Herpes simplex virus or cytomegalovirus,treatment of cold sores on the lips,m xmovies8,natural remedies ocular herpes last - PDF 2016

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L'herpes genital est une maladie infectieuse sexuellement transmissible ou indirectement par les doigts ayant ete en contact avec une autre partie du corps infectee (bouton de fievre) causee par le virus Herpes simplex (HSV) de type 1 ou 2. Elle consiste en des demangeaisons, brulures, petites cloques, plaies au niveau des organes genitaux. Le traitement consiste en des antiviraux pour diminuer la contagiosite, reduire la douleur, la duree et la frequence des crises. C'est une infection consideree sans gravite mais qui empeche les rapports sexuels pendant les poussees.
Il s'agit d'un co-facteur important de transmission du virus de l'immunodeficience humaine responsable du SIDA. Les infections genitales peuvent etre causees par le virus Herpes simplex (HSV) de type 1 ou 2 mais le HSV-2 est le plus courant (environ 70% des cas). L'herpes pourrait etre considere comme un probleme de sante publique mais la politique en matiere de prevention est inexistante et les connaissances des medecins generaliste faibles. Il semble que pour qu'il y ait infection sur la peau par les fluides (salive ou secretion vaginale), il est necessaire que la peau soit abimee.
Les cas d’auto-inoculation a partir d’un site d’infection oral ou labial anterieure a HSV-1 sont rares et arrivent le plus souvent durant la primo-infection orale (une personne a un herpes sur la bouche pour la premiere fois, touche les vesicules puis se touche le sexe).
L’excretion et la transmission asymptomatique (la personne qui est contagieuse n'a aucun signe lui faisant penser qu'il a une poussee d'herpes) du virus sont frequentes surtout pour le HSV-2.
La periode habituelle d’incubation (delai entre l'infection et les premiers signes) des primo-infections symptomatiques varie entre 2 et 21 jours. Les infections recidivantes se retrouvent habituellement sur le territoire des dermatomes S2 ou S3 (territoire de la peau innerve par la deuxieme ou troisieme racine sacree). Il s’agit du premier episode avec signes chez un patient n'ayant jamais ete au contact du HSV jusque-la.
On observe une eruption vesiculeuse et ulcerative aux points d’inoculation du virus ou a proximite.
Les problemes urinaires, y compris les retards a l’initiation de la miction ou une difficulte a uriner (dysurie), sont frequents chez les hommes et les femmes et ils peuvent durer longtemps.
Une meningite benigne est observee dans 10 a 30 % des cas de primo-infection symptomatique. Il s’agit du premier episode avec signes cliniques chez un patient ayant deja eu un contact avec le HSV, qu'il soit symptomatique ou non. La duree est habituellement moins longue, et il est rare que les symptomes interessent l’organisme entier. On peut observer une eruption vesiculeuse et ulcerative unilaterale ou bilaterale (chez les femmes) s’apparentant plutot a une infection recurrente symptomatique. Les symptomes sont moins graves et durent moins longtemps que dans le cas d’une primo-infection symptomatique. Les manifestations de l’infection se limitent generalement aux organes genitaux externes et sont unilaterales. La culture, apres prelevement au niveau de la lesion, demeure la methode de predilection a cause de sa specificite, de sa sensibilite et de sa capacite de typer la souche du virus. L'utilisation de preservatifs ne protege pas completement du risque de transmission de la maladie, ce dernier n'etant reduit que d'environ 30%[3].
Dans tous les cas, des antalgiques peuvent etre utile et des soins d'hygienes restent utiles pour eviter une infection bacterienne surajoutee.
Le traitement anti-viral est utile pour attenuer les symptomes, les complications et l’excretion du virus, mais il n'est efficace seulement s’il est administre au debut de l’episode symptomatique.
