Herpes Simplex Virus Infections (HSV)

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Herpes Simplex Virus Infections
Overview

What Is Herpes Simplex Virus Infection?

What is herpes simplex virus infection?

Herpes simplex virus infection refers to repeated infections of the skin, mouth, lips, eyes, and genitalia caused by herpes simplex virus (divided into 2 subtypes, HSV-1 and HSV-2). It can also cause serious infections including encephalitis, meningitis, neonatal herpes and, in immunocompromised patients, disseminated infection. Is one of the most prevalent infections worldwide.

Among them, HSV-1 infection mostly affects the lips and mouth, also known as herpes labialis. Genital organ can be involved by both HSV-1 and HSV-2, also known as genital herpes simplex virus infection. Most are self-limiting and some require antiviral therapy.

Is herpes simplex virus infection common?

Herpes simplex virus infection is common worldwide, especially in immunocompromised individuals. It has been reported that 5.7% of clinical pharyngitis cases are caused by HSV-1. Both HSV-1 and HSV-2 can cause genital herpes, but most cases of recurrent genital herpes are caused by HSV-2, and there is no exact incidence rate in China.

Cause

What Is The Cause Of Herpes Simplex Virus Infection?

What is the cause of herpes simplex virus infection?

Herpes simplex is caused by the herpes simplex virus (HSV). The viruses are classified into Type 1 (HSV-1) and Type 2 (HSV-2):

  • HSV-1 mainly causes nipple infection by living close contact such as sharing tableware, and lactation of infants with herpetic stomatitis by lactating women, causing skin mucosa besides genital organs and brain infection.
  • HBV-2 causes genital infections and neonatal infections primarily through close sexual contact such as sexual transmission.

How is herpes simplex virus infected?

  • Humans are the only natural hosts of HSV, and the virus can be present in the blister fluid, saliva, and feces of patients, recovering patients, or asymptomatic carriers.
  • It is transmitted mainly through direct contact, but also indirectly through tableware contaminated with saliva.

How does herpes simplex virus infection happen?

The damaged skin and mucosa are easily infected. After virus invades the skin mucosa, it can firstly proliferate locally to form the first infection, i.e., the primary infection, which will later lurk in the ganglion for a long time. When receiving certain precipitating factors (such as fever, catching cold, insolation, tiredness, stimulation, etc.), the virus in the dormant state can be activated to cause herpes to appear again, i.e., herpes recurrence.

Does herpes simplex virus always get sick after infection?

This is not necessarily the case. Primary herpes simplex infection is mostly recessive, with only 1%–10% of infected persons presenting with clinical symptoms, which are mainly found in the population with low immune function, severe malnutrition or other diseases and infections. However, the virus will continue to lurk in the human body and can be triggered to attack.

Can the immunity of human body itself resist herpes simplex virus infection?

Specific IgG antibodies against the virus were found in the patient's serum. Antibodies do not prevent recurrence but relieve clinical symptoms.

Is herpes simplex virus infection a sexually transmitted disease?

Genital herpes, one of the common sexually transmitted diseases, is a chronic, recurrent and refractory STD caused by HSV infection of genitourinary and perianal skin and mucosa. It is mainly caused by HSV-2 infection. In recent years, the proportion of HSV-1 infection caused by oral-genital sexual behavior increased significantly. The severity of clinical symptoms and recurrence frequency after infection are affected by such factors as the type of virus and the host immune state.

Symptom

What Are The Symptoms Of Herpes Simplex Virus Infection?

What are the characteristics of herpes simplex virus infection?

At the time of onset, clusters of blisters appear on the skin and mucosal surface of the patient, which can also be itchy and burning. The disease will heal itself, but it recurs easily. See below for specific performance.

Can herpes simplex virus infection cause cancer?

In recent years, it has been found that HSV-2 is related to the pathogenesis of cervical cancer, and HSV-1 may be related to lip cancer.

How long will symptoms occur after being infected with the herpes simplex virus?

Primary infection is found in patients who have not been infected with herpes simplex virus and have negative serum reaction for the first time. The incubation period is 2–12 days, with an average of 6 days. Some patients with relapse may have no symptoms of primary infection.

After the occurrence of herpes simplex virus infection, patients will feel itchy and painful, generally do not have the feeling of systemic discomfort. However, the symptoms generally improved after 1–2 weeks without special treatment.

