Herpes: An Insidious Disease of Modern Times

Herpes: An Insidious Disease of Modern Times

Herpes is considered one of the most insidious and pervasive viral diseases to affect the world population today. Conservative studies suggest that as many as 39% of men and nearly 1/2 of all women are expected to contract herpes in the U.S. alone by the year 2025 (Wetstein, 2002). Already nearly 1 in 5 people will have some form of herpes by the time they reach adolescence or early adulthood (Herpes, 2004).

In light of such dire statistics and information, it is important to examine the disease and its implications for the future. Researchers and scientists are working diligently to uncover new avenues for treatment of this incurable disease, and studies are underway for uncovering potential and promising vaccines to halt the spread of this increasingly common problem affecting millions.

There are many different forms of therapy that have been introduced in recent years to treat herpes. Among the more commonly used are episodic and suppressive therapies, meant to help patients with herpes lead as normal a life as possible with as few recurrences as possible. Patients who are diagnosed with herpes once faced huge stigma and esteem issues because of the nature of the illness. Though many people diagnosed with herpes still face anxiety and self-esteem issues, herpes is becoming more widely understood and accepted, in part due to the large numbers of people in the population suffering from the disease.

The report below will begin with a general overview of herpes, followed by a listing of the types of herpes, treatment options and lifestyle coping options available to patients diagnosed with the disease.

General Overview

Herpes is a virus called herpes simplex virus or HSV for short (ASHA, 2001). The virus is a member of a family of viruses that include several different categories, namely: Epstein-Barr, Varicella Zoster, HSV-1 and HSV-2 (ASHA, 2001). The two primary types of herpes simplex are HSV-1 which usually affects the oral area and HSV-2 which typically affects the genitals (ASHA, 2001). Herpes is one of the most easily contracted viral illnesses known to man, perhaps as common as the cold. Most people are exposed to herpes at some point during their life, often when they are children. It is not uncommon for parents to spread the virus to their children through kissing, shared use of utensils or day-to-day contact.

HSV-1 or oral herpes is very common; in fact studies suggests that as many as 80% of adult people have oral herpes (ASHA, 2001). The virus is primarily spread through person to person contact, and most people acquire it when children. 90% of people that carry the virus are unaware that they have it (ASHA, 2001).

Symptoms of all forms of herpes may appear within a few days or weeks, months and even years after exposure to the virus; some people have a severe first initial outbreak whereas others generally have mild symptoms that are easily mistaken for mild skin irritation, thus the disease may go unnoticed (ASHA, 2001). This varies largely from person to person. Some people will be exposed to the herpes virus but never experience any active symptoms. Part of this is relative to a persons overall lifestyle, immune system responses and health and well being.

HSV-1

HSV-1 or oral herpes is one of the most common forms of herpes simplex, affecting up to 80% of the population (Mayo, 2004). HSV-1 is commonly referred to as oral herpes, fever blisters or cold sores. They are highly contagious. It is also one of the most dreaded forms of herpes, because the symptoms affect a persons face, which is highly visible to the public.

Signs and symptoms of HSV-1 include small, fluid filled red and painful blisters on an area of the skin, usually on the lips, mouth, chin and nasal region (Mayo, 2004). Pain or tingling often accompanies formation of the prodrome, which is the stage of viral outbreak that immediately precedes the outburst of blisters (Mayo, 2004). Patients can generally tell when an outbreak is about to happen based on the tingling sensation experienced around the affected region. Outbreaks usually occur in the same location time and time again, though it is possible for the virus to spread to other areas of the body through personal contact.

Generally an outbreak of HSV-1 lasts anywhere from seven to 10 days, though there are anti-viral medications available that may now limit the duration of active symptoms and speed recovery rate (Mayo, 2004). Symptoms may not actually surface for as much as 20 days after exposure to the virus (Mayo, 2004).

HSV-1 usually causes cold sores, though it is possible that HSV-2 may be responsible for cold sores (Mayo, 2004). The virus is usually spread from person to person via shared utensils, food, towels and other common items (Mayo, 2004).

Prevention involves avoiding skin to skin contact with an individual while they are having an active outbreak of the disease, or when moist secretions are emanating from blisters (Mayo, 2004). Hand washing may also help spread the virus.

There are certain things that may trigger an active outbreak, which include high levels of stress and over exposure to bright sunlight (Mayo, 2004).

