Herpes simplex is a common viral skin infection caused by herpes simplex virus. There are two types of the causative virus, which are identified by viral typing. Generally, herpes simplex type 1 occurs on the mouth and type 2 occurs in the genital region, but both virals can be found in both locations or in other parts of the body. About 85% of the adults worldwide are seropositive for herpes type 1. The Prevalence rate of type is lower; type 2 usually appears at the onset of sexual activity. Serological testing shows that many more people are infected than having a history of clinical disease.
Herpes simplex is further classified as a true primary infection, a nonprimary initial episode, or a recurrent episode. True primary infection is the initial exposure to the virus whereas A non-primary initial episode is the initial episode of either type 1 or type 2 in a person previously infected with the other type. Recurrent episodes are subsequent episodes of the same viral type.
Types of Herpes simplex
Oralabial herpes, also called fever blisters or cold sores, consists of erythematous-based clusters of grouped vesicles on the lips. A prodrome of tingling or burning with pain may precede the appearance of the vesicles by up to 24 hours. Certain triggers, such as sunlight exposure or increased stress, may cause recurrent episodes. Fewer than 1% of people with primary Oralabial herpes infections develop herpetic gingivostomatitis. This complication occurs more often in children and young adults than in people of other ages. The onset is usually characterized by high fever, regional lymphadenopathy, and generalized malaise. Another complication of Oralabial herpes is the development of erythema multiforme, an acute inflammation of the skin and mucous membranes with characteristic lesions that have the appearance of targets which is concentric red rings with white bands between the red rings.
Genital herpes or type 2 herpes simplex, manifests with a broad spectrum of clinical signs. Minor infection may produce no symptoms at all; severe primary infections with type 1 can cause systemic flulike illness. Lesions appear as grouped vesicles on an erythematous base initially involving the vagina, rectum or penis. Now lesions can continue to appear for 7 to 14 days. Lesions are symmetric and usually cause regional lymphadenopathy. Fever and flu-like symptoms are common. Typical recurrences begin with a prodrome of burning, tingling, or itching about 24 hours before the vesicles appear. As the vesicles rupture, erosions and ulcerations begin to appear. Severe infections can cause extensive erosions of the vaginal or anal canal.
Diagnostic findings and Assessment
- Herpes simplex infection is confirmed in several ways.
- Generally, the appearance of the skin eruption is strongly suggestive.
- Viral cultures and rapid assays are available and the type of test used depends on lesion morphology.
- Acute vesicular lesions are more likely to react positively to the rapid assay, whereas older, crusted patches are better diagnosed with viral culture.
- In all cases, it is obvious to obtain enough viral cells for testing, and careful collection methods are therefore very important.
- All crust should be gently removed or vesicles gently unroofed.
- A sterile cotton swab the base of the vesicles to obtain a specimen for analysis.
Eczema herpeticum is a condition in which patients with eczema contract herpes that spreads throughout the eczematous areas. The same type of spread of herpes can occur in severe seborrhoea, scabies, and other chronic skin conditions. Eczema herpeticum is managed with oral or IV acyclovir.
Herpetic whitlow is an infection of the pulp of a fingertip with herpes type 1 or 2. There are tenderness and erythema of the cuticle. Deep-seated vesicles appear within 24 hours.
In mothers who have primary infections during pregnancy, intrauterine neonatal infections can occur. Most Cases of neonatal infection with herpes occur during delivery by contact of the infant with the mother’s active ulcerations. Fetal anomalies include skin lesions, microcephaly, encephalitis and intracerebral calcifications.
Treatment for Oralabial herpes:
In many patients, recurrent Oralabial herpes represents more of a nuisance than a disease. Because sun exposure is a common trigger, people with recurrent Oralabial herpes should use a sunscreen liberally on the lips and face. Topical treatment with drying agents may accelerate healing. In more severe outbreaks or in patients with identified triggers, Intermittent treatment with 200mg acyclovir administered five times each day for 5 days is often started as soon as the earliest symptoms occur.
Treatment of genital herpes:
Treatment of genital herpes depends on the severity, the frequency, and the psychological impact of reoccurrences an on the infectious status of the sexual partner. For people who have mild or rare outbreaks, no treatment may be required. For those who have more severe outbreaks but for whom outbreaks are still infrequent, Intermittent treatment as described for oral lesions can be used. Use of Intermittent oral medication has been shown to reduce the duration of herpes genital infections by only 24 to 36 hours. If a patient is using Intermittent treatment within the first 24 hours after the infection is identified.
Patients who have more than six reoccurrences per year may benefit from suppressive therapy. Use of acyclovir, valacyclovir, or famciclovir suppresses 85% of reoccurrences and 20% of patients are free of reoccurrences during suppressive therapy. Suppressive therapy also reduces viral shedding by almost 95% making the person less contagious. Treatment with suppressive doses of oral antiviral medications is a prevention of recurrent erythema multiforme (acute eruption of macules, papules, and vesicles with a multiform appearance).
Treatment during pregnancy:
Management of genital herpes in pregnancy differs among clinicians. Routine prenatal cultures do not predict shedding at the time delivery. The use of scalp electrodes during delivery should be avoided because they increase the risk of infection in the newborn. Because the risk of neonatal herpes is greater in women with their initial episode during pregnancy, suppression therapy should be started in affected women to reduce outbreaks during the third trimester. All of the women with active lesions at the time of delivery undergo a cesarean section.
- Education about the safe sexual habits.
- Focus on Personal hygiene.
- Awareness programme for the infectious diseases.
- Universal precaution in handling the secretions for care providers.
- Nutritious diet.
- Proper use of the medication.
- Follow up