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About Herpes Simplex

Herpes simplex is an infection caused by virus most often attacking the skin, but can also occationally attack the eyes and nervous system. There are two types of herpes vira and hence two types of Herpes simplex:  HSV-1 causing Herpes simplex type 1 and HSV-2 causing Herpes simplex rype 2.

A usual site for Herpes infection is the lips and the areas surrounding the mouth, HSV-1 most often attack this area. Attack by HSV-2 in this area gives less symptoms.

Anothet usual site for attck is the genital region of both men and women. Genital herpes is most often caused by HSV-2. Attack by HSV-1 in this area gives less symptoms.

Herpes often begin by itching or burning sensation in the affected area and then the area will swell. Then the herpes gives blisters filled with fluid that eventually rupture and develope into sores.

When a skin area has had one outbreak, new outbreaks at that area can occur, and a person can get new outbreaks for many years or the whole life.

The mechanism of the herpes virus

Herpes simplex is transmitted by body fluids or other body elements when an affected area of one person gets in contact with an injured area of another person. Such transmissions can also occur between two areas of the same person during the first outbreak, but autotransmissions are less likely during subsequent outbreaks.

A person having had one outbreak of herpes will get an immunity against both types of herpes vira, but best immunity against the virus type having caused the first outbreak. This immunity hinders or makes it more difficult for the herpes virus to attack a new area on the body. The immunity can eventually also make new outbreaks at the same areas less severe.

Vira from an attacked site tend to get into the nerves that ends in that site and wander upp to the cell bodies of the nerve cells. Here the genetic DNA of the virus will be incorporated in the genome of the nerve cells.

Upon certain trigging mechanisms, for example physical or psychological stress or other diseases, new vira are produced in the nerve cell bodies. These wander down the nerve cell to the skin area previously affected, the vira are relased and cause new attcks at that area. This is the reason why new outbreaks occur sveral times at the same area.

Drugs against herpes virus

There exist several drugs that can hinder the severity of herpes outbreaks or even nearly stop the outbreak in the beginning. These drugs intrevene into the replication of the virus, and give the immune system time to attck the vira.

Examples of herpes medications to be taken by mouth are aciclovir (Zovirax), valaciclovir (Valtrex), famciclovir (Famvir), and penciclovir. Aciclovir was the originally developed of these. Valaciclovir and famciclovir (prodrugs of aciclovir) and penciclovir have improved solubility in water and gets more easily to the site needed in the body.

Another anti-viral agent, Docosanol (Abreva) is used in  cream to smear onto the affected area of the skin. It prevents the virus from fusing to cell membranes and thus hindering the virus from entering into the skin.

Tromantadine is available as a gel that inhibits the entry and spread of the virus by altering the surface composition of skin cells and inhibiting release of viral genetic material. Zilactin is a topical analgesic barrier treatment, which forms a "shield" at the area of application to prevent a sore from increasing in size, and decrease viral spreading during the healing process.

There are also many natural substances that can hel against herpes. The next section deals with these.

Vaccines

One is beginning to develop vaxines against Herpes simplex and related diseases. These are however not yet shown themselves to be fully effective

The National Institutes of Health (NIH) in the US is currently performing phase III trials of the vaxine Herpevac targeted against  HSV-2. The vaccine has only exhibited effect for women who have never been exposed to HSV-1 and who had not yet aquired the HSV-2 infection when they got the vazine. The vaccine prevents HSV-2 from being found in blood serum 48% effectively, but it prevents symptoms from HSV-2 78% effectively in those women. During trials it did not seem to prevent HSV-2 in males.

Because about 20% of persons in the United States allready have HSV-2 infection, the number of persons that can get value from this vaxine is fairly small.

Zostavax is a live vaccine developed by Merck & Co. (September, 2008) which has been shown to reduce the incidence of herpes zoster (known as Shingles) by 51.3% in a pivotal phase III study of 38,000 adults aged 60 and older who received the vaccine.

Researchers at the University of Florida have constructed a hammerhead ribozyme that aims at and cleaves the mRNA of essential genes in HSV-1. The hammerhead which attacks the mRNA of the UL20 gene greatly decreased the intensity of HSV-1 eye infection in rabbits and reduced the viral concentration in their affected tissues..

A picture showing herpes simplex lessions - A free picture from Wikipedia.org

Herpes Zoster or shingles

Herpes zoster is a herpes virus infection that is caused by reactivation of varicella zoster virus, that is the same virus that causes chickenpox. It is a painful skin disorder.


Etiology and pathogenesis

Herpes zoster is caused by the same virus as chicken pox, Varicella zoster virus (VZV). People getting Herpes xoster have had a chickenpox infection earlier in life, usually in the childhood. This virus lies dormant in nerve ganglia after a primary outbreak in the form of chickenpox. VZV can then be reactivated when the immune system is reduced, and then causing shingles. Those who have shingles have therefore had chickenpox as children. Not rarely older people get shingles about half a year after the grandchildren have had chickenpox.
 

Symptoms of herpes zoster or shingles

Shingles is characterized by an intense, burning pain, blisters and subsequent ulcers after rupture of the blisters.

The blisters follow a dermatom (an area of the skin that is supported by one nerve bundle). This skin lession is limited to either the left or right body half. The area is located most commonly in the chest region, but some get outbreak of the lessions in the neck region and face.

Shingles on the face with affection of the eye's cornea may destroy the patient's vision.

Many other diseases can cause a reactivation of VZV and thereby outbreak of shingles, for example reduction of the immune system of old age, AIDS. Therefore it may be advisable to have conducted a general medical examination a few weeks after the shingles is over.


Treatment

The most usual treatment is to use over-the-counter analgesic and let the lesions heal by themselves. By soothing rash, topical drugs containing calamine is often used. By severa pain opioid pain-killers are used.

Shingles can be treated with antiviral drugs (aciclovir, valaciklovir). This is an expensive tablet cure. Newer drugs Valaciclovir and Famciclovir are also used. These may have better effects. These drugs are used both to prevent outbreaks in specially susceptible patients and for treatment of the outbreak.

The main reason for adminstering such an antiviral cure is to reduce the likelihood of post-infectious neuralgia, which is an intense pain in the same area as the original rash that can last years or a lifetime. However, these drugs have not proven so effective in preventing this longterm symptom

Sometimes steroid drugs are used, often in combination with acyclovir, but the effect is are not well documented.

By severe pain from herpes lesions, topical analgesic drugs or numbing remedies that contain aromatic substances can be helpful. Aromatic ointments are also believed to speed up recovery by increasing blood flow in the area and certain tissue reactions. Strong aromatic remedies may however irritate special sensitive areas, like the genitals, and should be used with caution.

There are also many natural drugs on the market that can be used to help the immune system hold down the virus from being reactivated and to help to fight down a reactivated infection.

 

Giving blood for shingles

For children receiving cancer treatment can chickenpox be a life-threatening illness. Adults who get shingles will develop much antibodies in the blood against the actual virus. Adults who give blood 2-3 weeks after the illness, should notify the blood bank.
 

A picture showing shingle lessions - A free picture from Wikipedia.org

(These articles have many elements from wikipedia.org and are therefore free for copy and reuse under the GNU common license)