Le nouveau-ne peut etre contamine par la mere lors de l'accouchement s'il existe des lesions actives secondaire au HSV au niveau de la sphere genitale maternelle, provoquant un Herpes neo-natal aux consequences dramatiques. Si la primo-infection survient lors du troisieme trimestre, un accouchement a terme par cesarienne est imperatif, prevenant ainsi la contamination[2]. De nombreux traitements non medicamenteux ont ete proposes, a base de plantes, de complements alimentaires ou d'huiles dites essentielles. S'agissant d'une infection sexuellement transmissible, les rapports proteges voire une abstinence (si les lesions ne sont pas couvertes par le preservatif) sont conseilles lors de la phase eruptive.
Dans un couple sero-discordant (une personne infectee, l'autre saine) il convient d'utiliser un preservatif pour tous les rapports car il est impossible de prevoir quand la personne infectee est contagieuse (on estime a au moins 5 a 10% des jours de l'annee le nombre de jours ou une personne positive est contaminante sans symptome). Pour un couple sero-discordant ayant des rapports non proteges, on estime a 10% de risque d'infecter le partenaire chaque annee.
Au cours des deux dernieres decennies, de nombreux efforts ont ete faits pour tenter de developper un vaccin contre l'herpes oculaire et genital. Le laboratoire AuRx n'a jamais reussi a trouver les financements pour poursuivre le developpement de son projet de traitement immunitaire[9].
Cytogenix travaillait sur le CY301 (SIMPLIVIR) (phase pre-clinique) une creme visant a annuler la capacite de reproduction du virus et son aptitude a migrer vers les cellules nerveuses, mais a gele ses etudes par manque de moyen[10].
D'autres societes ont suspendu ou abandonne leurs recherches, et notamment Chiron Corp (Novartis), Genvec[11], Tekron et Biovirus[12], Replicor[13] PowderMed et le pPJV7630 (Pfizer), ou bien encore Astellas Pharma Inc et son antiviral ASP2151. Il est probable qu'un certain nombre de petites societes de biotechnologie aient cherche a attirer des investisseurs sous de fausses promesses. Antigenics et le AG707 (phase I)[14] qui travaille avec David Koelle de l'universite de Washington[15] sur un vaccin. BioVex et son ImmunoVEX (phase I)[18] a debute en fevrier 2010 une etude en phase I sur un vaccin sur 42 personnes en Angleterre. Beechtreelabs et BTL-TML-HSV (phase I)[19] une molecule qui inhibe le re-assemblage des particules virales apres l'infection des cellules.
Vicale et son Vaxfectin (phase pre-clinique) a presente les resultats de la phase preclinique fin octobre 2010[20].
Vironova et le Herpes VN-180 (phase pre-clinique) qui permettrait de bloquer le processus de replication du virus[21].
En raison des ulcerations genitales provoquees par l'herpes, le risque de contamination par le VIH est double[37]. De meme l'herpes genital peut favoriser l'installation d'une candidose (mycose due au champignon Candida).
Herpes genital — El herpes genital es una infeccion causada por virus y de transmision sexual. Herpes, genital — A viral infection transmitted through intimate contact with the moist mucous linings of the genitals. Herpes et grossesse — Herpes et grossesse L herpes peut se transmettre de la mere a l enfant pendant l accouchement. At least 85% of the world population have serological evidence of having had a herpes simplex infection.
Herpes simplex infections can be primary- the first infection in a previously seronegative patient – or recurrent. Follows direct contact with an infected individual, either with active disease or shedding viral particles during a latent phase.
Trigger factors include minor trauma, febrile illnesses, ultraviolet light and possibly stress.
Complications include: Erythema multiforme (65% of attacks are triggered by a herpes simplex recurrence within the preceding two weeks), eczema herpeticum, persistent ulceration in the immunocompromised and keratoconjuctivitis.
These are transmitted sexually, and begin to appear at puberty or are spread from a mother’s genital tract infection to a newborn child.
The median recurrence rate is about one attack every 3 months for HSV-2 infections (and far less often for genital HSV-1 infections). Prevention is difficult because the virus is ubiquitous and spread by people with no obvious active infection. Those looking after patients with atopic eczema should stay away if they have cold sores because eczema herpeticum is so serious.