HSV-2

Among the more common types of herpes is genital herpes. Genital herpes is caused by HSV type 2, which usually causes sores on the genitals (NIH, 2003). HSV1 can result in sores in or around the vaginal area, on the penis and around the anus and buttocks (NIH, 2003). Transmission usually results from sexual contact. HSV-2 may also affect the oral surfaces of the body, just as HSV-1 may sometimes affect the genital regions, thus it is important that a person with an active outbreak take extreme care not to spread the disease when experiencing active outbreaks.

There is no cure for HSV-2 just as there is no cure for other forms of herpes; it usually resides in the nerve cells of a hosts body for their entire life, and may produce symptoms at any time, though symptoms generally subside over time (NIH, 2003).

The U.S. Center for Disease Control and Prevention have reported that as many as 45 million people in the United States are infected with HSV-2, which translates into 1 in 5 people (NIH, 2003). HSV-2 is rapidly becoming as common as other forms of the herpes virus.

Transmission is most common when an individual is having an active outbreak, meaning the HSV-2 virus is active, and lesions or sores are openly visible (NIH, 2003). When lesions are visible they shed viruses which can infect another person via skin to skin contact (NIH, 2003). The most common symptoms include itching, burning, pain, sores or lesion, discharge and even a feeling or pressure in the abdomen (NIH, 2003).

Generally the first outbreak is the most severe, and subsequent outbreaks are more and more mild (NIH, 2003). Some people do not experience recurrences, though the virus still remains alive in their nerve cells over the years.

Shingles - Varicella Zoster

Shingles is another form of the herpes virus, usually resulting from a previous infection with the chicken pox (NIH, June, 2003). It is estimated that more than 2 of every 10 people will develop shingles in their lifetime, and more than 500,000 people per year come down with the virus (NIH, June, 2003). It is caused by the same virus that results inc chicken pox (NIA, 2004).

The virus is more common in people over the age of 50 and those with weakened immune systems (NIH, June, 2003). Symptoms generally include rash or blisters on the skin that may be painful (NIH, June, 2003). Other common symptoms include burning, tingling, numbness of skin, chills, fever, headache, sensitive skin and fatigue (NIA, 2004). Generally the disease follows a pattern, where first a burning or tingling sensation is experienced, followed by a red rash that covers the body, face or neck, which then turns into fluid filled blisters (NIA, 2004). These blisters eventually dry up and crust over during a period of a few days, though the rash may last for up to 5 weeks (NIA, 2004).

Anyone who has been exposed to the varicella virus at some point in their life is at risk for contracting an active outbreak of shingles later in life, though generally the disease lies dormant until later in life when the immune system is compromised (NIA, 2004).

It is usually treated with anti-viral medications and pain medications (NIA, 2004). Most people with an outbreak of shingles can minimize their chances of recurrence by seeking prompt medical attention. It is recommended that a patient visit a physician within three days of an active outbreak, in order to assess treatment options and minimize the severity of the outbreak.

Epstein Barr

Epstein-Barr virus or EBV is also a member of the herpes family of viruses and is also very common, affecting as many as 95% of adults at one time or another during their lives (CDC, 2002). Children are commonly infected with the virus though they may not demonstrate any symptoms other than a brief illness that includes a fever and sore throat (CDC, 2002).

The primary symptoms of EBV include fever, sore throat and swollen lymph glands, and in more severe cases a swollen spleen or liver (CDC, 2002). Generally the symptoms of infectious mono last for between 1 or 2 months, though the disease like other forms of herpes lies dormant in a person for several years, and may reactivate from time to time, though usually without symptoms of illness (CDC, 2002).

Transmission of the disease generally occurs through saliva to saliva contact (CDC, 2002). Once a person has been exposed symptoms may not appear for up to six weeks, but the person has the ability to spread the disease during this entire time (CDC, 2002).

There are no specific treatments for EBV except to treat the symptoms, though anti-virals have been made available, and some steroids may reportedly decrease the length and severity of the illness (CDC, 2002).

Primary Treatment

The treatment protocol for most forms of Herpes is the same. Presently there is no cure for herpes, though some drugs including antivirals are being used to reduce the frequency and severity of outbreaks (Herpes, 2004). One of the more common drugs is Isoprinosine which has the ability to stimulate the bodies immune response and act as an anti-viral agent, though it is still under investigation in the U.S. (Herpes, 2004).

There are currently many investigations going on that are focusing on discovering a vaccine for herpes, and studies suggest that a vaccine may be developed within the next 3-5 years (Herpes, 2004). A vaccine has been developed to help prevent chicken pox in children (Herpes, 2004). A vaccine will only affect immunity in those who have not been exposed to the virus however, it will not help the thousands of people that have already been exposed to the virus (Herpes, 2004).

