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  Herpes simplex

Herpes is a contagious viral infection caused by the herpes simplex. There are two types of herpes: herpes simplex virus type 1 (HSV1) causing the cold sores or mouth sores and the herpes simplex type 2 (HSV2) causing the genital herpes. The former is described as clusters of fluid-filled blisters or vesicles around the mouth while the latter is a sexually transmitted disease that causes blisters and genital pain usually along the penile shaft, vulva, pubic area, buttocks and anus. Direct contact is the mode of transmission of both types of herpes simplex. An individual can acquire cold sores of HSV1 by kissing or sharing utensils for eating with an infected person while in cases of genital herpes or HSV2, intimate sexual contact with an infected individual can be a mode of transmitting the virus. A pregnant mother with genital herpes can infect the newborn once she delivers the baby through the infected vaginal canal. Majority of patients with herpes infection may be asymptomatic, so it is possible for a person to carry it, without being aware that they pass it on to someone else. Most of the vesicular skin lesions heal without scar formation.

Herpes simplex Skin diseases
Herpes simplex

Other uncommon forms of herpes affect the brain, newborns and eyes. These are the herpes simplex encephalitis (HSV 1); neonatal herpes simplex and ocular herpes. In herpes simplex encephalitis, the affected area is the temporal lobe of the brain and this is a very serious disease apparently caused by the retrograde transmission of the herpes simplex from a peripheral site of origin to the central nervous system. In some severe cases, hemorrhagic necrosis of the temporal lobe may occur. The main reason why there is a reactivation of the virus remains unclear and it is most commonly affecting children and middle-aged adults. Moreover, if the condition is left untreated, rapid death is expected in around 70% of cases and 20% develop long-term neurologic damage. Although neonatal herpes simplex disease is also serious disorder, it is rather a rare form of herpes simplex infection which is usually a consequence of transplacental HSV transmission from an infected mother to a newborn child. Ocular herpes (HSV-1) is another special case of herpes infection which is also known as herpes viral keratitis that affects the nerves supplying the cornea of the eye.

Cornea is a transparent structure located on the anterior aspect of the eyeball which has a very important role in the visual pathway. Ocular herpes is known to be the leading cause of infectious blindness in the developed countries but progression to visual loss may be hindered if the infection is treated early. Initial infections resolve spontaneously in a few weeks along with the use of antivirals either topical or oral for systemic infections. However, in immunocompromised states, the virus may stimulate an extensive immune-mediated response in the eye. This will result in loss of vision due to opacification of the cornea. Keratoplasty or corneal transplants may be not effective anymore in these cases because reinfection of the transplanted cornea is also common but concomitant use of antivirals will increase the chance of graft acceptance.

The following had been reported to increase the chance and severity of herpes outbreaks namely: stress, increased sun exposure, viral infections, facial injuries and arginine-rich foods (e.g. chocolate, peanuts and walnuts). In addition, some have even found out that excessive antibiotic use can limit the immune system's ability to keep the disease contained within the nerve ganglia. Even allergic reactions can also trigger an outbreak. A chronic undiagnosed low-level food allergy may be the cause of chronic herpes genitalis in some cases.

There is no specific treatment that can eradicate the virus completely from the body therefore; there is no cure for herpes infection. Prescription antiviral agents that work only by controlling herpes outbreaks include: acyclovir (Zovirax), valaciclovir (Valtrex), famciclovir (Famvir), and penciclovir. These antiviral drugs effectively slow down the replication rate of the virus hence; giving the body’s immune system a greater opportunity to intervene and fight off these microorganisms. Other medications are : Docosanol (Abreva), works by barring viral entry into the host’s cell and Zilactin that forms a "shield" preventing the sore from increasing in size and as well as preventing its spread by breakage. Over-the-counter analgesics may be given to reduce pain and fever during initial outbreaks. Other natural compounds found to have antiviral effects but under research are: Carrageenans (sulphated polysaccharides), a red seaweeds’ extract; Lactoferrin (derived from whey protein), has a synergistic effect with aciclovir against HSV in vitro; and Resveratrol (a component in red wine), shown to prevent replication of HSV in vitro by blocking a protein needed by the virus for replication.

A low dose (125 mg daily) of aspirin might give some benefits to patients with recurrent HSV infections but of limited statistical evidence. Moreover, aspirin is not recommended in persons below 18 years old with herpes simplex due to the increased risk of developing Reye's syndrome. Long-term aspirin intake may also lead to impaired blood coagulation. Other supplements with anecdotal evidence in terms of its beneficial effects include monolaurin, vitamins A, C and B12, garlic, echinacea , zinc and tea-tree oil.

Use of condoms as a physical barrier is recommended to prevent sexual transmission of herpes simplex but this is not absolutely effective. Other preventive measures suggested include: stress management, adequate sleep and nutrition, avoiding cross-infection at different sites on the body and use of a lip protectant.

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