Herpes: (Herpes simplex) – Dr Jalal Hajizade

Herpes simplex viruses are host-adapted pathogens that cause a variety of diseases. There are two types: herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2). Both are closely related but different epidemiology. HSV-1 is traditionally associated with oral and facial disease, while HSV-2 is traditionally associated with genital disease. However, the location of the lesion does not necessarily indicate the type of viral.

Up to 80% of herpes simplex infections are asymptomatic. Symptomatic infections can be characterized by significant complications and recurrences. In hosts with immunodeficiency , infections can cause life-threatening complications. Herpes simplex can cause a primary infection or reactivation (recurrence). Both HSV-1 and HSV-2 are involved in primary genital and oral infections after contact with infectious secretions that contain HSV-1 (usually oral secretions) or HSV-2 (usually genital secretions).

The clinical course depends on the age , immune status of the host, the anatomical location of the involvement and the type of virus. Primary HSV-1 and HSV-2 infections are associated with systemic symptoms, longer duration of symptoms, and higher rates of complications.

Recurrent infections are usually milder and shorter. HSV infections in immunocompromised hosts are more severe, prolonged, and widespread, and recurrence is more than HSV infections in individuals with normal immune system.

Cold sores:

This is the most common manifestation of recurrent HSV-1 infection. A precursor of pain, burning, and tingling often occurs at the affected site, usually the face, around the lips, followed by erythematous papules that rapidly develop into small, thin-walled vesicles that crust over and ulcerate. In most patients, less than two recurrences appear per year, but some People experience monthly relapses.

Genital herpes:

Primary genital herpes can be caused by HSV-1 and HSV-2 and can be asymptomatic.HSV-2 tends to have a predilection for the genital mucosa and is traditionally more associated with genital infections. However, HSV-1 is increasingly associated with genital infection and is reported to be more than

HSV-2 causes genital infections, especially in young men and homosexual men.

HSV-1 and HSV-2 are indistinguishable, but recurrence is higher with HSV-2. Primary genital herpes is characterized by severe and prolonged systemic and local symptoms. Preexisting antibodies against HSV-1 have an effect on disease severity caused by HSV-2. Previous oral HSV-1 infection appears to protect against or may reduce the risk of genital HSV-1 infection. Symptoms of primary genital herpes and its complications are more severe in women.

Symptoms of primary genital herpes:

The incubation period of primary genital herpes is 3-7 days (range, 1 day to 3 weeks). The main symptoms include fever, headache, weakness and myalgia (prominent in the first 3-4 days). Local symptoms include pain, itching, burning in urination, vaginal and urethral discharge, and painful swelling of lymph nodes.

Recurrent genital herpes:

Before recurrent genital herpes, sensitivity, pain and burning occur at the site of the disease, which may last from 2 hours to 2 days. In some patients, painful irritation of the lumbar nerves occurs on the same side as the sacral.

In women, vesicles are found on the labia majora, labia minora, or perineum. Lesions are often very painful. Fever and major symptoms are uncommon. Lesions heal in 8-10 days and virus shedding takes an average of 5 days. Symptoms are more severe in women than in men.

In men, recurrent genital herpes appears as 1 or more patches of grouped vesicles on the penis.The pain is mild and the lesions heal in 7-10 days. The frequency and severity of recurrence decreases with time.