Herpes Simplex: Forever and a Day

The word herpes originates from the Greek language- herpein- which means a creeping plant or reptile. This word is used to describe a medical disorder which is very familiar to most individuals. Despite having a word that sounds creepy- the infectio n is mostly known for its painful blisters and recurrence. The virus once acquired, never leaves the body. The organism stays in the body, forever. HSV infections are a painful annoyance and for some unlucky individual(s), the herpetic lesions may be recurrent. The sores are not only painful but have a nasty cosmetic appearance. There are a number of herpes viruses including the one that causes chicken pox, shingles and mononucleosis. The herpes simplex variety has two different subtypes: Type I and Type II viruses: herpes simplex 1 has traditionally been associated with oral sores (cold sores, fever blisters) while herpes simplex 2 virus has been associated with genital herpes. Type 1 Herpes simplex is a very common, contagious virus infection. The virus has a propensity to infect the mouth area. The infection may involve the lips, gums and mouth area and rarely the eye. There are many cures for herpes. Herpes simplex lesions on the mouth are often known as fever blisters or cold sores. The lesions are small blister like lesions and contain fluid. In the unfortunate individual, the herpetic lesions may also occur in the presence of wounds infections. Numerous individuals are exposed to herpes virus but less than 10% actually develop the painful sores.

Herpes infections are typically classified as primary or recurrent. The primary infection is usually acquired during childhood. In some individuals, there may be only episode of infection (primary); for the unlucky individual, the virus keeps on reactivating itself and causes repeat infections (secondary). After the first infection, the virus never disappears from the body. One of the oddities about herpes infections is that the organism has a great affinity for nervous tissue- and this is where it resides (latent or goes to sleep). The secondary infections occur when the virus is reactivated from its dormant state and causes the infection. Why and what makes the virus active again is a mystery but some factors are known to trigger its reactivation. These include stress both physical and emotional, excessive exposure to sun, major illness, colds, fevers and a lot of bad luck.

Herpes simplex has a fairly standard presentation. After the infection is acquired, most individuals will have some pain around the mouth area. In addition to pain, some individuals may also complain of itchiness, tingling or burning. The blisters usually appear after 4-7 days after the infection. The number of blisters is variable. Some may have one, others may develop many. The universal complain in all individuals when the blisters occur is the pain. The pain can be moderate to severe. Even though lesions are common on the outer lips, the occasional individual will develop the painful blisters on the gums, tongue and the inside of the mouth. During the ensuing days, the blisters mat rupture and ooze some fluid. After 10-14 days, the blisters dry up and form a scab which falls off. All individuals are very infectious during this time period. The duration of the infection tends to last 2-3 weeks.

Primary oral herpes infection (also known as herpes gingivostomatitis) is an initial infection by the virus. The infection causes painful sores or blisters around the mouth and gums primarily. It is believed that most individuals get their initial infection during childhood. Children are very prone to herpes simplex infection. They acquire the infection as early as age 5-8. These infections are acquired from adults (by kissing) or by touching contaminated utensils. The infectious period is associated with a low grade fever, tiredness, fatigue and general malaise. Some may even develop a sore throat and have difficulty swallowing food. The blisters may develop both on the inside and outside of the mouth. These blisters can ulcerate and are quite painful. The gums may become swollen, red and tender and eating food can be difficult. Foul breath and enlarged glands around the neck are common features during a severe episode of the infection. The acute episode lasts bout 5-14 days and most children take a few more days to fully recover. Scar is a rare occurrence with uncomplicated herpes sores. However, even when the blister has disappeared and all the symptoms resolved, the virus unfortunately goes into hiding. The virus has a great tendency to reside in nerve tissues, where it remains silent.

A number of individual keep on getting recurrent herpes sores. As to why some individuals get it and some do not, is a medical mystery. But we do know that some conditions can increase the chance of recurrence. The recurrence may be in the same location around the mouth or in a different site. The recurrence rate is variable. There may be one recurrence a month, or several a month or once a year. Secondary herpes is due to a local reactivation of the virus that produces a cold sore. Unlike the primary infection, recurrent herpes sores are not as painful. Most individuals claim that the pain is much less severe and tolerable. However, the unsightly cosmetic nature is no different compared to the first episode.

