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Herpes


Herpes is an infection caused by herpes simplex virus 1 or 2. It primarily affects the mouth or genital area. HSV is in the same family of viruses that causes chickenpox, shingles and mononucleosis. There are two types of herpes simplex virus (HSV): HSV-1, which infects 80 percent of the U.S. population, usually appears on the lips in cold sores; HSV-2 is usually found in the genital area. However, if a person with HSV-1 oral herpes (cold sores) performs oral sex, it is possible for the partner to get HSV-1 genital herpes. And HSV-2 can infect the mouth through oral sex.

HSV can cause sores, or lesions, to appear in and around the vaginal area and within the cervix in women, and on the penis and scrotum in men. Both males and females may also get lesions in the urinary tract, around the anal opening, on the buttocks or thighs, and sometimes on other parts of the body.

Herpes labialis (oral Herpes simplex)

Herpes labialis (cold sore) is an infection caused by the herpes simplex virus, characterized by an eruption of small and usually painful blisters on the skin of the lips, mouth, gums or the skin around the mouth. These blisters are commonly called cold sores or fever blisters. Herpes labialis is an extremely common disease caused by infection of the mouth area with herpes simplex virus, most often type 1. Herpes virus type 2 usually causes genital herpes and infection of babies at birth (to infected mothers), but may also cause herpes labialis.

Warning symptoms of itching, burning, increased sensitivity, or tingling sensation may occur about 2 days before lesions appear:

  • Skin lesions or rash around the lips, mouth, and gums
  • Small blisters (vesicles) filled with clear yellowish fluid
  • Mild fever (may occur)

Herpes genital (genital Herpes simplex)

Genital herpes is a sexually transmitted viral infection that is characterized by repeated eruptions of small, painful blisters on the genitals, around the rectum, or covering adjacent areas of skin. HSV-1 can cause genital herpes through transmission during oral-genital sex, thus both strains of the virus may be transmitted by sexual contact. Initial oral herpes infection, however, usually occurs in childhood. It is therefore not classified as a sexually transmitted disease. HSV-1 is responsible for only 5-10% of genital herpes cases, while HSV-2 causes the majority of genital herpes cases. HSV-2 can be transmitted through oral or genital secretions.

Prior to the appearance of blisters, the infected individual may experience increased skin sensitivity, tingling, burning, itching, or pain at the site where the blisters will appear. The skin may redden, and then erupt with multiple small blisters (vesicles) filled with clear, straw-colored fluid. The blisters then break, resulting in shallow ulcers that are very painful. These ulcers eventually crust over and slowly heal over a period of 7 to 14 days.

The infection may reactivate at any time, at which point the individual once again develops painful blistering over the genitals, anus, inner thigh, or mouth. A variety of events may trigger latent infection to become active, including mechanical irritation, stress, menstruation, and fatigue.

Herpes Treatment and Therapy

There is no treatment to cure herpes. However, there are medications that can help keep the virus in check. The Food and Drug Administration (FDA) approved three prescription medicines for herpes treatment.

  • Acyclovir (Zovirax) has been used for over 10 years and is available in generic form.
  • Valacyclovir (Valtrex) uses acyclovir as its active ingredient, is better absorbed by the body and can be taken less often.
  • Famciclovir (Famvir) is similar to acyclovir and is also better absorbed and can be taken less often.

Clinical studies have not found any major difference in effectiveness of these three drugs. Their main difference is in how often the drug must be taken. Acyclovir, valacyclovir and famciclovir are available in capsules or tablets. Acyclovir and famciclovir are available in cream for use in oral herpes cases. Topical creams are not recommended for genital herpes.

Episodic therapy
Episodic therapy means taking the medication only during an outbreak to speed healing. Your doctor will prescribe treatment to take at the first sign of prodrome and continue treatment for five days. For first episodes, the healing time can be dramatically reduced. For recurrences, the outbreak can be shortened by about two days. Episodic therapy has been shown to help stop some outbreaks from becoming full-blown if the medication was started when tingling, itching or burning was noticed, just before blisters or sores appeared.

Suppressive, or continuous, therapy
Suppressive therapy means taking an antiviral medication daily as a preventative - to keep HSV in check, reduce flare ups and lessen symptoms. Suppressive therapy can lower the number of outbreaks and, for some, prevent them altogether. This therapy also reduces asymptomatic shedding, and research studies are determining whether on-going antiviral medication can help prevent transmission.

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