HSV or Herpes simplex virus causes a transmissible infection that affects around 60-95% of adults worldwide.
There are over 80 herpesviruses, 8 of which can infect humans. Besides HSV-1 and HSV-2, VZV (varicella-zoster virus), Epstein-Barr virus, cytomegalovirus, human herpesviruses (HHV-6 and HHV-7), and HHV-8 (Kaposi sarcoma-associated herpes virus) can infect humans. Every herpes virus is an enveloped, double-stranded DNA virus that has highly structured genomes that encode over 84 polypeptides.
Though HSV-1 and HSV-2’s DNA sequences are extremely similar, the proteins in the envelope permit serologic distinction between both HSV types.
Infection is spread mainly through mucous membrane exposure or skin that present with active lesions or exposure to mucosal secretions of a person who’s experiencing an active HSV infection. HSV is spread most easily via the saliva and can stay stable outside the host for a limited period, permitting the spread for some time following direct mucocutaneous contact with the virus. Also, HSV can be spread via respiratory droplets or through exposure to mucocutaneous secretions from a person who is asymptomatically shedding the virus. Asymptomatic shedding refers to viral presence outside the cells on the dermal surface, regardless of the lack of clinical signs.
The primary or initial HSV-1 or HSV-2 infection typically involves an incubation period of around four days but can range from 2-12 days. This period is followed by a period of active viral shedding that can last at least a week or up to a couple of weeks. The majority of patients infected primarily with herpes are asymptomatic. So, still, the virus can be spread actively during the incubation period and viral shedding with no presence of active dermal lesions.
After primary infection, the virus typically remains dormant, persisting in the autonomic nervous system’s sensory ganglia, and the infection is considered incurable. In the autonomic ganglia, HSV replicates while dodging detection by the immune system of the host.
HSV-1 lives most usually in the trigeminal ganglion because of its primary target area in and around the mouth; HSV-2 primarily stays in sacral ganglia following genital region infection. Once reactivated by a stimulus, exposure to sunlight, including stress, menstruation, and fever, HSV can travel down the sensory nerve and trigger in the exact mucocutaneous region as the primary infection. The symptoms usually remain active for a shorter period than the primary infection, and viral shedding merely lasts 3-4 days.
Several techniques are utilized to diagnose HSV infection presence, each having variable degrees of sensitivity, selectivity, utility, and cost. The main clinical technique for diagnosing a primary HSV-1 infection is identifying the classic appearance of herpetic lesions around or in the oral cavity. Monomorphous, congregated vesicles on the erythematous base change into coalescing, encrusted papules and plaques in just 1-3 days. The lesions tend to ulcerate or erode. Initial infection can result in an extensive gingivostomatitis. On the other hand, the diagnosis for primary HSV-2 can be harder because the classic genital herpes signs, herpetic ulcers around and in the genital area, might not be present. In babies, the vesicular lesion presence ought to raise high indication for HSV infection.
The standard, specific and effective genital herpes treatment is antiviral therapy, which is typically in tablet form. Antiviral drugs function by inhibiting HSV from reproducing in the body. However, the antiviral drug merely works in cells where the HSV is present, thus making the drug safe to take and free from various side effects. The treatment works while you’re taking the drug and can’t inhibit future herpes outbreaks once you quit taking it.
Antiviral treatments can:
- Cut the duration of an outbreak and aid to speed healing.
- Decrease the number of herpes outbreaks endured – or inhibit them completely.
Antiviral treatment can be utilized in ways described below:
1. To treat herpes outbreaks as they occur – this is called “episodic” treatment. With episodic treatment, the goal is to cut the time every outbreak lasts as well as to relieve the symptoms. This treatment works best in people who undergo symptoms a few hours before blistering takes place.
2. To reduce or prevent herpes recurrences – this is called “suppressive” therapy. If your recurring outbreaks are severe or frequent– or if you think they are particularly problematic – your physician could suggest that you take antiviral medication orally daily to help inhibit recurrences from happening. Suppressive therapy is taken in a continuous manner, i.e. every day, for months or years.
Also, suppressive antiviral therapy has been established to decrease viral shedding between herpes episodes and thus may aid to reduce the odds of spreading the virus to sex partners. New studies have established that suppressive treatment along with Valtrex reduces the risk of symptomatic herpes transmission by 75%.
Oral antivirals now available are:
- Aciclovir, which is offered fully subsidized by prescription. Aciclovir is effective and safe, even when taken for extended periods of time.
- Valtrex, which is offered fully subsidized by prescription from a doctor via Special Authority application, for people with problematic recurring herpes infection not responding to aciclovir.