Herpes simplex recurrence

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:  Cafer Zorkun, M.D., Ph.D. [2], Lakshmi Gopalakrishnan, M.B.B.S.

## Overview[edit | edit source]

Genital herpes can cause recurrent painful genital sores in many adults, and herpes infection can be severe in patients with suppressed immune systems. It is important that women avoid contracting herpes during pregnancy because a newly acquired infection during late pregnancy poses an increased risk of transmission to the baby. If a woman has active genital herpes at delivery, a cesarean delivery is usually indicated. Patients infected with herpes are more susceptible to HIV infection; hence, herpes may indirectly play a role in the spread of HIV.

## HSV Latency[edit | edit source]

* Following active infection, herpes viruses become quiescent to establish a latent infection in sensory and autonomic ganglia of the nervous system. The double-stranded DNA of the virus is incorporated into the cell physiology by infection of the cell nucleus of a nerve's cell body.

* HSV latency is static, during which no virus is produced and is controlled by a number of viral genes including Latency Associated Transcript (LAT).[1]

## Triggers for HSV Reactivation[edit | edit source]

The causes of reactivation from latency are uncertain but several potential triggers have been documented.

* Physical or psychological stress can trigger an outbreak of herpes.[2]

* Local injury to the face, lips, eyes or mouth, trauma, surgery, wind, radiotherapy, ultraviolet light or sunlight are well established triggers.[3][4][5][6][7]

* Some studies suggest changes in the immune system during menstruation may play a role in HSV-1 reactivation.[8][9]

* In addition, concurrent infections such as viral upper respiratory tract infection or other febrile diseases, can cause outbreaks, hence the historic terms "cold sore" and "fever blister."

## Frequency and Severity of Recurrence[edit | edit source]

* The frequency and severity of recurrent outbreaks may vary greatly depending upon the individual.

* Outbreaks may occur at the original site of the infection or in close proximity to nerve endings that reach out from the infected ganglia.

* In the case of a genital infection, sores can appear near the base of the spine, the buttocks, back of the thighs, or they may appear at the original site of infection.

* Immunocompromised individuals may experience episodes that are longer, more frequent, and more severe.

## Treatment[edit | edit source]

### Medical Therapy[edit | edit source]

* Saline bathing, vaseline, analgesia, 5% lidocaine ointment may be generally advised.

* Antiviral medication has been proven to shorten the duration and/or frequency of the outbreaks.[10]

* You can read more in detail about the episodic and suppressive antiviral treatment for the management of HSV recurrence here.

## References[edit | edit source]

1. ↑ Stumpf MP, Laidlaw Z, Jansen VA (2002). "Herpes viruses hedge their bets". Proc. Natl. Acad. Sci. U.S.A. 99 (23): 15234–7. doi:10.1073/pnas.232546899. PMID 12409612.CS1 maint: Multiple names: authors list (link)
2. ↑ Sainz B, Loutsch JM, Marquart ME, Hill JM (2001). "Stress-associated immunomodulation and herpes simplex virus infections". Med. Hypotheses. 56 (3): 348–56. doi:10.1054/mehy.2000.1219. PMID 11359358.CS1 maint: Multiple names: authors list (link)
3. ↑ Chambers A, Perry M (2008). "Salivary mediated autoinoculation of herpes simplex virus on the face in the absence of "cold sores," after trauma". J. Oral Maxillofac. Surg. 66 (1): 136–8. doi:10.1016/j.joms.2006.07.019. PMID 18083428.
4. ↑ Perna JJ, Mannix ML, Rooney JF, Notkins AL, Straus SE (1987). "Reactivation of latent herpes simplex virus infection by ultraviolet light: a human model". J. Am. Acad. Dermatol. 17 (3): 473–8. PMID 2821086.CS1 maint: Multiple names: authors list (link)
5. ↑ Rooney JF, Straus SE, Mannix ML; et al. (1992). "UV light-induced reactivation of herpes simplex virus type 2 and prevention by acyclovir". J. Infect. Dis. 166 (3): 500–6. PMID 1323616.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
6. ↑ Oakley C, Epstein JB, Sherlock CH (1997). "Reactivation of oral herpes simplex virus: implications for clinical management of herpes simplex virus recurrence during radiotherapy". Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 84 (3): 272–8. PMID 9377190.CS1 maint: Multiple names: authors list (link)
7. ↑ Ichihashi M, Nagai H, Matsunaga K (2004). "Sunlight is an important causative factor of recurrent herpes simplex". Cutis. 74 (5 Suppl): 14–8. PMID 15603217.CS1 maint: Multiple names: authors list (link)
8. ↑ Myśliwska J, Trzonkowski P, Bryl E, Lukaszuk K, Myśliwski A (2000). "Lower interleukin-2 and higher serum tumor necrosis factor-a levels are associated with perimenstrual, recurrent, facial Herpes simplex infection in young women". Eur. Cytokine Netw. 11 (3): 397–406. PMID 11022124.CS1 maint: Multiple names: authors list (link)
9. ↑ Segal AL, Katcher AH, Brightman VJ, Miller MF (1974). "Recurrent herpes labialis, recurrent aphthous ulcers, and the menstrual cycle". J. Dent. Res. 53 (4): 797–803. PMID 4526372.CS1 maint: Multiple names: authors list (link)
10. ↑ Martinez V, Caumes E, Chosidow O (2008). "Treatment to prevent recurrent genital herpes". Curr Opin Infect Dis. 21 (1): 42–48. doi:10.1097/QCO.0b013e3282f3d9d3. PMID 18192785.CS1 maint: Multiple names: authors list (link)

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