Suppressive long-term antiviral therapy may be needed for particularly frequent or severe relapses. The decision to use oral antiviral therapy for recurrent facial herpes simplex depends on the frequency and severity of relapses and the damage being done to the quality of life. Long-term suppressive therapy can be considered in genital herpes relapsing more than 5 times per year. Martin, MD, MPH, ABIM Board Certified in Internal Medicine and Hospice and Palliative Medicine, Atlanta, GA. L’infection est localisee au niveau des organes genitaux externes, du pubis, du perinee et des regions perianales, ainsi qu’au niveau du col de l’uterus, de l’anus ou de l’uretre, suivant le type de contact.
Il faut d'abord que le virus s'installe avant de produire des eruptions, ce qui peut prendre plusieurs semaines. Elle s’effectue a plusieurs endroits au niveau des organes genitaux et elle est plus frequente dans le cas du HSV-2.
Le typage de la souche est souhaitable dans la plupart des cas pour permettre de mieux prevoir les recurrences ainsi que de fournir des renseignements pertinents sur la susceptibilite du partenaire. Il faut traiter systematiquement et le plus tot possible , c'est-a-dire des l'apparition des signes annonciateurs d'une poussee d'herpes (demangeaisons, genes ou irritations), ce qui aiderait a reduire la frequence des crises et les douleurs afferentes. Il ne permet pas de prevenir les recidives, sauf s'ils sont donnes de maniere prolongee[2].
La meme attitude est pronee en cas de presence de lesions d'herpes au niveau de la sphere genitale secondaire a une recidive. Differentes approches ont ete etudiees par les chercheurs, et represente un veritable defi pour la recherche[4]. Malgre des resultats prometteurs sur les etudes animales, les essais cliniques ont ete decevants. Un certain nombre de recherches passees n'ont pas vu le jour, soit par manque de financement pour aller jusqu'au bout des essais, soit suite au rachat par un grand laboratoire, laissant planer un doute sur l’interet economique pour les grands laboratoires d'un tel vaccin. L'etude en phase I a debute en mars 2008 aux Etats-Unis sur 35 personnes[16]et les resultats ont ete devoiles en juillet 2010[17]. ImmunoVEX HSV2 est un vaccin vivant attenue qui a ete concu pour supprimer les genes qui permettent aux virus de l'herpes d'eviter le systeme immunitaire. Debut 2005, David Knipe de la Harvard Medical School[22] a developpe un vaccin sous le nom de dl5-29. Cette technique a ete critiquee et jugee comme etant dangereux, car elle utilise l'ensemble du virus vivant plutot qu'un fragment de proteine. Cullen du Departement de Genetique Moleculaire de l'Universite de Duke travaille sur un medicament qui permettrait d'activer completement le HSV1 en inhibant les microRNA artificiellement. Hendricks de l'universite de Pittsburg[32] qui travaille sur les reponses immunitaires au HSV-1. Le developpement de ce vaccin est poursuivi par leur societe Micro Antigen Technologies[35]. By age 30, 50% of adults of high economic status in the US are seropositive to HSV-1, in contrast to 80% of those of lower status.
The introduction of aciclovir (DNA polymeras inhibitor) was a milestone although it does not eradicate the virus.
HSV-1 can also cause genital herpes. Herpes simplex virus 2 (HSV-2) is the most common cause of genital herpes, but it can also cause oral herpes.
La periode de latence peut parfois etre de plusieurs annees, certains patients ne presentant aucun symptome jusqu'a 20 ans apres la primo-infection.


