Written by Dr. Ringpfeil

Herpes simplex

Synonyms: cold sores, fever blisters, herpes simplex

Oral Herpes

The initial infection (primary stage) of oral herpes is generally asymptomatic and is acquired through person-to-person contact such as kissing. The virus then lies dormant in a nerve root. Reactivation of the virus may be caused by a number of events such as a fever, intense sunlight, intense cold, or stress.

In the active (secondary) stage, individuals with oral herpes have "cold sores" around the mouth or on the face that may become painful ulcers. The early period immediately before the outbreak is referred to as the prodromal period and from this time to the end of the outbreak, the virus can be transmitted to another person by direct contact.

Genital Herpes

The stages of genital herpes are very similar to oral herpes with an initial stage that manifests with few symptoms and is less contagious. The secondary stage, which can occur unpredictably but is usually mediated by stress or sickness, shows lesions on the vulva or penis.

The lesions are often painful and itchy may also be accompanied by difficulty urinating, lymph node enlargement with tenderness, and puss-like discharge. The herpes virus is most contagious during the active periods but can spread immediately before the outbreak occurs.

For both genital and oral herpes, the dormancy period involves the virus "resting" within the nervous tissue around the initially infected area.

Diagnosis

Herpes is commonly diagnosed based upon the symptoms described above paired with frequent recurrence in the same area. Rapid tests have been developed to detect antibodies to the herpes virus. Positive results reveal that you have been exposed to HSV1 or HSV2 in the past.

However, 90% of inner-city populations carry HSV1 antibodies and about 35% carry HSV2. The presence of antibodies does not diagnose a current outbreak. In some instances, samples of representative lesions are taken and tested for the presence of the HSV1 or HSV2 virus.

Management

Once diagnosed with herpes, managing the disease includes caring for sores during outbreaks as well as preventing their recurrence. Several medications and dietary guidelines are outlined below as well as advice on how to prevent the spread of the disease.

Treatment and Medication

While there is no cure for herpes, a few medications are available for control. Famvir™, Valtrex™, and Acyclovir are currently used to treat and prevent cold sores and genital herpes. None of these drugs cure the disease but all help alleviate or prevent symptoms. In addition to medication, you should keep lesions as dry as possible to speed healing.

Your diet can also play an important role since the amino acid lysine, found in fish, chicken, beef, lamb, milk, cheese, and beans, has been shown to reduce the recurrence of outbreaks. Some people feel that they can stop outbreaks by daily lysine supplementation. Condoms help prevent the spread of herpes among individuals.

Coping

Remember, if you have been infected with herpes, you are not alone. The disease affects many people who live normal lives. Especially with genital herpes, the ulcers are concealed and do not affect any daily activities. Open communication with partners is important so that both of you can practice safe intercourse. In the middle of an outbreak, you should avoid contact, and medications can mitigate symptoms.

Support Groups and References

Since genital and oral herpes is extremely common in the United States, with an estimate of 45 million people or one out of every five infected, there are many places to turn for support.

The website: http://www.herpes.com contains more information regarding the disease. A list of support groups organized by state is found on http://www.herpes.com/supportgroups.shtml. The Center for Disease control also contains information on herpes and other genital diseases at http://www.cdc.gov/std/herpes. If you think you have genital herpes speak to your physician about treatment options.