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Erma L. Benitez, M.D.
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Herpes Simplex
The herpes simplex virus (HSV) can cause blisters and sores almost anywhere on a person;s skin. These sores usually occur either around the mouth and nose or the genitals and buttocks.

HSV infections can be very annoying because they can reappear. The sores may be painful and unsightly. For chronically ill people and newborn babies, the viral infection can be serious but rarely fatal.

There are two types of HSV
Type 1 and Type 2.
The Type ! virus causes cold sores. Most people get Type 1 infections during infancy or childhood. They usually catch it from close contact with family members or friends who carry the virus. It can be transmitted by kissing, or by using the same eating utensils and towels. The sores most commonly affect the lips, mouth, nose, chin, or cheeks and occur shortly after exposure. Symptoms may be barely noticeble or the patient may need medical attention for relief of pain.

Type 2 virus causes genital sores. Most people get type 2 infection following sexual contact with an infected person. The virus affects anywhere between five and 20 million persons, or up to 20 percent of all sexually active adults in the United States.

What is Herpes?
Herpes is the scientific name used for some 50 related viruses. Herpes simplex is related to the viruses that cause infectious mononucleosis (Epstein-Barr Virus) and for chicken pox and shingles (varicella zoster virus).

Herpes Simplex Type 1
Called fever blisters or cold sores, HSV Type 1 infections are tine, clear, fluid-filled blisters that most often occur on the face. Type 1 infections may also, less often, occur in the genital area. Type 1 may also develop in wounds on the skin. Nurses, physicians, dentists, and other health care workers sometimes get a herpetic sore after HSV enters a break in the skin of their fingers.

There are two kinds of infections - primary and recurrent. Although most people are infected with the virus, only 10 percent will actually develop sores or cold blisters when this infection occurs. The sores of a primary infection that last from seven to ten days and appear two to twenty days after contact with an infected person.

The number of blisters varies, from one to a cluster. Before the blisters appear, the skin may itch or become very sensitive. The blisters can break by themselves or as a result of minor injury, allowing the fluid inside the blisters to ooze and crust. Eventually, crusts fall off, leaving slightly red healing skin.

The sores from the primary infection heal completely and rarely leave a scar. However, the virus that caused the infection remains in the body. It moves to nerve cells where it remains in a resting phase.

Many people will not have a recurrence. Others will have a recurrence, either in the same location as the first infection or in a nearby site. The infections may recur every few weeks or less frequently.

Recurrent infections tend to be milder than primary infections. They can be set off by a variety of factors including fever, sun exposure and menstruation. However, for many the recurrence is unpredictable and has no recognizable cause.

Herpes Simplex Virus Type 2
Infection with herpes simplex virus Type 2 usually results in sores on the buttocks, penis, vagina or cervix, two to twenty days after contact with an infected person. Sexual intercourse is the most frequent means of getting the infection. Both primary and repeat attacks can cause problems including: a minor rash or itching, painful sores, fever, aching muscles and a burning sensation during urination. HSV Type 2 can also occur in locations other than the genital area, but is usually found below the waist.

As with Type 1, sites and frequency of repeated bouts vary. The initial episode can be so mild that a person does not realize that he or she has an infection. Years later, when there is a initial attack, leading to unfair accusations about the source of infection.

After the initial attack, the virus moves to nerve cells remaining there until set off again by a menstrual period, fever, physical contact, stress or something else.

Pain or unusual tenderness of the skin may begin between one to several days before both primary and recurrent infections may develop. This is called prodrome.

How Are the HSV Infections Diagnosed?
The appearance of HSV is often so typical that no further testing is necessary to confirm an HSV infection. However, if the diagnosis is uncertain, as it may be in the genital or cervix areas, a specimen may be taken and sent to the laboratory for analysis. Several laboratory tests are available for diagnosis including looking at a scraping under the microscope, culture and blood tests for antibodies. More than one of these tests may be required to confirm the presence of herpes. Genital herpes can be mistaken for other diseases, including syphilis. A small number of women with genital herpes don't know they have it because it occurs on the cervix which is not sensitive to pain.

How Are Herpes Infections Treated?
There is no vaccine that prevents this disease from occurring. Oral anti-viral medication, called acyclovic or famcylovir have been developed for severe or frequently recurrent infections. Low doses of these medicines may be helpful in reducing the number of herpes attacks in people with frequent outbreaks.

How Do You Prevent Transmission?
Between 200,000 and 500,000 persons "catch" genital herpes each year and the number of Type 1 infections is many times higher. Prevention of the disease, which is contagious before and during an outbreak, is important.