La detection de ces derniers signe un contact anterieur avec le virus mais de maniere retardee. Entre 1996 et 1999, le meme laboratoire avait deja teste un vaccin en phase III, le gD2t avec l'adjuvant GSK208141, sans suite. Le AG-707 administre avec l'adjuvant QS21 ont entraines une induction significative des reponses immunitaires des cellules CD4 + et CD8 +. Ses etudes ont ete poursuivies par le laboratoire Acambis, rachete en juillet 2008 par Sanofi. Le produit prendrait la forme d'une creme qui bloquerait le developpement du virus sur les cellules non infectees. Cela va a l'encontre de la plupart des recherches depuis les annees 1970, mais Halford fait valoir que cette technique a fait ses preuves pour les vieux vaccins pour enfants contre la rougeole, les oreillons et la rubeole. They are closely related but differ in their epidemiology, although both are spread by close personal contact. Regular use of condoms helps prevent genital herpes and a high protection factor sunscreen helps to prevent recurrent facial lesions. Trends in HSV Types and Genital HerpesGenital herpes can be caused by either HSV-2 or HSV-1. Elles peuvent etre utilisees pour determiner si les femmes enceintes qui n’ont pas d’antecedents d’herpes symptomatique sont a risque.
La recente decouverte que les cellules T permettent de differencier les individus symptomatiques et asymptomatiques pourrait conduire a un progres fondamental dans le developpement immunologique d'un vaccin contre l'herpes[7]. La molecule est present suivie par Harry Kleanthous et Simon Delagrave de Sanofi Pasteur sous le nom ACAM-529. Elle ne peut determiner naturellement s'il s'agit d'une primo infection ou d'une recidive mais peut definir le type de virus en cause (HSV 1 ou 2). In recent years, HSV-1 has become a significant cause in developed countries, including the United States.
The risk of infection is highest during outbreak periods when there are visible sores and lesions. SymptomsWhen genital herpes symptoms do appear, they are usually worse during the first outbreak than during recurring attacks.
Herpes, Pregnancy, and Newborn InfantsHerpes can pose serious risks for a pregnant woman and her baby.
The risk is greatest for mothers with a first-time infection, because the virus can be transmitted to the infant during childbirth.
Guidelines from the American Academy of Pediatrics recommend using specific diagnostic tests for women in labor to determine the risk of transmission. Babies born to mothers infected with genital herpes are often treated with the antiviral drug acyclovir, which can help suppress the virus.
Herpes viruses include human herpes virus 8 (the cause of Kaposi sarcoma) and varicella-zoster virus (also known as herpes zoster, the virus responsible for shingles and chickenpox). The word "herpes" comes from the Greek word "herpein," meaning "to creep." This refers to the unique characteristic pattern of all herpes viruses to creep along local nerve pathways to the nerve clusters at the end, where they remain in an inactive (dormant) state for variable periods of time. The usual cause of oral herpes (herpes labialis), which are commonly called cold sores or fever blisters. HSV-1 can also cause genital herpes, which is a sexually transmitted disease (STD). Herpes simplex virus 2 (HSV-2).
Until recently, the general rule was to assume that HSV-1 caused oral herpes and HSV-2 caused genital herpes.
It is now clear, however, that either type of herpes virus can be found in the genital or oral areas (or other sites). In fact, HSV-1 is now responsible for more than half of all new cases of genital herpes in developed countries. The Disease ProcessHerpes is transmitted through close skin-to-skin contact.
To infect people, the herpes simplex viruses (both HSV-1 and HSV-2) must get into the body through tiny injuries in the skin or through a mucous membrane, such as inside the mouth or on the genital or anal areas. The risk for infection is highest with direct contact of blisters or sores during an outbreak.
But the infection can also develop from contact with an infected partner who does not have visible sores or other symptoms. Once the virus has contact with the mucous membranes or skin wounds, it enters the nuclei of skin tissue cells and begins to replicate. The virus is then transported from the nerve endings of the skin to clusters of nerve cells (ganglia) where it remains inactive (latent) for some period of time. However, at some point, the virus wakes up and travels along nerve pathways to the surface the skin where it begins to multiply again. During this time, the virus can infect other people if it is passed along in body fluids or secretions.
Viral shedding may be accompanied by noticeable symptoms (outbreak) but it can also occur without causing symptoms (asymptomatic shedding).
