavity and earlobes. Occasionally, a feeling of sickness is added. Those affected then feel tired and listless or have a slight fever. If it is genital herpes, there is also pain and burning during urination and an unpleasant itching sensation. The lymph nodes are often swollen. If herpes simplex is not treated, the symptoms can increase in intensity and significantly affect the well-being of the affected person. There is also an acute risk of infection. Two-thirds of people who carry the virus do not experience any symptoms. The first signs that indicate an approaching outbreak of the disease are painful areas around the corners of the mouth and nose, as well as an acute feeling of illness that does not appear to have any underlying cause. When these symptoms are noticed, a physician should be consulted.
Diagnosis and course
Symptoms occur in only 1% of cases of initial HSV-1 infection. Typically, the first illness occurs in the form of oral thrush (stomatitis aphtosa). Aphtae and lesions on the oral mucosa are the result. It can also lead to vesicles on the lips. It is usually a cluster rather than individual lesions as in recurrent. An acute condition of herpes infection is accompanied by a typical course. It begins with a feeling of tightness and swelling in one area of the lips (in HSV-1). In a few hours, there is visible swelling. After 1 to 2 days, the skin forms a series of small, fluid-filled blisters. Over the course of another 3 to 5 days, the vesicles crust over and dry up. In the case of HSV-2, the initial infection is usually accompanied by severe symptoms. In principle, an infection with genital herpes is similar to an outbreak of HSV-1, but because of the sensitive region, HSV-2 is much more painful. The virus can lead to years of suffering due to frequent recurrences in the worst cases. Herpes simplex can be diagnosed in several ways. In most cases, a clinical diagnosis is sufficient. A laboratory examination of the blood can determine whether antibodies against HSV-1 or HSV-2 are present.However, this method is only of limited value. Since the infection rate for labial herpes is about 90%, the majority of people have positive values in the laboratory, without a connection with the current symptoms being possible. An expensive and very complex diagnostic technique is the PCR (polymerase chain reaction) method, which allows the DNA of the virus to be directly detected if present.
Complications
Infection with herpes simplex virus can cause serious complications. First, there is a risk that the infection will spread to areas of skin that are already damaged. Such a superinfection makes the healing process considerably more difficult and is associated with further general symptoms such as fever and exhaustion. In certain risk groups (newborns, HIV patients, patients undergoing chemotherapy), herpes simplex can lead to an overload of the immune system. This can lead to life-threatening complications such as pneumonia, herpes encephalititis or herpes inflammation of the brain. Occasionally, the eyes may also be affected (herpes simplex retinitis), associated among other things with reduced vision and corneal scarring. In severe cases, an infection can cause herpes sepsis. This leads to blood poisoning and a partial failure of the immune system, which is usually fatal. Rarely, nerve infestation also occurs, resulting in nerve paralysis and dysfunction. Sometimes an infection with the virus can also lead to herpes simplex meningoencephalitis. This is an inflammation of the brain associated with flu-like symptoms and impaired consciousness. If meningoencephalitis is left untreated, it can lead to coma or even death of the affected person.
When should you see a doctor?
Herpes simplex is usually a harmless infection that does not normally require medical treatment. Almost everyone carries the herpes virus. At times, however, it can become active, and the infection is usually manifested by blisters on the lip. In rare cases, there are other localizations of the virus, special forms or generalized infections that require medical examination. The doctor should be consulted, among other things, in case of infestation of larger skin areas with herpes blisters (eczema herpeticatum), in case of occurrence of retinitis, in case of facial paralysis, in case of stomatitis aphthosa (mouth rot) or esophagitis. Eczema herpeticatum is often associated with severe illness and, in immunocompromised individuals, may even lead to herpes simplex encephalitis, which is often fatal. Therefore, the physician must be consulted immediately if psychotic symptoms such as behavioral changes, confusion or disorientation suddenly appear in addition to high fever. Retinitis caused by herpes viruses can lead to blindness if not treated by a doctor. A generalized herpes simplex should also be taken as a reason to consult a doctor, as it can lead to sepsis-like courses of the disease. In the case of a herpes infection during pregnancy, a doctor must also be consulted because there is a high risk of transmitting the virus to the unborn child. To avoid infection, the child must be delivered by cesarean section. Herpes infections of newborns also require urgent treatment because they can lead to severe complications, including herpes simplex encephalitis.
