Herpes Simplex Virus: Types, Treatments, and Living With HSV

Introduction

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

In light of such significant statistics, 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 to identify promising vaccines that might 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, designed to help patients lead as normal a life as possible with as few recurrences as possible. Patients diagnosed with herpes once faced enormous stigma and self-esteem issues because of the nature of the illness. Though many people diagnosed with herpes still face anxiety and self-esteem challenges, herpes is becoming more widely understood and accepted, in part due to the large numbers of people in the general population who carry the disease.

This paper begins with a general overview of herpes, followed by a discussion of the types of herpes, treatment options, and lifestyle coping strategies available to patients diagnosed with the disease.

General Overview of Herpes

Herpes is caused by the herpes simplex virus, commonly abbreviated as HSV (ASHA, 2001). The virus belongs to a family that includes several categories: 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, perhaps as common as the cold. Most people are exposed to herpes at some point during their lives, often during childhood. It is not uncommon for parents to spread the virus to their children through kissing, shared use of utensils, or ordinary day-to-day contact.

HSV-1, or oral herpes, is very common; studies suggest that as many as 80% of adults have oral herpes (ASHA, 2001). The virus is primarily spread through person-to-person contact, and most people acquire it during childhood. Notably, 90% of people who 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 — or even months and years — after exposure to the virus. Some people experience a severe initial outbreak, whereas others have mild symptoms easily mistaken for minor skin irritation, meaning the disease may go unnoticed (ASHA, 2001). This varies significantly from person to person. Some individuals are exposed to the herpes virus but never experience any active symptoms, a result that is partly related to a person's overall lifestyle, immune system responses, and general health and well-being.

Types of Herpes Virus

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). It is commonly referred to as oral herpes, fever blisters, or cold sores. HSV-1 lesions are highly contagious and are among the most dreaded manifestations of herpes because the symptoms appear on a person's face, which is highly visible to others.

Signs and symptoms of HSV-1 include small, fluid-filled, red, and painful blisters on the skin, usually on the lips, mouth, chin, and nasal region (Mayo, 2004). Pain or tingling often accompanies the formation of the prodrome — the stage of viral outbreak that immediately precedes the eruption of blisters (Mayo, 2004). Patients can generally detect an impending outbreak based on tingling sensations around the affected region. Outbreaks usually occur in the same location repeatedly, 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 ten days, though antiviral medications may now limit the duration of active symptoms and speed recovery (Mayo, 2004). Symptoms may not surface for as long as 20 days after initial exposure to the virus (Mayo, 2004).

HSV-1 usually causes cold sores, though it is possible that HSV-2 may also be responsible for cold sores in some cases (Mayo, 2004). The virus is typically 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 during an active outbreak or when moist secretions are emanating from blisters (Mayo, 2004). Thorough hand washing may also help prevent the spread of the virus. Certain factors may trigger an active outbreak, including high levels of stress and overexposure 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 typically produces sores on the genitals (NIH, 2003). HSV-2 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, a person with an active outbreak must take extreme care not to spread the disease.

There is no cure for HSV-2, just as there is no cure for other forms of herpes. The virus typically resides in the nerve cells of a host's body for the remainder of that person's life and may produce symptoms at any time, though symptoms generally become milder over time (NIH, 2003).

The U.S. Centers 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 to approximately one in five people (NIH, 2003). HSV-2 is rapidly becoming as prevalent as other forms of the herpes virus.

Transmission is most common when an individual is experiencing 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 viral particles that can infect another person through skin-to-skin contact (NIH, 2003). The most common symptoms include itching, burning, pain, sores or lesions, discharge, and even a feeling of pressure in the abdomen (NIH, 2003). Generally the first outbreak is the most severe, and subsequent outbreaks are progressively milder (NIH, 2003). Some people do not experience recurrences, though the virus continues to remain dormant in their nerve cells.