Clinically, it is impossible to judge whether the patient is infected by the virus for the first time or has been infected by the virus in the past for the first time with herpes symptoms, so it is often divided into two categories, i.e., first-onset type type and recurrent type.

What are the characteristics of the first-onset type of herpes simplex virus infection?

The initial type has a wide range relative to the recurrent type, with obvious uncomfortable feeling of conscious itching and pain, and a slightly long recovery time. It mostly manifests as herpetic gingivitis of children aged 1–5 years old, and clinically manifests as clustered small blisters in the oral cavity, gums, tongue, pharynx and other parts, which will soon burst and form painful shallow ulcers, affecting food intake. The whole disease will be improved for about two weeks.

What are the characteristics of recurrent type of herpes simplex virus infection?

The clinical symptoms of recurrent herpes simplex virus infection were mild and the recovery time was short. The typical clinical manifestations were erythema-based blisters with the size of clusters of rice grains to mung bean appeared on the erythema, usually in one group or in two to three groups. There was a flush around the blisters, the blisters were clear in liquid, and the blisters were broken, followed by erosion and scab. After one to two weeks, the scab skin fell off and healed, with temporary pigmentation left. It is easy to repeatedly occur in the same part, and frequently occurs at the mouth, nose, and vulva. Among them, the recurrence at the vulva is commonly known as "genital herpes", and it belongs to sexually transmitted diseases.

If a mother who has herpes simplex virus infects her genitals, will she infect her baby during childbirth?

Can lead to neonatal herpes, severe symptoms. Seventy percent of patients are infected by HSV-2, which is mostly through the birth canal. Generally, the disease starts 5–7 days after birth and manifests as blisters and erosion on the skin (especially the scalp), oral mucosa and conjunctiva. Severe cases may include fever, dyspnea, jaundice, hepatosplenomegaly, and disturbance of consciousness. Patients with central nervous system involvement and extensive dissemination of rash are in critical condition and the mortality rate is as high as 15%–50%.

Detect

How To Check For Herpes Simplex Virus Infection?

What check should herpes simplex virus infection do?

Virus culture identification is the gold standard for the diagnosis of HSV infection.

Detection of viral antigen and HSV-DNA in blister fluid by immunofluorescence and PCR, respectively, is currently the most commonly used rapid diagnostic method.

How to diagnose herpes simplex virus infection?

For most herpes simplex virus infections, the diagnosis can be made based on the fact that clinically clustered blisters frequently occur at the junction of the skin and mucosa, with conscious burning, pruritus or pain, which often self-heal around a week, and often recur.

What diseases should be differentiated from herpes simplex virus infection?

Recurrent aphthous ulcers, the most frequently confused disease with HSV infection, do not present with blisters and only occur on the surface of the oral mucosa, such as the inner surface of the lip, buccal mucosa, the ventral aspect of the tongue, and the buccal mucosal folds in the anterior aspect of the mouth.

Other diseases that present with lesions similar to oral herpes include syphilis, bacterial pharyngitis, enterovirus infection (such as herpetic angina and hand-foot-and-mouth disease), herpes zoster, and others, which need to be distinguished by doctors' attention.

Etiological testing when the etiology is unknown can help to differentiate between ulcers caused by HSV and those caused by other causes.

Prevention

How To Prevent Herpes Simplex Virus Infection?

How to prevent herpes simplex virus infection?

  • For patients with frequent recurrence of herpes, should try to remove or avoid inducing factors, such as cold, fatigue, etc.
  • Children who develop herpes simplex in a nursery should be quarantined at home and treated for recovery before returning.
  • Cesarean section shall be adopted for delivery in pregnant women with genital herpes.

How should the family member of patient with herpes simplex virus infection prevent to be infected?

Herpes simplex can be infected through kissing or other close contact with life, such as public tableware, towels, razor, etc. Therefore, forming a good habit of hand washing is the simplest way to block virus infection.

Treatment

How To Treat Herpes Simplex Virus Infection?

Is herpes simplex virus easily killed?

The herpes simplex virus has no strong resistance to the outside world. It can be inactivated by heating at 56 C for 30 minutes, ultraviolet radiation for 5 minutes or by fatty solvents such as ether.

How to treat herpes simplex virus infection?

Herpes simplex is self-limited, and most of it can be cured by itself. The principle of treatment is symptomatic treatment, shortening the course of the disease, preventing infection and complications, and controlling the recurrence.

What are the topical drugs commonly used to treat herpes simplex virus infection?