Treatment and therapy
Therapy for herpes simplex is primarily with antivirals (drugs against viruses). Common preparations are aciclovir or penciclovir. In mild cases, a cream for the skin with the appropriate active ingredients is prescribed. In severe cases or in immunocompromised people, the drugs can also be administered in tablet form or as an infusion. An alternative is herpes plasters, which form a moist cushion around the blisters with hydrocolloids and thus prevent them from spreading. The disease itself is not curable. Only the acute outbreak can be treated. The course of the disease is shortened and mitigated by the medication. The viruses in the nerve cells could not be destroyed by any therapy so far. Current research is focusing on helicase-primase inhibitors, which target the enzymes that the virus needs for duplication. So far, initial successes have been achieved in animal studies.Scientifically not proven is the effectiveness of certain home remedies, such as toothpaste, zinc paste or tea tree oil.
Outlook and prognosis
The prognosis for herpes simplex is favorable. Normally, relief of symptoms occurs within a few days. The course of the disease can be positively influenced if the affected person takes drug treatment immediately when the first symptoms appear. The application of ointments or special plasters curbs the herpes simplex. This prevents the spread of the virus and the damaged areas of skin also heal more quickly. Without medical treatment, the course of the disease is delayed. The disease regresses on its own after about seven to ten days. There is also a risk of the virus spreading. If herpes blisters burst open, fluid escapes and more blisters form. Nevertheless, most patients are cured within a week. The use of alternative healing methods can also contribute to recovery from herpes simplex. The use of home remedies or appropriate natural remedy-based products can help alleviate symptoms and improve healing. Despite the good prognosis, most affected individuals experience repeated outbreaks of herpes simplex during their lifetime. In children, the infection may spread throughout the body and additionally become life-threatening.
Prevention
Recurrence is often associated with an immunocompromised situation, such as a cold. To avoid reactivation of the viruses, a healthy diet rich in vitamins is important. During an acute outbreak, skin contact with other people should be avoided. In the case of HSV-2, sexual intercourse should not take place during a recurrence.
Aftercare
Compared with the initial infection, recurrence of the disease herpes simplex is much weaker. This is because the body is already familiar with the virus and thus establishes effective defense mechanisms more quickly. It is not uncommon for those affected not to notice herpes simplex at all in the case of recurrence. If, on the other hand, symptoms persist permanently, patients should definitely consult a doctor. The doctor makes a diagnosis on the basis of external examination. Only rarely is the pathogen determined separately in the laboratory. The peculiarity of the disease means that there is no scheduled follow-up examination. Herpes simplex either resolves on its own or is successfully treated with antiviral drugs. To prevent the recurrence of the disease, no special precautions based on medical action are suitable. An effective vaccination does not yet exist. Patients themselves are responsible for preventive measures. They should strengthen their immune system by eating a balanced diet, exercising regularly and getting enough sleep. Permanent stress can also contribute to a weakening of the immune system. Contraception is recommended for contact with unfamiliar sexual partners. After symptoms subside, it is possible to continue a normal life. Complications are not expected.
What you can do yourself
Herpes simplex is a viral disease that breaks out especially in people with a weakened or unstable immune system. Affected people can therefore contribute a lot through their lifestyle to ensure that their organism is and remains strengthened. To do this, they should eat as healthy a diet as possible and drink enough fluids. A vitamin-rich and balanced diet helps to avoid obesity and promotes one’s own health. Sufficient exercise, playing sports or regular sauna sessions, especially in the winter months, also support the immune system and help to maintain one’s own well-being. People who are convinced that herpes simplex occurs due to psychological problems, stress or emotional strain should independently create framework conditions in which these trigger factors are minimized as much as possible. Already at the first feeling of blistering caused by herpes simplex, the affected person should initiate measures of relief. The viruses often spread and multiply within a few hours without intervention. The symptoms can be alleviated and treated with medical preparations or various home remedies. The opening of the herpes blisters should be avoided.The fluid in the vesicles is contagious and can lead to further vesicle formation in the surrounding regions. To generally avoid infection, refrain from exchanging saliva with infected persons.
