Herpes Virus Infections

The familiar “fever blister” or “cold sore” is caused by Herpes Simplex Virus (HSV). The lesions most frequently occur on the vermillion border of the lip (where the lip meets the skin) but may occur on the chin or inside the mouth. Occasionally, they will appear in unusual locations. Sunlight, emotional upset, concurrent illness and other factors may elicit an outbreak of the virus. There is no cure for HSV. Some people get several attacks a year and others only a few lesions in a lifetime. The virus can be transmitted and you should avoid close contact of the sore to other people and avoid getting virus on your hands and spreading it to your eyes. Several topical and oral agents may be used. For severe and frequent attacks, oral medication taken every day is available

Genital Herpes

Genital herpes involving the male penis or the female vulva, vagina or cervix is caused by a closely-related Herpes virus. Like the oral herpes virus, recurrences or outbreaks are unpredictable and vary widely from individual to individual. Genital herpes in the adult is not a serious threat to health. The biggest problem is the transmission from pregnant women to infants during birth. Infants may be severely affected by herpes virus leading to death or mental retardation. Herpes is transmitted by sexual contact. Condoms or other types of barrier birth control methods should be used when active blisters or sores are present though may not protect uncovered skin. Most infections by Herpes virus occur when no symptoms or visible lesions are present. There is still no cure for genital herpes. The initial episode is usually the most severe and painful. Typically, oral medications can be quite effective in controlling symptoms. Being infected with the genital herpes virus means a higher risk for getting other sexually transmitted diseases (syphillis, AIDS, gonorrhea, chlamydia, etc.)

Herpes Zoster

Zoster or “Shingles” is caused by a related but entirely different virus. The zoster virus is the same as the virus causing varicella or “chicken pox”. The virus is present in the nerves of most people. In some individuals, the virus begins to replicate in later life. The lesions are painful blisters on a red base. The pain frequently precedes the blisters. The blisters follow the course of the affected nerve and lesions are usually on one side and stop at the middle of the body. If the lesions are on the face and close to the eye, immediate medical attention is necessary to prevent eye and vision complications. Pain may persist and be quite severe after an attack and early treatment may be helpful to prevent this “post-herpetic neuralgia”. Treatment with oral medication is helpful in treating the outbreak and preventing post-herpetic pain; however, it must be started as early as possible.

Treatment

Oral agents: Acyclovir (Zovirax), valacyclovir (Valtrex), famcyclovir (Famvir): These medications interfere with replication of the virus.

Topical agents: Acyclovir (Zovirax), pencyclovir (Denavir) Use 5 times a day at the onset of symptoms.

Prednisone: This medication has anti-inflammatory effects and may help prevent neuralgia after “Zoster attacks”

Vaccine: Recently, a vaccine to prevent or limit the outbreak of shingles has been developed.  Anyone over the age of 65, who has not had a shingles attack, should have the Zostavax shot.