Shingles — Varicella Zoster

Shingles is another form of the herpes virus, usually resulting from a previous infection with chickenpox (NIH, June 2003). It is estimated that more than two of every ten people will develop shingles in their lifetime, and more than 500,000 people per year contract the virus (NIH, June 2003). It is caused by the same virus responsible for chickenpox (NIA, 2004).

The virus is more common in people over the age of 50 and in those with weakened immune systems (NIH, June 2003). Symptoms generally include a rash or blisters on the skin that may be painful (NIH, June 2003). Other common symptoms include burning, tingling, numbness of the skin, chills, fever, headache, skin sensitivity, and fatigue (NIA, 2004). The disease typically follows a pattern: first a burning or tingling sensation is experienced, followed by a red rash covering the body, face, or neck, which then develops into fluid-filled blisters (NIA, 2004). These blisters eventually dry up and crust over within a few days, though the rash may last for up to five 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 the immune system becomes compromised (NIA, 2004). It is usually treated with antiviral medications and pain medications (NIA, 2004). Most people experiencing an outbreak of shingles can minimize their chances of recurrence by seeking prompt medical attention within three days of the outbreak's onset, in order to assess treatment options and minimize severity.

Epstein-Barr Virus

Epstein-Barr virus (EBV) is also a member of the herpes family of viruses and is very common, affecting as many as 95% of adults at some point during their lives (CDC, 2002). Children are commonly infected with the virus, though they may not demonstrate any symptoms beyond a brief illness involving 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). The symptoms of infectious mononucleosis generally last between one and two months, though the disease — like other forms of herpes — lies dormant in a person for several years and may reactivate periodically, usually without symptoms of illness (CDC, 2002). Transmission generally occurs through saliva-to-saliva contact (CDC, 2002). Once a person has been exposed, symptoms may not appear for up to six weeks, yet the person retains the ability to spread the disease throughout that entire period (CDC, 2002).

There are no specific treatments for EBV other than management of symptoms, though antivirals have been made available, and some steroids may reportedly decrease the length and severity of the illness (CDC, 2002).

Conclusion

Herpes is one of the most common viral infections affecting humanity today. Studies suggest that one in five people will have some form of herpes by the time they reach adulthood. Most people contract herpes when they are young, particularly during childhood. Though there is currently no cure for herpes, there is considerable hope for a vaccine and newer, more effective treatment options in the future.

The initial outbreak of herpes is often the most severe. Symptoms may include fever, sore throat, fatigue, pain, tingling, and the eventual eruption of one or more blisters in the affected area. There are two primary forms of herpes simplex: HSV-1 and HSV-2. HSV-1 generally causes an outbreak on the oral surfaces of the body, while HSV-2 generally results in genital herpes, though cross-site infection is possible in both cases.

Most forms of herpes are spread through person-to-person contact with body fluids. The virus is most likely to be transmitted during an active phase, when blisters, pain, tingling, or numbness are present. During such periods, it is best for an infected person to avoid close contact with others to prevent further spread of the disease.

Herpes can manifest in many different forms, including shingles and Epstein-Barr virus. Most people who are exposed to one form of herpes have an increased likelihood of contracting another form at some point during their lifetime.

There is no cure for herpes at this time. However, a number of antiviral therapies are now available that may help suppress an active outbreak or decrease the severity and duration of symptoms. Dietary supplements such as lysine have also shown some benefit in lessening symptom severity. The most reliable method of preventing infection remains educational programs aimed at increasing knowledge and understanding of the disease.

A number of promising vaccines are currently under investigation. Though no cure yet exists, people diagnosed with herpes can lead normal and active lives. There are numerous support groups and patient resource centers available for those living with the condition.

References

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Mayo Foundation. "Cold Sores." April 28, 2004. Mayo Foundation for Medical Education and Research. Retrieved October 30, 2004, from http://www.mayoclinic.com/invoke.cfm?id=DS00358

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