HSV 2 – localization and symptoms | Herpes Simplex

HSV 2 – localization and symptoms

This virus is transmitted during sexual intercourse or even at birth. In this infection the itchy blisters form on the genital mucosa. The danger of infection is present in an active infection, but can be effectively prevented by condoms. If a pregnant woman suffers from genital herpes, a Caesarean section should be performed to prevent infection of the child during birth. Infection is particularly dangerous in newborns, as they have a still weak immune system and tend to get life-threatening meningitis.

Severe courses and complications of Herpes Simplex

Herpes simplex infections can be particularly severe if not the outer areas of the skin but inner areas of the body are affected. Severe courses and complications are:

• Herpes simplex retinitis: In some cases the retina of the eye may be affected by an infection caused by Herpes simplex. The disease, also known as herpes simplex retinitis, is serious and dangerous.

  If treatment is not started immediately, there is a risk of severe vision loss or even blindness.

• Eczema herpeticatum: If there was another skin disease before the Herpes Simplex infection, the herpes infection may spread to already damaged and affected skin areas. This is called superinfection and makes the healing process of the already damaged skin more difficult. The resulting clinical picture is also known as eczema herpeticatum.Severe general symptoms such as fever and general condition reduction can occur and often result in a life-threatening condition that must be treated in the intensive care unit.
• Herpes sepsis: In principle, every herpes infection can lead to a systemic attack, i.e. the body’s viral load is so great that the immune system can no longer cope with the clean-up.

  This leads to blood poisoning (sepsis). In some cases, patients die, especially if they are already immunocompromised, elderly or have severe concomitant diseases.

• Herpes esophagitis: Rather less frequently, the esophagus is affected. The so-called herpes esophagitis is initially relatively difficult to diagnose and makes a gastroesophageal endoscopy (GIES) necessary.
• It can happen in special cases that a particularly large accumulation of herpes viruses leads to nerve damage.

  This becomes apparent in a reduced function of the nerve and in extreme cases in a complete nerve paralysis. Sometimes the facial nerves are affected, which can lead to drooping corners of the mouth and eyelids. Exact proof of herpes involvement is still missing, however.

  However, the nerve impairments can regress over time. Treatment with acyclovir to combat the virus should be carried out in any case.

In rare cases, the Herpes Simplex virus can also cause an inflammation of the brain (so-called encephalitis). In this case the actually rather harmless herpes infection turns into a severe medical emergency, which is fatal in more than 75% of cases if left untreated.

Since the use of antivirals, i.e. drugs that inhibit the reproduction of the virus, the risk of dying from herpes encephalitis has become relatively low. Therefore, only if herpes encephalitis is suspected, treatment must be carried out with courage. Although herpes simplex encephalitis accounts for only 10% of all encephalitis, it is responsible for most deaths from encephalitis.

Every year, 1-2/100,000 people contract herpes encephalitis. Encephalitis almost always develops from an acute infection with the Herpes Simplex virus. The viruses migrate from the blood via the so-called cranial nerves retrogradely, i.e. practically backwards into the brain, mostly along the olfactory nerve.

Unfortunately, there are no known factors that influence the probability of a “normal” herpes infection turning into encephalitis, so you can hardly protect yourself from such an infection. However, it is known that most encephalitis results from reactivated infections and not from initial infections. If you are suffering from encephalitis, the symptoms usually begin in a flu-like manner, i.e. with fever and headache and aching limbs.

After a few days, symptoms due to the impairment of the brain come to the fore. This often leads to disturbances of consciousness and epileptic seizures. Not infrequently, speech disorders and paralysis also occur.

What usually does not occur are herpes blisters. If the meninges are also affected by the infection, the most severe headaches and neck stiffness usually occur. If herpes encephalitis is suspected, this is always an emergency and must be treated in a neurological ward.

As a rule, the brain is then examined for suspicious changes using an MRI of the brain and, in addition, spinal fluid (so-called “liquor”) is taken from the spinal canal. This cerebrospinal fluid is then examined to confirm the suspicion. Regardless of this, “Aciclovir” is administered even before there is any certainty about the pathogen.

This is an active substance which is also contained in creams against herpes blisters. In encephalitis, however, the drug is injected in high doses via a vascular access or administered as an infusion. In addition, because of the danger of epileptic seizures, epilepsy medication is also administered until the inflammation of the brain is over.

Early treatment of encephalitis is crucial for survival. In this case, the motto is “danger recognized, danger averted”. If no therapy is administered, the mortality rate is 70%, with therapy only 20%.

Among survivors, the frequency of permanent damage after the disease varies greatly depending on how quickly therapy was started. On average, about half of the patients retain permanent damage, mostly epileptic seizures or mental restrictions. If therapy is started very early, this figure drops to below 30%.All in all, herpes simplex encephalitis is a serious disease, which unfortunately is difficult to diagnose due to its mostly unspecific symptoms. However, if it is detected, herpes simplex encephalitis can be treated very well.