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Herpes Simplex Health Article

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Description

Herpes simples virus (HSV, or herpesvirus) is a virus that causes infection of skin and mucous membrane and rarely infects other parts of the body. However, in the immunosuppressed patient, HSV may cause pneumonia and other more severe infections. When the infection occurs in the mouth it is commonly referred to as cold sores. An outbreak of HSV infection can be very painful. There are two distinct types of HSV: type 1 and type 2. It was believed that HSV-1 mostly caused oral herpes (herpes labialis), while HSV-2 generally caused genital herpes that typically affects the penis, vulva, and rectum. This is not completely true. Both type 1 and type 2 can cause herpes lesions on the lips or genitals. The first symptoms occur within 2-20 days after contact with an infected person.

Symptoms of the primary infection are usually more severe than those of recurrent infections. The primary infection can cause symptoms like those experienced in other viral infections, including lack of energy, headache, fever, and swollen lymph nodes in the neck. The first sign of infection is formation of fluid-filled blisters that may last up to two weeks. However, the pain in the area may last much longer. Once HSV enters the body it spreads to nearby mucosal areas through nerve cells. Once it infects the body the virus remains latent for the life of that individual. During the period of latency there are no symptoms. At times the infected person may shed the virus, even in the absence of visible symptoms, and infect others. Individuals infected with the virus can have recurrent infections; however, normally, recurrent infections are milder and shorter. However, cancer patients can have severe recurrences.

Typically, 50-80% of persons with oral herpes experience a prodrome (symptoms of oncoming disease) of pain, burning, itching, or tingling at the site where blisters will form. This prodrome stage may last anywhere from a few hours to one to two days. The herpes infection prodrome occurs in both the primary infection and recurrent infections.

Causes

Everyone with cancer has a higher risk of catching viral infections of any type. This is because the cancer itself, and the methods used to treat it, affect the immune defense mechanisms that fight infection. Normally the mucous membrane is one of the first lines of defense against infectious organisms. However, chemotherapy and radiation can damage this very important barrier. The barrier that skin provides is also compromised because of needles used for drawing blood or injecting drugs. Radiation and chemotherapy also suppress the immune system. Certain cancers like Hodgkin's disease, lymphoma, and T-cell leukemia cause defects in cellular immunity, which is a primary defense mechanism against viral infections. Thus cancer patients, especially those who are undergoing chemotherapy or radiation treatments, are at greater risk of primary and secondary herpes infections.

Oral herpes simplex infections are more common in children than adults following chemotherapy. Patients who have the virus latent in the system have a higher chance of recurrent infection. Primary infection generally causes gingivitis (inflammation of the gums, vesicles on the mucosa (blisters on the lining of the mouth), and a coated tongue (white covering on tongue). Women with genital herpes can have severe recurrence following chemotherapy because of immunosuppression.

Treatment

There is no cure for HSV infection although there are antiviral drugs available that have some effect in lessening the symptoms and decreasing the length of herpes outbreaks. There is evidence that some of these drugs may also prevent future outbreaks. For the best results drug treatment should begin during the prodrome stage before blisters are visible. Depending upon the length of the outbreak, drug treatment could continue up to 10 days.

Acyclovir (Zovirax) is the drug of choice for herpes infection and can be given intravenously or taken by mouth. It can be applied directly to sores as an ointment but is not very useful in this form. A liquid form for children is also available. Acyclovir is effective in treating both the primary infection and recurrent outbreaks. When taken by mouth to prevent an outbreak, acyclovir reduces the frequency of herpes outbreaks.

Alternative and complementary therapies

A number of steps can relieve the symptoms of herpes infections. It is important to keep the blisters or sores clean and dry with an agent like cornstarch. One should avoid touching the sores, and wash hands frequently. Local application of ice may relieve the pain. Over-the-counter medication for fever, pain, and inflammation— such as aspirin, acetaminophen, or ibuprofen—may help. Children should never be given aspirin. Sexual intercourse should be avoided during both the active stage and the prodrome stages. During an outbreak of cold sores salty foods, citrus foods (oranges etc.), and other foods that irritate the sores should be avoided. Over-the-counter lip products that contain the chemical "phenol" (such as Blistex Medicated Lip Ointment) and numbing ointments (such as Anbesol) help to relieve the pain of cold sores. A bandage may be placed over the sores to protect them and prevent spreading the virus to other sites on the lips or face.

A diet rich in the amino acid lysine may help prevent recurrences of cold sores. Foods that contain high levels of lysine include most vegetables, legumes, fish, turkey, and chicken. Oral lysine supplements in the amount of 1000 mg per day may help sores heal faster. There is a belief that foods with high lysine-to-arginine ratio will help prevent outbreaks of herpes simplex. That has not been proven, and it is important to include foods that have a low lysine-to-arginine ratio also, such as nuts, onion, garlic, and green vegetables. It is also suggested that the amount of arginine in the diet be limited as there is a belief that arginine is needed for herpesvirus growth. This amino acid is found in peanuts, beer, chocolate, gelatin, and raisins.