The diagnosis of herpetic sores requires a simple physical examination. No other blood work or x rays are required. In the very rare case, small amount of fluid may be obtained to confirm the diagnosis. In the era of modern medicine where money factors a lot into a physician’s income, unnecessary testing is common. This may include testing the blood for antibodies- redundant tests which do not affect therapy. Confirmation of the herpes virus may be of an issue in hospitalized patients who are sick. For the average individual, a simple physical exam will suffice.

General Care: The first thing to do is avoid physical contact with individuals who have an active infection. Hand washing is a key aspect of preventive care. Because most individuals have difficulty with solid food, fluids are the mainstay of diet for a few days. Cool liquids also help sooth the pain and reduce the discomfort during swallowing. There are numerous solutions and ointments which can be applied on the lips. Some even recommend a local anesthetic solution. Viscous anesthetic creams and ointments are available and may help decrease the pain. One should refrain from rubbing the eye with the fingers so as not to infect the eye. All activities with another partner which involve the mouth should be avoided. Medications: The pain can vary in intensity and most individuals require pain control. Over the counter pain medications are effective for most individuals but some may require much stronger prescription pain pills. One should never apply any cortisone to the infected area. Cortisone encourages the virus growth and makes the condition worse. There are several anti viral drugs available and Acyclovir is probably the best and most effective. It comes as a topical cream and a pill. The topical cream is expensive and useless. It is a complete waste of one’s money. It only reduces the infective period by a day or two at most. The oral pill is effective and decrease the duration of infection and recurrences. However, it has to be taken 5 times a day, for 10 days and costs a fortune. Oral anti-viral medications such as famciclovir or valacyclovir have been developed to effectively treat herpes infections. These medications can be used to treat the acute infection or may be used to prevent recurrences. Unlike acyclovir, these medications are generally used in the sick patients who have other illnesses. The drugs are fairly expensive. Alternative therapy Like most things in medicine, patients rapidly become dis-satisfied with conventional treatment- everyone wants instant relief and Nirvana- and when this fails they seek alternative care. The alternative health care business is flourishing even without the back up of any scientific data. The reason is patient gullibility because of the false claims made by this industry. Every type of nutritive and herbal agent has been postulated to help cure herpes. From mega doses of all vitamins, minerals to gouging on the liver, spleen, thymus of cows, chickens and pigs. Hundreds of herbs are sold as a remedy for herpes-teas, powders, capsules of every kind are sold- some are recommended to be taken in orally, some to be pasted on the lips and some to placed in the rectum (it sure is a medical miracle if a rectally placed herb can cure an infection in the mouth) - yet millions of people buy and use these products Other therapies that have been used to treat herpes include acupuncture, psychological therapy, behavioral counseling and massage therapy.

The number of individuals who acquire Type 1 herpes infections are in the millions. So far, there is no vaccine available to treat the infection. However, there are some methods of preventing the spread of the infection. Any individual, who has an acute infection with signs of tingling, burning, itching, or pain suggestive of a herpetic infection, should refrain from contact from other individuals. All oral activity should be stopped until the infection has subsided- even separate utensils should be utilized by the infected person. Fingering different parts of one’s or the partner’s body is an absolute no-no.

Most individuals recover from the infection in 5-10 days. The few lucky individuals just get one infection for remembrance. The unlucky ones get recurrences at variable rates. As far as a cure is concerned, it is still several years away and it definitely won’t come cheap. The drug industry is not in the business of losing money. If the price of acyclovir is anything to go buy, the vaccine will definitely not be cheap. There is no doubt that conventional medical therapy has not been very effective in treating herpes simplex. However, it does offer drug therapy (Acyclovir) which is still the most effective compared to whatever else is available. Alternative care may work in some but in most individuals it does not. Herpes, unfortunately is forever and so buyer beware of anyone making claims that they can cure it.

 

Mono is part of the herpes family.  Find out more.