In either case, a person is infectious during periods of viral shedding. Symptoms may appear as multiple small red bumps or patches that develop blisters. Certain triggers can wake up the virus from its dormant state and cause it to become active again. In general, recurrent episodes of herpes cause less severe symptoms than the primary outbreak. HSV-1 is the most prevalent form of herpes simplex virus, and infection is most likely to occur during preschool years.
In addition, because HSV-1 can be passed in saliva, people should also avoid sharing toothbrushes or eating utensils. Transmission of Genital Herpes Genital herpes is transmitted through sexual activity.
People can get HSV-2 through genital contact or HSV-1 through mouth-to-genital contact with an infected partner. People with active symptoms of genital herpes are at very high risk for transmitting the infection. Unfortunately, most cases of genital herpes infections occur when the virus is shedding but producing no symptoms.
Most people either have no symptoms or do not recognize them when they appear. In the past, genital herpes was mostly caused by HSV-2, but HSV-1 genital infection is increasing. There is also evidence that children today are less likely to get cold sores and become exposed to HSV-1 during childhood. Centers for Disease Control and Prevention (CDC), about 1 in 6 Americans ages 14 to 49 years have genital herpes.
While HSV-2 remains the main cause of genital herpes, HSV-1 has significantly increased as a cause, most likely because of oral-genital sex. African-American women are at particularly high risk. People with compromised immune systems, such as those who have HIV, are at very high risk for genital herpes. Drugs that suppress the immune system, and organ transplantation, can also weaken the immune system and increase the risk for contracting genital herpes. It is almost impossible to defend against the transmission of oral herpes, because it can be transmitted by very casual contact, including kissing.
Still, you can help reduce the risk of transmitting oral herpes by not sharing objects that touch the mouth, such as eating and drinking utensils, toothbrushes, and towels. It is best to refrain from any type of sex (vaginal, anal, or oral) during periods of active outbreak.
However, herpes can also be transmitted when symptoms are not present (asymptomatic shedding). Although condoms may not provide 100% protection, they are proven to significantly reduce the risk of sexual disease transmission, including herpes.
Natural condoms made from animal skin do NOT protect against HSV infection because herpes viruses can pass through them. Use a water-based lubricant.
Lubricants can help prevent friction during sex, which can irritate the skin and increase the risk for outbreaks. Only water-based lubricants (K-Y Jelly, Astroglide, AquaLube, and glycerin) should be used.
However, it is best not to use condoms pre-lubricated with spermicides. Do not use spermicides for protection against herpes. Nonoxynol-9 can cause irritation around the genital areas, which makes it easier for herpes and other STDs to be transmitted. Use a dental dam or condom for oral sex. If you have any symptoms of oral herpes, it is best not to perform oral sex on a partner until any visible sores or blisters have healed. Limit the number of sexual partners. The more sexual partners you have, the greater your chances of becoming infected or infecting others.
It is very unlikely to transmit or contract genital herpes from a toilet seat or bath towel. Studies suggest that male circumcision may help reduce the risk of HSV-2, as well as human papillomavirus (HPV) and HIV infections. However, herpes can cause significant and widespread complications in people who don't have a fully functioning immune system.
The CDC recommends that all people diagnosed with herpes simplex virus 2 (HSV-2) get tested for HIV. Most people with HIV are co-infected with HSV-2 and are particularly vulnerable to its complications.
HSV-2 infection increases HIV levels in the genital tract, which makes it easier for the HIV virus to be spread to sexual partners. Herpes and PregnancyPregnant women who have genital herpes due to either HSV-2 or HSV-1 have an increased risk for miscarriage, premature labor, inhibited fetal growth, or transmission of the herpes infection to the infant in the uterus or at the time of delivery. Herpes in newborn babies (herpes neonatalis) can be a very serious condition. Fortunately, neonatal herpes is rare.
