Herpes simplex recurrence: Difference between revisions
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==Overview== | ==Overview== | ||
Genital herpes can cause recurrent painful genital sores in many adults, and herpes infection can be severe in patients with suppressed immune | [[Genital herpes]] can cause recurrent painful [[Sore|genital sores]] in many adults, and herpes infection can be severe in patients with suppressed [[immune system]]s. 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== | ==HSV Latency== | ||
*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 [[Soma (biology)|cell body]]. | *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 helix|double-stranded DNA]] of the [[virus]] is incorporated into the cell physiology by [[infection]] of the [[cell nucleus]] of a nerve's [[Soma (biology)|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).<ref name="pmid12409612">{{cite journal |author=Stumpf MP, Laidlaw Z, Jansen VA |title=Herpes viruses hedge their bets |journal=Proc. Natl. Acad. Sci. U.S.A. |volume=99 |issue=23 |pages=15234–7 |year=2002 |pmid=12409612 |doi=10.1073/pnas.232546899}}</ref> | *HSV latency is static, during which no [[virus]] is produced and is controlled by a number of viral genes including Latency Associated Transcript (LAT).<ref name="pmid12409612">{{cite journal |author=Stumpf MP, Laidlaw Z, Jansen VA |title=Herpes viruses hedge their bets |journal=Proc. Natl. Acad. Sci. U.S.A. |volume=99 |issue=23 |pages=15234–7 |year=2002 |pmid=12409612 |doi=10.1073/pnas.232546899}}</ref> | ||
==Triggers for HSV Reactivation== | ==Triggers for HSV Reactivation== | ||
The causes of reactivation from latency are uncertain but several potential triggers have been documented. | 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.<ref name="pmid11359358">{{cite journal |author=Sainz B, Loutsch JM, Marquart ME, Hill JM |title=Stress-associated immunomodulation and herpes simplex virus infections |journal=Med. Hypotheses |volume=56 |issue=3 |pages=348–56 |year=2001 |pmid=11359358 |doi=10.1054/mehy.2000.1219}}</ref> | *Physical or [[psychological stress]] can trigger an outbreak of [[herpes]].<ref name="pmid11359358">{{cite journal |author=Sainz B, Loutsch JM, Marquart ME, Hill JM |title=Stress-associated immunomodulation and herpes simplex virus infections |journal=Med. Hypotheses |volume=56 |issue=3 |pages=348–56 |year=2001 |pmid=11359358 |doi=10.1054/mehy.2000.1219}}</ref> | ||
*Local injury to the face, lips, eyes or mouth, trauma, surgery, wind, [[radiotherapy]], [[ultraviolet light]] or sunlight are well established triggers.<ref name="pmid18083428">{{cite journal |author=Chambers A, Perry M |title=Salivary mediated autoinoculation of herpes simplex virus on the face in the absence of "cold sores," after trauma |journal=J. Oral Maxillofac. Surg. |volume=66 |issue=1 |pages=136–8 |year=2008 |pmid=18083428 |doi=10.1016/j.joms.2006.07.019}}</ref><ref name="pmid2821086">{{cite journal |author=Perna JJ, Mannix ML, Rooney JF, Notkins AL, Straus SE |title=Reactivation of latent herpes simplex virus infection by ultraviolet light: a human model |journal=J. Am. Acad. Dermatol. |volume=17 |issue=3 |pages=473–8 |year=1987 |pmid=2821086 |doi=}}</ref><ref name="pmid1323616">{{cite journal |author=Rooney JF, Straus SE, Mannix ML, ''et al'' |title=UV light-induced reactivation of herpes simplex virus type 2 and prevention by acyclovir |journal=J. Infect. Dis. |volume=166 |issue=3 |pages=500–6 |year=1992 |pmid=1323616 |doi=}}</ref><ref name="pmid9377190">{{cite journal |author=Oakley C, Epstein JB, Sherlock CH |title=Reactivation of oral herpes simplex virus: implications for clinical management of herpes simplex virus recurrence during radiotherapy |journal=Oral Surg Oral Med Oral Pathol Oral Radiol Endod |volume=84 |issue=3 |pages=272–8 |year=1997 |pmid=9377190 |doi=}}</ref><ref name="pmid15603217">{{cite journal |author=Ichihashi M, Nagai H, Matsunaga K |title=Sunlight is an important causative factor of recurrent herpes simplex |journal=Cutis |volume=74 |issue=5 Suppl |pages=14–8 |year=2004 |pmid=15603217 |doi=}}</ref> | *Local injury to the face, lips, eyes or mouth, trauma, surgery, wind, [[radiotherapy]], [[ultraviolet light]] or sunlight are well established triggers.<ref name="pmid18083428">{{cite journal |author=Chambers A, Perry M |title=Salivary mediated autoinoculation of herpes simplex virus on the face in the absence of "cold sores," after trauma |journal=J. Oral Maxillofac. Surg. |volume=66 |issue=1 |pages=136–8 |year=2008 |pmid=18083428 |doi=10.1016/j.joms.2006.07.019}}</ref><ref name="pmid2821086">{{cite journal |author=Perna JJ, Mannix ML, Rooney JF, Notkins AL, Straus SE |title=Reactivation of latent herpes simplex virus infection by ultraviolet light: a human model |journal=J. Am. Acad. Dermatol. |volume=17 |issue=3 |pages=473–8 |year=1987 |pmid=2821086 |doi=}}</ref><ref name="pmid1323616">{{cite journal |author=Rooney JF, Straus SE, Mannix ML, ''et al'' |title=UV light-induced reactivation of herpes simplex virus type 2 and prevention by acyclovir |journal=J. Infect. Dis. |volume=166 |issue=3 |pages=500–6 |year=1992 |pmid=1323616 |doi=}}</ref><ref name="pmid9377190">{{cite journal |author=Oakley C, Epstein JB, Sherlock CH |title=Reactivation of oral herpes simplex virus: implications for clinical management of herpes simplex virus recurrence during radiotherapy |journal=Oral Surg Oral Med Oral Pathol Oral Radiol Endod |volume=84 |issue=3 |pages=272–8 |year=1997 |pmid=9377190 |doi=}}</ref><ref name="pmid15603217">{{cite journal |author=Ichihashi M, Nagai H, Matsunaga K |title=Sunlight is an important causative factor of recurrent herpes simplex |journal=Cutis |volume=74 |issue=5 Suppl |pages=14–8 |year=2004 |pmid=15603217 |doi=}}</ref> | ||
