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Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Every winter, cold and flu sweep across the country, bringing aches, runny noses and fever to millions. If our immune system recognises the virus as an intruder, it will be destroyed before the virus can gain entry to a cell. Once inside the cell, the virus can hijack the cell's own replication machinery, which starts to make many copies of the virus. Some of the symptoms caused by viruses - such as fever, vomiting and tiredness - are a result of the body's defence mechanisms. Scientists have used this concept to protect people against viruses, with some notable success. In the 17th century, a method of smallpox immunisation saw people snort or rub dried smallpox scabs into their skin to create an immune response, which then protected them from contracting the virus. Then in 1796, British physician Edward Jenner developed the first vaccine (for smallpox) which led to a complete eradication of the disease by 1980.
Acetaminophen or ibuprofen may help reduce fever and pain caused by the herpes simplex virus sores. If you develop a tender, painful sore on the finger, see a physician, especially if it is not going away or if it seems to be getting worse. This Site and third parties who place advertisements on this Site may collect and use information about your visits to this Site and other websites in order to provide advertisements about goods and services of interest to you. If you would like to obtain more information about these advertising practices and to make choices about online behavioral advertising, please click here. Orofacial herpes simplex virus is the medical name for herpes simplex infection of the mouth and face, also known as cold sores or fever blisters. The most common locations for HSV-1 infections include: Lips Mouth (including gums, tongue, roof of mouth, and inside the cheeks) Nose Chin Cheeks Shortly after exposure to the virus, a newly infected person may develop fluid-filled blisters, occurring singly or in a cluster. Acetaminophen or ibuprofen may help reduce fever, muscle aches, and pain associated with the cold sores. The flu virus can kill vulnerable people and a full-blown pandemic can cause a national health crisis.
These viruses burst out of the cell, destroying it, and will attempt to infect many more cells unless tackled by the immune system. For the first time ever, the World Health Organisation announced the total global eradication of a once deadly disease. But in certain types of virus, these proteins keep changing as the virus mutates, so a vaccine developed one year might not work the next. Staying at home when infected will avoid spreading the infection to others, and minimising contact with virus particles by thoroughly washing hands and cleaning surfaces will limit the spread of the virus to others.
We may never be able to totally beat viruses, but by harnessing the power of vaccination, the latest anti-virals and adopting the right behaviour, we stand a good chance of keeping one step ahead of viruses' most harmful effects. Herpetic whitlow is caused by infection with the herpes simplex virus (HSV).Infections with HSV are very contagious and are easily spread by direct contact with infected skin lesions. You should definitely seek medical attention if you have a finger sore as well as typical symptoms of oral or genital herpes.
On occasion, however, a swab from the infected skin may be sent to the laboratory for viral culture, which takes a few days to grow. These are common, contagious sores that usually occur on the inner and outer lips but can also be spread to the fingers and other body parts. HSV -1 is more common, and almost all adults in the United States are carriers of the virus, though only some people develop the associated sores. These blisters may be yellow to gray and are fragile, so that many people never notice blisters but instead see tiny ulcers. Seek medical advice as soon as possible, especially if you are at risk for more serious complications.
It is a painful disease which attacks the nervous system and rashes appear over the affected nerves.
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.
In fact, viruses are the most common biological unit on Earth, outnumbering all other types put together.
HSV infection usually appears as small blisters or sores around the mouth, nose, genitals, and buttocks, though infections can develop almost anywhere on the skin. Children often contract herpetic whitlow as a result of thumb- or finger-sucking when they have a herpes infection of the lips or mouth. Small (1–3 mm) fluid-filled blisters develop, often clustered together on a bright red base. Blood tests may also be performed.Untreated HSV infections will go away on their own, but medications can reduce the symptoms and shorten the duration of outbreaks.
There are 2 major strains of herpes simplex virus (HSV): herpes simplex type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2). Chemotherapy also increases the risk.Those recovering from an illness or under stress are also at a higher risk. Trends in HSV Types and Genital Herpes Genital herpes can be caused by either HSV-2 or HSV-1. Dental and medical workers may contract herpetic whitlow by touching the contagious lesions of a patient with herpes simplex virus infection.
In general, cold sores and fever blisters are caused by HSV-1, and genital herpes is caused by HSV-2. It is seen that fatigue and injury on the skin where rashes appeared are among the other causes. HSV-1 infections usually occur around the mouth, lips, nose, or face, while HSV-2 infections usually involve the genitals or buttocks. In recent years, HSV-1 has become a significant cause in developed countries, including the United States. Recurrent herpetic whitlow is rare.However, people with recurrent HSV infections may report that the skin lesions are preceded by sensations of burning, itching, or tingling (prodrome). Because it is so contagious, the herpes simplex virus causes a primary infection in most people who are exposed to the virus.
They are often painful when the sores are open, and before they appear, some people experience a tingling sensation that indicates that the cold sore is on its way. In severe cases of HSV infections, the infection may involve the entire lining of the mouth and both lips.
While you will be able to view the content of this page in your current browser, you will not be able to get the full visual experience. However, only about 20% of people who have a primary infection with the herpes simplex virus actually develop visible blisters or sores.
These severe HSV infections may be accompanied by fever, sore throat, foul breath, and difficulty eating.Repeat (recurrent) HSV infections are often milder than the primary infection, though they look alike. The risk of infection is highest during outbreak periods when there are visible sores and lesions. Please consider upgrading your browser software or enabling style sheets (CSS) if you are able to do so. Cold sores and fever blisters can be spread by kissing or sharing intimate objects such as toothbrushes, lip balms, utensils, or towels.Both HSV-1 and HSV-2 are very contagious. However, some people never develop the symptoms of a primary HSV infection and may mistake a recurrent infection for a primary infection. However, only about 20% of people exposed to either virus will experience the associated sores. Symptoms When genital herpes symptoms do appear, they are usually worse during the first outbreak than during recurring attacks.
For this reason, it is important to protect yourself by knowing your sexual partners and by avoiding contact with others' intimate items. People who struggle with frequent outbreaks of sores often learn specific triggers that bring the sores on and can take medicines or use treatments to help lessen the attacks. Herpes, Pregnancy, and Newborn Infants Herpes 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 treated with the antiviral drug acyclovir, which can help suppress the virus.


They 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.
HSV-1 can also cause genital herpes, which is a sexually transmitted disease (STD). Herpes simplex virus 2 (HSV-2) is the usual cause of genital herpes, but it can also cause oral herpes. 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. 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). Only water-based lubricants (K-Y Jelly, Astroglide, AquaLube, and glycerin) should be used.
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, 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.
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. 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. 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 Herpes Oral 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. 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.
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. 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.
They usually heal within 2 weeks without treatment. Canker sores (Aphthous ulcers) are very common. 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, Camphophenique, 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. Epub 2013 Jan 28. Martin ET, Krantz E, Gottlieb SL, Magaret AS, Langenberg A, Stanberry L, et al. Genital shedding of herpes simplex virus among symptomatic and asymptomatic persons with HSV-2 infection.



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