Although about 25 to 30% of pregnant women have genital herpes, less than 0.1% of babies are born with neonatal herpes. The baby is at greatest risk during a vaginal delivery, especially if the mother has an asymptomatic infection that was first introduced late in the pregnancy. The risk for transmission also increases if infants with infected mothers are born prematurely, there is invasive monitoring, or instruments are used during vaginal delivery. Transmission can occur if the amniotic membrane of an infected woman ruptures prematurely, or as the infant passes through an infected birth canal. This risk is increased if the woman is having or has recently had an active herpes outbreak in the genital area. Very rarely, the virus is transmitted across the placenta, a form of the infection known as congenital herpes.
Also rarely, newborns may contract herpes during the first weeks of life from being kissed by someone with a herpes cold sore. Infants may get congenital herpes from a mother with an active herpes infection at the time of birth.
Aggressive treatment with antiviral medication is required. Most infected pregnant women do not have a history of symptoms, so herpes infection is often not suspected or detected at the time of delivery. Fortunately, if a woman does have genital lesions, rapid diagnostic blood tests can quickly determine her chances of transmitting the virus to her baby during delivery.
Some women with new or recurrent herpes may also be prescribed antiviral medication during pregnancy. A woman with herpes can usually safely breastfeed her baby, as long as she does not have a lesion on her breast or nipple. Neonatal herpes can spread to the brain and central nervous system, causing encephalitis and meningitis. Herpes can also spread to internal organs, such as the liver and lungs. Infants infected with herpes are treated with acyclovir, an antiviral drug. They usually receive several weeks of intravenous acyclovir treatment, often followed by several months of oral acyclovir. It is important to treat babies quickly, before the infection spreads to the brain and other organs. Fortunately, rapid diagnostic tests and treatment with acyclovir have significantly improved survival rates and reduced complication rates. Nearly all who recover have some impairment, ranging from very mild neurological changes to paralysis.


Like encephalitis, meningitis symptoms include headache, fever, stiff neck, vomiting, and sensitivity to light. Fortunately, herpes meningitis usually resolves after about a week without complications, although symptoms can recur. Herpes Eye ComplicationsOcular herpes is a recurrent infection that affects the eyes.
Ocular herpes is usually a simple infection that clears up in a few days, but in its more serious forms, and in severe cases, it can cause blindness. It only affects the upper layer (epithelium) of the cornea and heals with scarring. Stromal Keratitis. Iridocyclitis is another serious complication of ocular herpes, in which the iris and the area around it become inflamed. Herpes Skin ComplicationsEczema Herpeticum A rare form of herpes infection called eczema herpeticum, also known as Kaposi varicelliform eruption, can affect people with skin disorders and those with a weakened immune system. Untreated, this condition can be extremely serious and possibly fatal. Gingivostomatiti Oral herpes can cause multiple painful ulcers on the gums and mucus membranes of the mouth, a condition called gingivostomatitis. Children with gingivostomatitis commonly develop herpetic whitlow (herpes of the fingers). Herpetic Whitlow A herpetic whitlow is an infection of the herpes virus involving the finger, often around the fingernail. In children, this is often caused by thumb sucking or finger sucking while they have a cold sore.
It can also occur in adult health care workers, such as dentists, because of increased exposure to the herpes virus.
The use of latex or polyurethane gloves prevents herpes whitlow in health care workers. SymptomsHerpes symptoms vary depending on whether the outbreak is initial or recurrent. The primary outbreak is usually worse than recurrent outbreaks, with more severe and prolonged symptoms. In fact, studies indicate that 10 to 25% of people infected with HSV-2 are unaware that they have genital herpes. The first signs are a tingling sensation in the affected areas (genitalia, buttocks, and thighs) and groups of small red bumps that develop into blisters. The sores may sometimes itch, but itching decreases as they heal. About 40% of men and 70% of women develop other symptoms during initial outbreaks of genital herpes, such as flu-like discomfort, headache, muscle aches, and fever. Some women may have difficulty urinating and may, occasionally, require a urinary catheter. Women may also experience vaginal discharge. Recurrent Genital Herpes Outbreak In general, recurrences are much milder than the initial outbreak. The virus sheds for a much shorter period of time (about 3 days) compared to an initial outbreak of 3 weeks. Women may have only minor itching, and the symptoms may be even milder in men. On average, people have about four recurrences during the first year, although this varies widely. There are some differences in frequency of recurrence depending on whether HSV-2 or HSV-1 caused genital herpes.
