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This is a viral infection of the lips and mouth which is caused by the herpes simplex virus a€“ termed HSV. Herpes doesna€™t always develop symptoms a€“ it does not always cause any outward, visible signs.
Kissing or touching and any sexual contact with the area that is infected spreads oral herpes.
Many individuals have symptoms of itching, burning, and tingling proceeding the outbreak of blisters or sores.
The most concentrated pain from these sores occurs at the onset and can make drinking or eating hard. If a child with cold sores is less than 6 weeks old, the babya€™s physician needs to be notified if oral blisters or sores appear. Individuals with weakened immunity systems should also notify their primary care physician if sores or blisters appear. A physician will make a tentative diagnosis on data provided by the patient and on the physician exam. Topical anesthetic such as lidocaine (xylocaine, Nervocaine, Dilocaine, Zilactin-L) can be approved for pain relieve of oral blisters and lesions. Oral or IV drugs exist for HSV but only for individuals with weakened immune systems, infants younger than 6 weeks or those with severe disease. Topical Denavir (penciclovir) creams can shorten attacks of recurrent HSV-if it is applied early, normally before lesions develop. These medications may stop viral reproduction in the skin but do not eradicate HSV from the body or stop later outbreaks. This website is for informational purposes only and Is not a substitute for medical advice, diagnosis or treatment.
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. If ongoing clinical trials pan out, it's possible that one day people could be cutting their risk of HIV infection simply by popping a couple of pills per day. Simply quelling genital herpes could be enough to substantially reduce an individual's risk of acquiring and transmitting HIV. Preventive approaches that aim to modify behavior are yielding only modest gains against HIV transmission, so many researchers are now exploring such innovative biological preventive measures—earlier this year a clinical trial in South Africa found that male circumcision could reduce the risk of HIV acquisition (see Cutting HIV transmission, IAVI Report 9, 3, 2005).
Prevention strategies that focus on biology rather than behavior, or a combination of the two, may provide greater gains in prevention than a behavioral approach alone.
But before researchers can go distributing drugs against herpes to HIV at-risk populations they need to demonstrate that these medications can reduce HIV transmission in real world settings, says Jairam Lingappa, medical director of one of the studies organized by the University of Washington. Herpes is a lifelong infection and the virus cycles between latency and reactivation to cause clinical disease, producing painful ulcers at the genital mucosa. Individuals with genital herpes are at 3 times greater risk of acquiring HIV, according to a just published meta-analysis of 19 studies (AIDS 20, 73, 2006) conducted by Esther Freeman and colleagues at the London School of Hygiene and Tropical Medicine (LSHTM). What is more, the proportion of HIV transmission events due to HSV-2 could be on the rise, according to a presentation from Freeman at the July 2005 International Society for Sexually Transmitted Disease Research meeting in Amsterdam. This elevated risk of acquiring HIV may be greatest in the first few months following infection with HSV-2, when severe outbreaks are most common (J.


Genital herpes heightens the risk not only of acquiring HIV but also of transmitting it to a sexual partner. In addition, HSV-2 is one of the most common opportunistic infections and takes advantage of the immunocompromised status of HIV-infected persons to cause frequent and prolonged outbreaks of genital herpes. These lines of evidence open up the exciting possibility that suppressing HSV-2 could reduce both the risk of acquiring HIV (acquisition) and the risk of transmitting it to a sexual partner (infectiousness). To examine the public health benefit, a number of clinical trials are starting up to assess whether giving a drug to suppress HSV-2 can knock down HIV transmission (Table 1). Acyclovir is affordable, it has few side effects, and the virus rarely becomes resistant, even after years. Yet some researchers, including Philippe Mayaud of the LSHTM, think episodic treatment could significantly reduce the amount of HIV shed.
While shedding studies are important, what researchers really want to know is whether acyclovir can reduce HIV acquisition in people who have HSV-2. Another important question is whether acyclovir can prevent HIV-infected individuals from passing the virus to a partner.
If acyclovir proves capable of reducing HIV transmission the trial results will benefit everyone—but none so much as the discordant couples themselves. An exciting aspect of the study of herpes suppression among HIV-discordant couples is the implementation of strategies to promote couples' counseling and recruitment of HIV-discordant couples in Africa, says Celum.
If the trials are successful, what will that mean for the average person who is at risk of either acquiring the disease or, if they have it already, transmitting it to a partner? Suppressive therapy—that is, a 400 mg pill of acyclovir twice a day for years—will be expensive and difficult to distribute in Africa.
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. Researchers have long known that sexually transmitted infections (STIs) play a facilitative role in HIV transmission. Numerous studies have found a strong association between genital ulcer diseases and increased HIV transmission (Herpes 11 Suppl.
Yet two large trials in the early 1990s, one conducted in Mwanzaa, Tanzania and the other in Rakai, Uganda, yielded conflicting results. HSV-2 replication, even if actual herpes sores are not present, can lead to more frequent and greater amounts of HIV shedding in the genital tract since HSV-2 regulatory proteins can interact with a regulatory region of the HIV genome to upregulate its replication. So the vicious cycle is complete: HIV-related immunosuppression causes more HSV-2 to be present in the genital tract, which in turn promotes more HIV replication. These randomized, blinded, placebo-controlled trials will evaluate treatment with acyclovir, a proven anti-herpes drug efficient at suppressing HSV-2 activity, particularly clinical episodes.
The drug is typically used in two ways: as a long-term suppressive therapy and as an episodic treatment when herpes flares up.
He is involved in three studies, one of which is looking at HIV transmission when acyclovir is given to women in Ghana and the Central African Republic who come to clinics seeking treatment for genital herpes. It does not control asymptomatic HSV-2 shedding, a situation that researchers now know is extremely common.
A suppressive regimen of acyclovir or a placebo is being given to 1000 HIV-infected and HIV-uninfected women in a trial led by Debby Watson-Jones at the LSHTM. A large scale study to answer that question is being conducted by Wald and Connie Celum, also of the University of Washington. HSV-2 is the biggest cause of genital ulcers in married couples, says Susan Allen, a professor at Emory University's Rollins School of Public Health and a pioneer in studying HIV-discordant couples. A counseling program developed collaboratively by Allen, Liverpool Voluntary Counseling and Testing, and staff at the US Centers for Disease Control and Prevention has been used at some study sites to help couples understand the risks they face and help them make choices about how to minimize that risk.
The couples study is meant to examine acyclovir's role in preventing HIV transmission to the HIV-uninfected partner, but it does not test whether a greater reduction in intra-couple transmission could result if both members of the couple took acyclovir, to prevent both the infected partner from transmitting HIV and the uninfected partner from acquiring it. Mayaud hopes that if the episodic treatment proves successful acyclovir will be offered as a standard treatment for genital herpes when people visit a clinic.


