Quick Guide to the Herpes simplex Virus

We understand that the subject of Herpes viral infections is at times confusing, consequently here is a short guide which simplifies some Herpes simplex viral knowledge.

What Everyone Should Know about the Herpes simplex virus

Herpes simplex virus


Herpes simplex virus – Transmission Electron Microscope image – Courtesy CDC

Research has provided some insight into the mechanism of action of the Herpes simplex virus (either HSV-1 or HSV-2). HSV-1 usually refers to the oral form of herpes, commonly associated with cold sores. HSV-2 normally refers to the herpes virus variant that causes genital herpes. A transmission electron micrograph of HSV-1 is pictured to the right. Herpes simplex is a double stranded, linear DNA genome within an icosahedral-shaped glycoprotein cage.

The word “Herpes” derives from the Greek ‘herpês’ meaning latent or “creeping.” This is Herpes in a nutshell. In the active phase of herpes, the virus travels along sensory nerve axons, to the nerve terminals in the skin, where viral particles are released. This is typically seen as a cold sore or blister in oral herpes, or a similar sore in the genital area, if the viral infection is caused by HSV-2. It then becomes latent by hiding in nerve cells after the initial phase of infection, characterized by lesions or blisters on the skin.

What does Herpes Look Like?

Oral Herpes


Oral Herpes – Courtesy CDC

In the picture at the right, we see a typical manifestion of HSV-1, commonly called a ‘cold sore.’ The correct terminology is ‘Herpes labialis.’ Sometimes, oral herpes can manifest as ‘Herpes gingivostomatitis’ which is a herpes infection in the gums. Symptoms are more severe than a cold sore. If either HSV-1 or HSV-2 manifests in the genital area, one has a case of ‘Herpes genitalis’ which is defined by painful clusters of inflamed lesions on the outer surface of the genitals. Lastly, shown below is a picture of Herpes outbreak on the fingers or thumbs. This is referred to as ‘Herpetic whitlow.’

Herpes can lead to Encephalitis and Psychological Problems

Herpes simplex virus types 1 and 2 (HSV-1 and HSV-2) are the principal agents of recurring facial and genital herpes lesions – HSV-1 causing facial herpes and HSV-2 causing genital lesions.  HSV-2 infections should be seen as sexually transmitted disease (STD), also infections can lead to short term painful blisters, and significant psychological trauma.  Herpes infections are additionally a major cause of encephalitis — a  rarer but very serious disease.

Herpes zoster (“Shingles”)

Varicella zoster virus (VZV) is the causative agent of chicken pox and shingles. It is also a double-stranded DNA virus, but with subtle differences with Herpes simplex virus. Shingles is seen mainly in the very old, or in immune compromised individuals. After an initial infection with chicken pox, often at a young age, and a long latent period, some individuals manifest a recurrence of VZV, seen as a shingles outbreak.

Statistics on Herpes simplex Incidence

In the chart shown below, you can see the alarming rise in incidence of HSV-2, seen over the past several decades. Genital herpes rates have tripled in the last several decades.

Genital Herpes - U.S. Initial Visits to Physicians' Offices


Genital Herpes – U.S. Initial Visits to Physicians’ Offices – Courtesy CDC

Incredibly, worldwide incidence of HSV-1 and HSV-2, combined, has been estimated to fall between 60-95% of the adult population. Prevalence of HSV-2 (genital herpes) in the age group 15-50 years was estimated at 535 million, worldwide, in 2003. This means about 16% of the adult population has genital herpes. Women have slightly greater rates of incidence of genital herpes than men.

U.S. statistics mirror the worldwide Herpes simplex incidence, with 50% of the population infected with HSV-1 and 16% infected with HSV-2.

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Transmission of Herpes

Oral herpes is transmitted by direct contact with a lesion or body fluid of an infected individual. The actual transmission of HSV is by travelling through tiny openings in the skin or via mucous mouth membranes.

Due to the nature of transmission of genital herpes, an infected individual can transmit genital herpes to their sexual partner by direct skin-to-skin contact, without either one knowing they are infected. This is because HSV-2 can be transmitted even when there is “subclinical shedding.”

Treatment of HSV

Some history is needed here. As long as 2,000 years ago, Roman civilization was beset with an epidemic of cold sores, which we now know as herpes. In the 18th century, cold sores were considered an occupational hazard for prostitutes. Only in the 1940′s was it discovered that Herpes is a virus. Then, acyclovir ( Zovirax™ ) came to prominence as an anti-viral drug in the late 1970′s, as a result of much research. In 1998 the FDA gave its blessing to acyclovir as the anti-Herpes drug of choice. valacyclovir and famciclovir are closely related anti-viral drugs also prescribed frequently by physicians.

Some Important Conclusions about Herpes simplex Virus

There is no cure for herpes, but medication is available to reduce symptoms and make it less likely that you will spread herpes to an uninfected individual

 

Most infected individuals with genital herpes infection do not even know they have it.

 

 

You can get genital herpes from an infected partner, even if your partner has no herpes symptoms. The technical term for this is ‘subclinical shedding.’