Cold Sore Herpes Simplex Infections

Herpes simplex infections are caused by a herpes simplex virus. This virusis most likely to attack the skin and nervous system. The infection is temporary, usuallylasting 1 to 3 weeks. It causes small, irritating, and often painful blisters on the skinand mucous membranes. These blisters become fluid-filled and eventually crust overas healing starts. They are most often found on or around the mouth and nose, the eyes, and in thegenital region.

What is going on in the body?

Humans are the only known source of herpes simplex viruses. Theinfection is spread by close physical contact and can be passed from mother to infantduring pregnancy or childbirth. The infection is chronic and can reactivate throughout life.

This type of infection is caused by two types of herpes simplex virus.Herpes simplex virus-1, also called HSV-1, is an infection that tends to appear in thefacial area, most often around the nose and mouth. Herpes simplex virus-2, also calledHSV-2, tends to appear in the genital region. HSV-2 infections are usuallyspread sexually. Symptoms of infection with HSV include burning, itching, tingling, andpain at the site of infection, along with blisters filled with fluid. The affected individual may also have a lowfever and enlarged lymph nodes in the neck.

Most people first get HSV-1 during childhood. It causes blisters around themouth and nose. Although the infection clears up within 2 to 3 weeks, the inactive virusremains in the body forever. Reactivation of HSV-1 later in life often causes cold sores inthe same areas.

Adults or young adults generally contract HSV-2 through sexual contact.HSV-2 causes painful ulcers in the genital region. Sometimes HSV-2 infection isassociated with mild cases of meningitis,which is an inflammation of the brain and spinal cord. For both HSV-1 and HSV-2,reactivation takes the form of single ulcers at the site of the original infection.

The eyes can also be a site of HSV infection. Eye infections can vary inseverity. The person should get treatment for them as soon as possible to avoid complications. An HSVinfection can also occur on the finger. This is called a herpetic whitlow, and it oftenresults from touching an ulcer at some other site.

Infants can acquire HSV-1 or HSV-2 from their mothers during pregnancy orchildbirth. This usually happens when the mother has HSV for the first time.HSV infection in newborn babies is a serious matter. It can result in thedeath of the infant or brain damage even when the infant is treated appropriately.Infection in someone with a weakened or damaged immune system can also besevere and may require prolonged treatment.

Many outbreaks occur without any obvious reason. However, the followingfactors may trigger a recurrence:

• dental work
• emotional stress
• exposure to sunlight
• fatigue
• an upper respiratory infection, such as a cold or flu

What are the causes and risks of the infection?

Causes of this infection include:

• being born to a mother who has a first-time HSV infection
• close contact with an infected person

People in the following categories may be more at risk for herpes simplex infection:

• people undergoing radiation therapyor chemotherapy
• people with cancer or other debilitating diseases
• people with HIV or other immunodeficiency disorders

What are the signs and symptoms of the condition?

Someone with an active herpes infection may have the following symptoms:

• difficulty eating
• fatigue
• malaise, which is a vague feeling of illness
• mild fever
• sore throat
• swelling and redness, usually both before and during an outbreak
• tiny blisters that grow into larger sores in the mouth, on the tongue, on the lips, orin the genital region

How is the infection diagnosed?

A doctor can take a swab of the infected secretions from the mouth,nose, or genital sores. Then he or she sends it to a lab where techs test it for HSV.This is called a culture, and HSV can be detected rapidly in infected specimens byusing special stains. The doctor will also evaluate the person’s symptoms and ask aboutrecent exposure to someone who has or had a herpes simplex infection.

What can be done to prevent the infection?

The herpes simplex virus can be passed from person to person. Someonewith oral herpes should not share lipstick, utensils, or drinks with others. Touching andkissing can also spread the virus. Someone with genital herpes should usecondomsduring sexual activity to help prevent the spread of the infection. People who haveimmune system problems or who have frequent recurrences often take antiviral drugs,such as acyclovirand valacyclovir,to help prevent reactivation. A doctor who specializes in the condition should monitor apregnancy complicated by HSV infection.

What are the long-term effects of the infection?

Most infections clear up in 3 weeks or less. But the infection is chronicbecause the virus stays in the body forever. So, it may come back over andover throughout the rest of the individual’s life. Infection in newborn babies and people whose immunesystems are not working well can result in brain damage or death.

What are the risks to others?

Herpes infections are highly contagious and can be passed from oneperson to another much like a coldor the flu. Good hand washing,wearing gloves, and avoiding direct contact can all help prevent the spread to others.

What are the treatments for the infection?

In most cases, herpes simplex blisters on the face are self-limiting. Theywill usually crust over and go away in about 2 weeks. If they last longer, a doctor should be consulted. Treatment for oral herpes includes the following:

• diluted, or 1 1/2%, hydrogen peroxide mouth rinse
• lip balm to soothe sores on the lips
• penciclovir cream
• prescription antiviral medicines, such as acyclovir,valacyclovir, andfamciclovir
• salt-water rinse, with 1/2 teaspoon salt in 8 ounces of warm water
• sunblock cream for lip protection

Acycloviris used to treat HSV in newborn babies and people with genital herpes who have faulty immune systems.Acycloviror its relative, valacyclovir,can also be used to treat HSV in otherwise healthy people. Other treatment is aimed atpreventing secondary infection and relieving symptoms.

What are the side effects of the treatments?

Antiviral medicines may cause nausea, vomiting, diarrhea, andallergic reactions. Creamsand ointments may cause an allergic reactionin some individuals.

What happens after treatment for the infection?

Some people will have frequent recurrences of HSV. They sometimesbenefit from taking acycloviras a preventive measure.

How is the condition monitored?

Any new or worsening symptoms should be reported to a healthcare provider.