Valacyclovir, the newer form that can be taken just once a day, is not yet produced generically. 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. Now nearly a dozen clinical trials are investigating whether drugs that suppress herpes simplex virus-2 (HSV-2), the causative agent of genital herpes, can reduce HIV transmission.
The trials involved treating curable STIs such as syphilis, gonorrhea, chlamydia, and trichomoniasis, but not genital herpes, a strategy that resulted in a 40% reduction in HIV-transmission rate in Tanzania but no reduction in Uganda. And acute episodes of genital herpes result in transient increases of HIV RNA levels in the plasma (J. The suppressive regimen helps keep HSV-2 latent, reducing the frequency and severity of outbreaks. Women who consent to be in the study are HIV tested and offered acyclovir three times a day for five days or a placebo. The HIV-uninfected women are being monitored for seroconversion, while the HIV-infected women are being monitored to see if the suppressive acyclovir regimen decreases their HSV-2 shedding and consequently their HIV shedding. The study is following women in three African nations (South Africa, Zambia and Zimbabwe) and men who have sex with men (MSM) in the US and Peru to see if acyclovir gives them protection against acquiring HIV. By studying acquisition and infectiousness in two separate trials, the researchers run the risk of finding only weak associations in both. A year's course of generic suppression therapy could cost as little as US$40 per year in Africa, but that is still prohibitive in most settings.
HIV is rather inefficient at spreading via sexual intercourse, leaping from one person to another in perhaps as few as one time out of every 1000 sexual exposures under certain conditions.
The differing results are thought to be due to population characteristics, notably that the Tanzania cohort exhibited more high-risk behavior than the cohort in Uganda, where the HIV epidemic was more mature. The episodic treatment shortens the duration of the outbreak, although only by about one day out of a six-day period. Mayaud and his colleagues will take genital samples from all women to see if they shed less HSV-2 and HIV (the latter among HIV-infected women only) due to the acyclovir treatment; the HIV-uninfected women will be followed to see if acyclovir protects them from acquiring HIV.
Together with colleagues from Burkina Faso and the University of Montpellier in France, Mayaud is also exploring how highly active antiretroviral therapy (HAART) may alter HSV-2's impact on HIV shedding. The researchers will also be looking at how well the drug controls the occurrence and frequency of genital ulcers, whether the participants adhered to the regimen of two pills daily, and also the effect of acyclovir on HIV setpoint in HIV seroconverters.
The study will track nearly 3000 HIV discordant couples at twelve sites in seven African countries. But Celum says the team carefully considered combining the trials and decided it would be better to separate the studies to determine the relative impact of acyclovir on acquisition and infectiousness.
Despite the costs, most researchers argue that if there is a remedy on the shelf that can be used to reduce HIV transmission it should be made available. Genital sores facilitate transmission by disrupting the physical barrier of the skin and enabling HIV to much more easily enter the body.
The HIV-infected, HSV-2-infected partner will be given either acyclovir or a placebo to see if they are at reduced risk of passing HIV to their non-infected partner, in the context of couples' counseling, bacterial STI treatment, and condom provision.
In addition, genital herpes causes inflammation that recruits dendritic cells (DCs) and activated CD4+ T cells to the genital mucosa. Because of this relatively small improvement, acyclovir is not a standard treatment for genital herpes under World Health Organization guidelines. There, DCs can entrap HIV particles and then traffic them to CD4+ T cells at distant sites like the lymph nodes. However, some researchers believe that another factor was the lack of herpes treatment, which is not curable and is the most widespread STI in sub-Saharan Africa. In some regions of Africa, HSV-2 seroprevalence is greater than 80% in men and women 35 and older.



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