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Herpes simplex is a viral disease caused by Herpes simplex virus 1.
This viral disease manifests in two forms:
- Primary herpes simplex
- Recurrent herpes simplex.
The primary herpes simplex occurs when the patient has been exposed to the virus for the first time. The site of the lesions depends upon the place of entry of the virus and can thus manifest as acute gingivo-stomatitis, balanitis, vulvovaginitis, proctitis or keratoconjunctivitis.
The lesions consist of multiple, small, superficial ulcers with severe inflammation in the region and acute pain. Sometimes, general symptoms such as malaise, fatigue and fever may also accompany. The lesions persist for one or two weeks and then subside spontaneously unless there is secondary infection with pyogenic organisms.
Rarely, the infection can spread to the brain and manifest as encephalitis which can be fatal. In case a pregnant lady develops herpes simplex infection, the infection can get transmitted to the child even before childbirth or during childbirth leading to neonatal herpes simplex.
Primary herpes simplex infection is generally mis-diagnosed and missed frequently.
Recurrent Herpes Simplex
Following the primary infection, the virus gets lodged in the neural ganglion and remains dormant.
Under certain circumstances however, the virus gets reactivated and produces signs and symptoms of recurrent herpes simplex. This is generally milder than the primary disease, but keeps recurring at intervals varying from seven to ten days to even a year or so. These intervals vary from individual to individual and also from one attack to the other.
The clinical manifestations of recurrent herpes simplex consist of multiple, small vesicles or superficial ulcerated lesions associated with burning sensations. These lesions are usually situated on the muco-cutaneous junctions such as around the mouth and the nose or the genitals, but occasionally these may be located on the hands or other skin areas.
Labial herpes is generally caused by the virus HSV1 which is immunologically different from the virus HSV2 which causes genital herpes.
Genital herpes is transmitted by sexual contact.
Patients with immuno-suppresion can have a disseminated disease. If a patient having lesions of another skin disease especially atopic dermatitis, contact dermatitis etc. gets exposed to herpes simplex virus, it can lead to a widespread vesicular eruption.
Treatment
The ulcers as a rule, heal by themselves within a week’s time, but local applications of an astringent lotion may accelerate the healing process.
Anti-bacterial drugs may be applied topically but use of steroids has to be particularly avoided.
The main problem in the treatment of herpes simplex is the prevention of recurrences, for which so far, no specific remedy is available.
Acyclovir 200 mg tablets and 2% ointment is effective if used early enough. The the course of the clinical lesions can be shortened but this treatment does not prevent the next recurrence. . The oral dose consists of one tablet five times a day, while the ointment can be applied three to four times a day.