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Even high-dose antiherpetic therapy may not be enough to quell short bursts of subclinical genital herpes simplex virus (HSV) reactivation, which may account for the continued transmission of HSV despite suppressive antiviral therapy. Researchers from the University of Washington, Seattle, United States, conducted 3 separate but complementary open-label crossover studies that compared standard-dose acyclovir (400 mg twice daily), standard-dose valacyclovir (500 mg daily), high-dose acyclovir (800 mg 3 times daily), high-dose valacyclovir (1 g 3 times daily), and no medication.
In all, 23,605 swabs were collected from 90 patients, of which 5.4% were HSV-positive and 80% were subclinical. Genital HSV is the most common sexually transmitted infection (STI) in both men and women, but as many as 90% don’t know they are infected because their symptoms are too mild to notice or mistaken for another condition. Symptomatic genital herpes is characterized by a burning and itching sensation in the genitals, followed by blistering. HSV skin lesions usually appears as small blisters or sores around the mouth, nose, genitals, buttocks, and lower back, though infections can develop almost anywhere on the skin.
This photo shows HSV-1 lesions on the buttock of a five-year-old girl — also called sacral herpes simplex.
Herpetic whitlow is an intensely painful infection of the hand involving 1 or more fingers that typically affects the terminal phalanx.
Serologic testing for HSV has limited value in acute clinical diagnosis because of the time delay for seroconversion following initial infection. Acyclovir, valacyclovir and famciclovir are the most commonly used agents for treating HSV infections. A wide disparity exists between the public and medical community regarding the significance of herpes infections.
The majority of recurrent oral herpes cases are caused by herpes simplex virus type 1 (HSV-1) and the majority of genital herpes cases are caused by HSV-2.


Differentiating between the two types of infection using either type specific swab testing, preferably PCR, or type specific IgG antibody testing, is very important because HSV-1 genitally recurs less, is shed less, and presents far less risk of transmission to others than HSV-2.
Fifty seven percent of Americans between 14 and 49 have HSV-1, and 16% of the same group has HSV-2 infection.
In women who contract the disease, the cervix is infected 80% to 90% of the time during primary infection.
This photo shows a close-up of lesions on the upper eyelid in a 20-year-old male patient due to HSV-1. Of patients who develop seropositivity, 65% do so within six weeks, while approximately 20% do not make antibodies for six months. While all three drugs decrease the duration and severity of illness and viral shedding, they have no effect on nonreplicating viruses, nor do they eliminate the virus from the ganglia. Although treatment options exist, respondents in one survey considered contracting herpes as worse than breaking up with a significant other, getting fired from a job, or failing a course in school.
HSV infection is a persistent and chronic infection of the sensory ganglia with a varying, unpredictable degree of skin expression.
Each of these viruses causes different problems, but in this post we are focussing on the Type 1 Herpes Simplex Virus (or Human Herpesvirus 1, HHV-1) which is primarily responsible for oral infections.
Primary infections can range from subclinical to severe, with fever, headache, malaise, anorexia, pain, lymphadenopathy and edema.
Clinical recurrence occurs on average 3 to 4 times a year, but some patients experience monthly outbreaks.
Cervical infection alone is rarely symptomatic, but because the cervix is not sensitive to pain, infection may pass unnoticed.


Be sure to provide adequate counseling to help patients put their diagnosis in perspective.
This slideshow will highlight variations in presentation and provide more information about diagnosis and treatment.
During reactivation, herpes labialis, the virus migrates from the ganglion back down to the peripheral nerves and then is actively shed via cold sores.
Reactivation can occur repeatedly.In up to 90% of patients, the primary infection of HHV-1 is asymptomatic and usually occurs in childhood.
However, they can then still go and develop secondary reactivation in the future.Herpetic GingivostomatitisThe primary infection is quite common and as mentioned, often is asymptomatic. Symptoms include headaches, pyrexia and behavioural changes over several days.SummaryHuman Herpesvirus 1, HHV-1, is responsible for primary and secondary oral infectionsHerpetic gingivostomatitis is the primary infection. QuestionPrimary infection of HHV-1 is called… Herpes Labialis HSV Encephalitis Herpetic Gingivostomatitis Herpetic Whitlow Herpectic Lesions of the eye Correct Incorrect Question 3 of 5 3.
QuestionThe incubation period for primary infection is around… 1-3 days 3-5 days 5-7 days 7-10 days 10-14 days Correct Incorrect Question 4 of 5 4. QuestionTreatment for primary infection is usually… Rest, antipyrexics, analgesics, acyclovir Acyclovir Rest, antipyrexics, analgesics, soft diet and cross-infection control Rest and acyclovir Cross-infection control Correct Incorrect Question 5 of 5 5.



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