HSV-2 genital infection is more likely to cause recurrences than HSV-1. Symptoms of Oral HerpesOral herpes (herpes labialis) is most often caused by HSV-1, but it can also be caused by HSV-2. It usually affects the lips and, in some primary attacks, the mucus membranes in the mouth.
A herpes infection may occur on the cheeks or in the nose, but facial herpes is very uncommon. Primary Oral Herpes Infection If the primary (initial) oral infection causes symptoms, they can be very painful, particularly in children.
The sores last 10 to 14 days and can be very uncomfortable. Blisters that may be preceded or accompanied by sore throat, fever, swollen glands, and painful swallowing. Recurrent Oral Herpes Infection A recurrent oral herpes infection is much milder than the primary outbreak.
It usually manifests as a single sore, commonly called a cold sore or fever blister (because it may arise during a bout of cold or flu). The sore usually shows up on the outer edge of the lips and rarely affects the gums or throat.
Recurrences of genital herpes are more likely with HSV-2 infection than with HSV-1 infection. The outbreak of infection is often preceded by a prodrome, an early group of symptoms that may include itchy skin, pain, or an abnormal tingling sensation at the site of infection.
Recurrent outbreaks feature most of the same symptoms at the same sites as the primary attack, but they tend to be milder and briefer.
Occasionally, the symptoms may not resemble those of the primary episode, but appear as fissures and scrapes in the skin or as general inflammation around the affected area.
They include sunlight, wind, fever, physical injury, surgery, menstruation, suppression of the immune system, and emotional stress. Oral herpes can be triggered within about 3 days of intense dental work, particularly root canal or tooth extraction. Timing of Recurrences Recurrent outbreaks may occur at intervals of days, weeks, or years. For most people, outbreaks recur with more frequency during the first year after an initial attack. The good news is that in most healthy people, recurring infections tend to become progressively less frequent, and less severe, over time. However, other conditions can resemble herpes, and doctors cannot base a herpes diagnosis on visual inspection alone. These tests include: Virologic tests (viral culture of the lesion) Serologic tests (blood tests that detect antibodies) The CDC recommends that both virologic and serologic tests be used for diagnosing genital herpes.
People diagnosed with genital herpes should also be tested for other sexually transmitted diseases. At this time, experts do not recommend screening for HSV-1 or HSV-2 in the general population. Genital herpes can be caused by either HSV-1 or HSV-2.
It is important to determine which virus is involved, as the type of herpes infection influences prognosis and treatment recommendations.
Recurrences of genital herpes, and viral shedding without overt symptoms, are much less frequent with HSV-1 infection than with HSV-2. False-negative (testing negative when herpes infection is actually present) or false-positive (testing positive when herpes infection is not actually present) results can occur. Your health care provider may recommend that you have a test repeated. Virologic TestsViral culture tests are made by taking a fluid sample, or culture, from the lesions as early as possible, ideally within the first 48 hours of the outbreak.
PCR tests are much faster and more accurate than viral cultures, and the CDC recommends PCR for detecting herpes in spinal fluid when diagnosing herpes encephalitis.
PCR can make many copies of the virus' DNA, so that even small amounts of DNA in the sample can be detected. However, many labs now use PCR for herpes testing because it is highly accurate. An older type of virologic testing, the Tzanck smear test, uses scrapings from herpes lesions.
The scrapings are stained and examined under a microscope for the presence of giant cells with many nuclei or distinctive particles that carry the virus (called inclusion bodies).
