Philippine Dermatological Society

A Closer Look at Herpes Simplex Infection

Heirich Fevrier P. Manalili, RPh MD, DPDS

What is herpes simplex?

Herpes simplex is a viral infection caused by the herpes simplex virus (HSV), a type of DNA virus. It can be classified into two, namely: HSV 1 associated with oral infections, while the HSV 2 causes mainly genital infections, but in recent times, each type can infect any site.

How does the herpes simplex infection spread throughout the body?

They cause infection through their entry to the nerve endings in the skin directly below the lesions and go up to the dorsal root ganglia, where they remain in a latent stage (stage without any symptoms) until they are reactivated by factors such as extreme heat, manipulation, or a state of immunosuppression. The pain felt by the patient is because of the inflammation of the nerves upon reactivation.

What is the clinical course of the herpes simplex infection?

Herpes simplex virus infections have a wide range of clinical presentations, and even asymptomatic infection may occur. Symptoms of the herpes simplex infection may occur from three to seven days after contact (either from respiratory droplets or direct contact). Initial symptoms (prodrome) include the following: low-grade fever, headache, body pains, inflamed lymph nodes and localized pain may occur before the onset of mucus membrane and skin lesions which may be preceded by localized pain, tenderness upon contact, burning and tingling. Lesions on the skin will start to show as grouped vesicles (fluid-filled elevated lesion smaller than one centimeter with thin wall and usually contains either clear, serous or blood) with surrounding redness. The areas commonly affected include the following: border of lips and inner lining of the cheeks (termed gingivostomatitis), genital organs, buttocks, fingertips (termed herpetic whitlow), and trunk. Lesions then can evolve to form pustules (elevated lesion containing pus), and ulcer with characteristic border. Crusting of lesions and resolution of lesions typically occurs within two to six weeks. Patients will have some difficulty to eat when vesicles are inside the mouth or even have a difficulty in urinating when the genital organs are involved.

What is the clinical course of the herpes simplex infection?

Recurrences occur in 30–50% of cases of oral herpes, but are more frequent after genital herpes infection, developing in 95% of those with HSV type 2 compared with 50% in individuals with type 1 infection. Recurrences may be triggered by minor trauma, or by infections including febrile illnesses, ultraviolet radiation, surgery, or even procedures such as dermabrasion or laser resurfacing. Recurrent infections differ from primary infections in the smaller size of the vesicles and their close grouping, and in the usual absence of constitutional symptoms.

How can I make sure that my fluid-filled rash is really herpes simplex?

Diagnosis is usually clinical. There may also be other diagnosis that will present as fluid-filled vesicles. Consult your board-certified dermatologist for a thorough evaluation and accurate diagnosis.

What are the treatment goals in the management of herpes simplex?

Consult your board-certified dermatologist for the right treatment. Goals of therapy in herpes simplex include: (1) decrease replication of virus thus decreasing the duration of the disease, (2) prevent secondary bacterial infection, (3) decrease pain, and (4) decrease further ulceration of lesions.

What possible complications may arise if herpes simplex is left untreated?

Common complications will include ulceration, and secondary bacterial infection. In the case of genital herpes, there can be erosions (shallow, moist or crusted lesion resulting from the loss of the superficial loss of the upper epidermis) can occur from the areas with mucosa causing pain during urination. There might have been cases of scarring. A rare complication noted in books include aseptic meningitis (inflammation of the lining of the brain).

What preventive measures can one do to prevent recurrence of herpes simplex?

Strategies to prevent HSV infection have proved inadequate. In genital herpes, abstinence and consult with the doctor regarding sexual practices should be taken into consideration. As of this writing, there is still no vaccine licensed to protect against acquisition of HSV (prophylactic) or to reduce the number of recurrent episodes (therapeutic).

References

  1. Cohen, J. ed. Chapter 164 Herpes Simplex. In: Kang et al. eds. Fitzpatrick’s Dermatology. 9th edition. McGraw Hill Inc; 2018. pp.3021-3035.
  2. Downing, C., Mendoza, N., Sra, K and Tyring, S. eds. Chapter 80 Human Herpesviruses. In: Bolognia, J., Schaffer, J and Cerroni, L eds. Dermatology 4th edition. Elsevier Saunders Philadelphia; 2018. pp.1400-1424.
  3. Sterling J. ed. Chapter 25 Viral Infections. In: Griffiths et al. eds. Rook’s Textbook of Dermatology. 9th edition. Wiley-Blackwell USA; 2016. pp.25.15-25.24.
  4. Schiffer, J. and Corey, L eds. Chapter 135 Herpes Simplex Virus. In: Bennett, J, Dolin, R and Blaser, M eds. Mandell, Douglas and Bennett’s Principles and Practice of Infectious Diseases. 9th edition. Elsevier Inc. Philadelphia; 2020. pp.1828-1848.
  5. Cole, S. Herpes Simplex Virus Epidemiology, Diagnosis and Treatment. Nurs Clin N Am. 2020, 55: 337-345.