Anti-Virals

As anti-viral medications are the more commonly prescribed drug to help treat herpes, they deserve further exploration.

The three most common anti-viral medications prescribed for treatment of herpes are acyclovir, famciclovir and valaciclovir. Acyclovir is considered the first effective agent against the herpes disease, but it isn't necessarily considered the most convenient, primarily because its actions are very short lasting (IHMF, 2004). It can be taken to treat episodes or acute outbreaks of herpes to reduce the severity or to shorten the duration (IHMF, 2004).

Acyclovir is also sometimes used as a suppressive agent to reduce the frequency of outbreaks in patients that have several outbreaks per year (IHMF, 2004). Clinical trials have in fact shown that it may reduce the number of recurrences from 11 to less than 2 per year (IHMF, 2004).

Valaciclovir like Acyclovir is used to treat acute outbreaks of the virus (IHMF, 2004). It helps reduce the severity of sores and helps lesions heal faster, generally cutting down the time in which an active lesion and the virus can be detected on the skin of patients (IHMF, 2004). For some patients, if they take this drug when they first notice tingling and burning sensations they may be able to completely prevent the development of tell tale blisters associated with herpes (IHMF, 2004). Clinical trials suggests that valaciclovir successful prevented development of blisters in 1/3 of patients who took the drug within 24 hours of first noticing symptoms (IHMF, 2004).

Valaciclovir may also be used as a suppressive agent. Famciclovir is also used to reduce the time that a patient is suffering from an outbreak, and also works to decrease the severity of pain that is associated with an outbreak (IHMF, 2004). It is more often used as a form of suppressive therapy.

Research on Famciclovir suggests that it can reduce the frequency of outbreaks by as much as 72%, and 2 to 3 more patients were shown to be outbreak free when they took famciclovir over a placebo in clinical trials of the drugs efficacy (IHMF, 2004).

Generally the side effects associated with anti-viral use are considered minimal and may include symptoms such as a headache or nausea (IHMF, 2004). For most people these relatively minor side effects are much more welcome that an active outbreak of herpes.

When anti-viral medications are taken for acute outbreaks (as episodic therapy) it is generally recommended that they are taken up to five times per day for up to one week (IHMF, 2004). Generally suppressive therapy requires that a patient take a tablet only once per day, sometimes twice if a patient is experiencing active outbreaks (IHMF, 2004). Again, most patients are willing to put up with the prospect of taking a pill daily indefinitely if it will result in an almost permanent reduction of symptoms and outbreaks.

There is some evidence to suggest that supplementation with the amino acid Lysine may help control herpes when combined with a diet that is high in lysine and low in the amino acid arginine (Herpes, 2004; Griffith, 1987). Foods that are high in lysine include the following: chicken, lamb, beef, fish, beans, vegetables and cheese (Herpes, 2004).

Lysine is though to work because it consists of certain proteins that are capable of enveloping the herpes virus and thus suppress it (Herpes, 2004).

Stress management may also be an effective technique for lessening the impact of Herpes. Stress has been identified as one of the triggers that may cause recurrent outbreaks of herpes in patients (Wood, 1986). Thus one might consider stress management techniques as an additional treatment option for managing both HSV-1 and HSV-2 outbreaks. Along with this is the idea that a healthy diet and lifestyle that incorporates exercise, all of which help boost the immune system, may contribute to a decreased incidence of herpes outbreaks in patients carrying the disease (Wood, 1986).

Living With Herpes

Despite the fact that so many people in the population suffer from herpes, it is one of those diseases that carries with it a stigma. Most people who have lesions do everything possible to hide them, and often suffer from depression or self-esteem issues when an outbreak occurs.

It is important that patients diagnosed with herpes learn as much as possible about the condition so they can prevent future spread of the disease through sexual contact and manage their illness to the best of their ability.

With knowledge of the disease comes the opportunity to engage in preventive behaviors. As this paper has shown, a number of lifestyle changes including eating a healthy diet, managing stress and possibly supplementing with certain amino acids or anti-virals may help reduce the severity of future outbreaks among the population at large.

Herpes is often associated with other conditions including anxiety and depression, which usually result when a person does not have an adequate support foundation or network of people that can help them understand and cope with the illness (Herpes, 2004). Because there is no cure for Herpes, and most people who contract herpes are generally young, diagnosis of the disease for some may be devastating.