Antiviral external ointments can be selected, including 3% acyclovir ointment and 1% penciclovir cream commonly available in the market. When the blister rupture easily combined with bacterial infection, can be added with anti infection drug, such as 0.5% neomycin cream, mupirocin ointment, etc.

The mouth should be kept clean for herpetic gingivitis and gargle with a 1:1000 solution of bromogeramine.

Can the blisters formed by herpes simplex virus infection be pierced?

Herpes simplex blisters generally only rice to mung bean size, blister fluid can be absorbed by themselves, without special treatment. If the blister is broken, the blister wall should be preserved as much as possible to prevent secondary bacterial infection. External drugs such as fusidic acid cream and mupirocin ointment can be applied.

What are the oral medicines for the treatment of herpes simplex virus infection?

The only agents currently considered to be positively effective against herpesvirus are acyclovir and its derivatives, including valacyclovir, famciclovir, and penciclovir. Acyclovir has a low oral utilization rate and a short half-life which require multiple oral doses. The pharmacodynamics of valacyclovir and famciclovir are superior to acyclovir, but safety and efficacy have not been established in children. Recurrent herpes simplex is often accompanied by low cellular immune function, so preparations that improve immune function have a certain therapeutic effect.

What are the precautions for using acyclovir to treat herpes simplex virus infection?

Acyclovir enters the body and is excreted through the kidneys. Therefore, patients with renal insufficiency need to adjust the dose according to renal function. Large-dose intravenous infusion can cause transient blood urea and creatinine to increase. Therefore, it is recommended to use this medicine slowly intravenous infusion, preferably not less than 1 hour, while appropriately supplementing water.

Can herpes simplex virus infection use interferon to treat?

Type I interferon, including IFN-α and IFN-β, has broad-spectrum antiviral activity and antibacterial proliferation activity, and can be clinically used to treat viral infectious dermatosis, such as herpes simplex, by solution external application or intramuscular/subcutaneous injection.

When to use medicine after infection of herpes simplex virus?

Acyclovir treatment can shorten the course of the disease and reduce the severity of the attack. The treatment should be started as soon as possible when the clinical symptoms appear.

How should treat the herpes simplex virus infection that breaks out repeatedly?

The frequent relapse refers to the relapse more than 6 times in one year. To reduce the relapse times, continuous inhibition therapy can be adopted, that is, continuous oral administration of nucleotide drugs for 6–12 months.

Is herpes simplex virus resistant to acyclovir?

The resistance of herpes simplex virus to acyclovir is not serious, at least in the immunocompetent population, while in immunocompromised patients requiring long-term or frequent repeated treatment, the emergence of resistant strains leads to the presence of refractory lesions.

If patients with herpes simplex virus infection are resistant to acyclovir, systemic application of foscarnet sodium may be considered, as the drug achieves antiviral effects by blocking DNA replication. In addition to systemic application, foscarnet sodium is also effective topically.

Can physical therapy be used to treat herpes simplex virus infection?

Ultraviolet or microwave local irradiation can promote the resolution of skin lesions.

How to treat herpes simplex virus infection in immunodeficiency patients?

Genital herpes complicated with HIV/AIDS infection is often difficult to treat, requiring a long period of treatment. Antiviral and inhibitory treatment is often needed, and acyclovir resistance is easy to develop. The dose of the drug can be appropriately increased and the drug is administered continuously until clinical remission.

If skin lesions or symptoms persist after acyclovir treatment, treatment should exclude the possible presence of other infections, such as syphilis, and HSV resistance to acyclovir should be suspected.

All acyclovir-resistant HSV strains were resistant to valacyclovir, and the majority were also resistant to famciclovir and could be treated with foscarnet intravenously until clinical remission.

Herpes simplex virus infection can cause herpes labialis?

In most cases, it is herpes simplex virus infection, especially the herpes that often recurs, it is herpes simplex virus infection more, it is zoster virus infection possibly also, be careful not to transmit to others during infection.

Topical ointment containing glucocorticoid was contraindicated for medication, and antiviral creams such as acyclovir cream could be used for external use.

Life

What Should Patients With Herpes Simplex Virus Infection Pay Attention To In Life?

Is herpes simplex virus infection influential to the fetus?

Primary herpes simplex virus infection in pregnant women within three months of pregnancy, which can cause fetal growth retardation and maturation disorders. In the event of a non-primary infection or recurrent infection during pregnancy or puerperium, the possibility of serious illness in the neonate is minimal because the fetus is protected by antibodies in the mother.

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