The Tzanck test is not reliable for providing a conclusive diagnosis of herpes infection and is not recommended by the CDC. Serologic TestsSerologic (blood) tests can identify antibodies that are specific for either HSV-1 or HSV-2. When the herpes virus infects you, your body's immune system produces specific antibodies to fight off the infection. If a blood test detects antibodies to herpes, it is evidence that you have been infected with the virus, even if the virus is in a non-active (dormant) state.
The presence of antibodies to herpes also indicates that you are a carrier of the virus and might transmit it to others. Serologic tests can be especially useful for people who do not have active symptoms, but who have other risk factors for herpes (such as other STDs, multiple sex partners, or a monogamous partner who has genital herpes). Although glycoprotein (gG) type-specific tests have been available for many years, many of the older nontype-specific tests that cannot distinguish HSV-1 from HSV-2 are still on the market.
Canker sores frequently crop up singly or in groups on the inside of the mouth, or on or underneath the tongue. The drugs are used initially to treat a first attack of herpes, and then afterward to either treat recurrent outbreaks (episodic therapy) or reduce frequency of recurrences (suppressive therapy).
Drugs can, however, reduce the severity of symptoms, improve healing times, and prevent recurrences. If people experience very severe disease or complications, they need to be hospitalized and receive an antiviral drug intravenously. Your health care provider will prescribe one of the three antiviral medications, which you will take for 7 to 10 days.
You should begin the medication as soon as you notice any signs or symptoms of herpes, preferably during the prodrome stage that precedes the outbreak of lesions. If taken during prodrome, episodic therapy may help prevent an outbreak from occurring or reduce its severity.
Valacyclovir is taken once a day. Suppressive treatment can reduce the frequency of outbreak recurrences by 70 to 80%. It is generally recommended for people who have frequent recurrences (6 or more outbreaks per year). Because herpes recurrences often diminish over time, you should discuss annually with your health care provider whether you should stay with drug therapy or discontinue it.
While taking any suppressive therapy for genital herpes, it is still important to regularly use latex condoms and to avoid any sexual activity during recurrences.
A new form of acyclovir (Sitavig) is administered orally as an adhesive tablet; it is applied to the gum region of the mouth, where it dissolves during the course of the day. In addition, acyclovir is available in topical form, as is the related drug penciclovir (Denavir). Topical TreatmentsThese ointments or creams can help shorten healing time and duration of symptoms. However, none are truly effective at eliminating outbreaks. Penciclovir (Denavir) heals HSV-1 sores on average about half a day faster than without treatment, stops viral shedding, and reduces the duration of pain. Ideally, you should apply the cream within the first hour of symptoms, although the medication can still help if applied later.
Apply the cream 5 times a day, beginning at the first sign of tingling or pain. Over-the-counter topical ointments may provide modest relief. They include Anbesol gel, Blistex lip ointment, Campho-phenique, Herpecin-L, Viractin, and Zilactin. Some contain a topical anesthetic such as benzocaine, tetracaine, or phenol. Lip balm that contains sunblock, or sunscreen applied around the lips may help prevent sun-triggered outbreaks. Herbs and SupplementsGenerally, manufacturers of herbal remedies and dietary supplements do not need FDA approval to sell their products. Just like a drug, herbs and supplements can affect the body's chemistry, and therefore have the potential to produce side effects that may be harmful.
There have been several reported cases of serious and even lethal side effects from herbal products.
Always check with your provider before using any herbal remedies or dietary supplements. Many herbal and dietary supplement products claim to help fight herpes infection by boosting the immune system.
There has been little research on these products, and little evidence to show that they really work. Epidemiology, clinical presentation, and antibody response to primary infection with herpes simplex virus type 1 and type 2 in young women. Seroprevalence of herpes simplex virus type 2 among persons aged 14 - 49 years -- United States, 2005-2008. Guidance on management of asymptomatic neonates born to women with active genital herpes lesions. Genital shedding of herpes simplex virus among symptomatic and asymptomatic persons with HSV-2 infection.



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