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*Some studies suggest changes in the immune system during [[menstruation]] may play a role in HSV-1 reactivation.<ref name="pmid11022124">{{cite journal |author=Myśliwska J, Trzonkowski P, Bryl E, Lukaszuk K, Myśliwski A |title=Lower interleukin-2 and higher serum tumor necrosis factor-a levels are associated with perimenstrual, recurrent, facial Herpes simplex infection in young women |journal=Eur. Cytokine Netw. |volume=11 |issue=3 |pages=397–406 |year=2000 |pmid=11022124 |doi=}}</ref><ref name="pmid4526372">{{cite journal |author=Segal AL, Katcher AH, Brightman VJ, Miller MF |title=Recurrent herpes labialis, recurrent aphthous ulcers, and the menstrual cycle |journal=J. Dent. Res. |volume=53 |issue=4 |pages=797–803 |year=1974 |pmid=4526372 |doi=}}</ref> | *Some studies suggest changes in the immune system during [[menstruation]] may play a role in HSV-1 reactivation.<ref name="pmid11022124">{{cite journal |author=Myśliwska J, Trzonkowski P, Bryl E, Lukaszuk K, Myśliwski A |title=Lower interleukin-2 and higher serum tumor necrosis factor-a levels are associated with perimenstrual, recurrent, facial Herpes simplex infection in young women |journal=Eur. Cytokine Netw. |volume=11 |issue=3 |pages=397–406 |year=2000 |pmid=11022124 |doi=}}</ref><ref name="pmid4526372">{{cite journal |author=Segal AL, Katcher AH, Brightman VJ, Miller MF |title=Recurrent herpes labialis, recurrent aphthous ulcers, and the menstrual cycle |journal=J. Dent. Res. |volume=53 |issue=4 |pages=797–803 |year=1974 |pmid=4526372 |doi=}}</ref> | ||
*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" | *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== | ==Frequency and Severity of Recurrence== | ||
*The frequency and severity of recurrent outbreaks may vary greatly depending upon the individual. | *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. | *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 [[Herpes simplex anogenital infection|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. | *In the case of a [[Herpes simplex anogenital infection|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. | *Immunocompromised individuals may experience episodes that are longer, more frequent, and more severe. | ||
==Treatment== | ==Treatment== | ||
===Medical Therapy=== | ===Medical Therapy=== | ||
*Saline bathing, | *Saline bathing, [[vaseline]], [[analgesia]], 5% [[Lidocaine/Prilocaine (topical)|lidocaine]] ointment may be generally advised. | ||
*[[Herpes simplex genitalis antiviral treatment of recurrent genital herpes|Antiviral medication]] has been proven to shorten the duration and/or frequency of the outbreaks.<ref name="pmid18192785">{{cite journal |author=Martinez V, Caumes E, Chosidow O |title=Treatment to prevent recurrent genital herpes |journal=Curr Opin Infect Dis |volume=21 |issue=1 |pages=42–48 |year=2008 |pmid=18192785 |doi=10.1097/QCO.0b013e3282f3d9d3}}</ref> | *[[Herpes simplex genitalis antiviral treatment of recurrent genital herpes|Antiviral medication]] has been proven to shorten the duration and/or frequency of the outbreaks.<ref name="pmid18192785">{{cite journal |author=Martinez V, Caumes E, Chosidow O |title=Treatment to prevent recurrent genital herpes |journal=Curr Opin Infect Dis |volume=21 |issue=1 |pages=42–48 |year=2008 |pmid=18192785 |doi=10.1097/QCO.0b013e3282f3d9d3}}</ref> | ||
*You can read more in detail about the episodic and suppressive antiviral treatment for the management of HSV recurrence '''[[Herpes simplex genitalis antiviral treatment of recurrent genital herpes|here]]''' | *You can read more in detail about the episodic and suppressive antiviral treatment for the management of [[HSV]] recurrence '''[[Herpes simplex genitalis antiviral treatment of recurrent genital herpes|here.]]''' | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
{{WH}} | |||
{{WS}} | |||
[[Category:Sexually transmitted diseases]] | |||
[[Category:Viral diseases]] | |||
[[Category:Gynecology]] | |||
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[[Category:Disease]] | [[Category:Disease]] | ||
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[[Category:Infectious disease]] | [[Category:Infectious disease]] | ||
[[Category: | [[Category:Otolaryngology]] | ||
[[Category:Urology]] | |||
Latest revision as of 22:09, 29 July 2020
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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
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
- 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
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
- 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
Medical Therapy
- 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
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.