Herpes
Medical Guides

Herpes: every truth you need to know about it

Infection with the herpes virus is for life. Occasionally, the virus may erupt and cause sores on the lips and genitals. It is possible to recover without treatment, but drugs shorten the suffering

Herpes is the name of a family of viruses, the most common of which is herpes type 1, which mainly causes a disease that manifests itself in vesicular lesions on the lips.

All viruses in the herpes family share a common feature: their ability to be latent, that is, their ability to “sleep” inside the body and “flare up” from time to time.

There is no way to predict which of the infected will suffer from repeated events and who will not. Mental or physical stress, heat illness and exposure to the sun, dryness and cold may be a catalyst for an outbreak.

What is herpes?

The term “herpes” refers to a family of viruses, the most prevalent (and best-known) of which is Type 1, which mostly causes a condition that shows up as vesicular sores on the lips (Labial Herpes).

Other members of this family are Type 2, which mainly causes the disease of vesicular lesions on the genitals (Genital Herpes), the varicella-zoster virus, which causes chicken pox and shingles . Both the EBV virus (which causes the kissing disease ) and the CMV virus (which can harm fetus) belong to this family. 

What is special about this family?

All viruses in this family share a common feature: their ability to be latent, that is, their ability to “sleep” inside the body and “flare up” from time to time.

This is the reason for the repeated occurrences of herpes on the lips or herpes on the genitals, and this is why shingles may appear many years after an outbreak of chicken pox (it is the same virus).

That is, there is really no way to get rid of the virus after getting it, just hope that it will “fall asleep” for a long time. And that is indeed what usually happens.

H1: where does it appear and what are its symptoms? 

The most common disease caused by the herpes virus 1 is labial herpes, commonly called “cold sores”. Once infected with the virus, the incubation period between infection and the appearance of the first symptoms is between two and 10 days.

After incubation, painful vesicular lesions appear in the oral cavity (mainly in the first incident) or on the lips (mainly in repeated incidents). Sometimes the lesions also appear in the nostrils of the nose and sometimes also in the genitals , usually as a result of unprotected oral sex with a patient.

The disease is characterised by a tingling sensation that precedes the appearance of the lesions. Then small and painful blisters appear, and these later explode, ulcerate and finally freeze and heal. This whole process takes between one and two weeks for the first time. Sometimes such an initial event is accompanied by fever, muscle pain and swelling of the local lymph nodes.

H2: where does it appear and what are its symptoms?

In the same way, the herpes virus 2 causes the same disease, but this manifests itself in lesions in the genital organs  and more rarely in the lips and oral cavity (similar to herpes 1) – usually as a result of unprotected oral sex with a patient. Even a first episode of herpes 2 may be accompanied by fever and severe pain. Sometimes the pain is so intense that it interferes with urinating.

Could I have herpes but have no symptoms?

Yes, about 20% of people who contract herpes have no clinical manifestation of their disease. In the absence of any sign, those 20% are not aware of their disease at all, and it is discovered – if at all – randomly, following a blood test.

And what happens after the first event? 

The virus enters its latent phase, that is, “goes to sleep” inside the body. In some people, the virus will never flare up again, and the only way to know that they have been exposed to the virus is through a blood test that will indicate this (it is not really important to know this).

Others will have another flare-up or have more flare-ups over the following years. The recurring events are usually milder in severity, and shorter in duration. This is true for both herpes 1 and herpes 2 flares, regardless of the location of the infection.

What determines whether there will be recurrent outbreaks of herpes? 

There is no way to predict which of the infected will suffer from repeated events and who will not. Mental or physical stress, exposure to the sun and dryness, exposure to cold, heat illness (hence the name “heat sores”) or local trauma – all of these may be a catalyst for an outbreak.

There are people who before stressful exams will experience a flare-up, there are those who will return from a ski vacation or a long time at sea with inflamed lips (every good thing has a price…), and there are those who simply will not know what was the accelerating factor for the outbreak.

Is herpes something common? 

is very. It is estimated that about 90% of the adult population in developing countries has been exposed to herpes 1. In developed countries, the rate of exposure to the virus reaches about 50% of the population.

How do you get infected?

The virus is found in the fluid in the blisters and is transmitted by direct contact from person to person (eg kissing and sexual intercourse). Infection of the genitals with the herpes virus is considered a sexually transmitted disease, as it is transmitted from person to person through sexual contact.

The spread of the virus and the infection mainly occur when the patient with the disease has blisters, that is, active lesions, but infection through saliva is also possible during the latent periods when the virus is dormant, and there is no sign of its presence. However, the degree of infection is significantly less during these periods compared to the periods when there are blisters.

How is herpes diagnosed? 

Most of the time, no laboratory diagnosis is necessary since the appearance and course of the disease are so typical that it can be diagnosed with certainty. In special cases, a sample can be taken from the bladder and sent for molecular diagnosis (PCR). A blood test has no diagnostic value.

In a blood test, antibodies to herpes are seen in those who have been exposed to the disease in the past, even if at the time of the test there is no active disease. And as mentioned, more than half of the population has herpes antibodies.

Can herpes be dangerous?

Herpes of the lips and genitals is not dangerous, but it causes pain and great discomfort. A woman who has genital herpes blisters at the end of pregnancy can infect her baby at birth, which can cause a dangerous disease in the newborn.

In what other places can herpes appear?

Other diseases whose cause is herpes 1 (and sometimes also herpes 2) are inflammation of the cornea of ​​the eye , inflammation of the brain or cranial nerves, widespread disease of the newborn or widespread disease in people who suffer from severe suppression of the immune system. These are all serious and rare diseases.

Is there a treatment for herpes on the lips and genitals?

Herpes 1 and herpes 2 on the lips go away on their own even without treatment, and there is no obligation to treat them. However, antiviral treatment shortens the duration of an event and its severity, so in mild events the decision whether to treat or not to treat is up to the discretion of the patient and his doctor. Usually, the earlier you start treatment (and it’s better right in the initial tingling stages), the easier the course of the disease will be.

Genital herpes infection also goes away on its own without treatment, but in such cases it is always accepted to treat to reduce pain and suffering. These are the preparations available to patients in Israel:

1.  Acyclovir (trade name Zovirax, Acyclo-V). 

2. Valciclovir (Valtrex).

In addition to this, there is also acyclovir ointment for local treatment, but this treatment is less effective than the pill treatment.

It must be remembered that antiviral treatment only affects the present event; It does not affect the frequency of flare-ups in the future.

Herpes on the lips. Not dangerous, but what is uncomfortable

How do you prevent infection?

  1. Using a condom reduces infection of the genitals and also prevents other sexually transmitted diseases.
  2. Kissing or oral sex should be avoided when there are active lesions.
  3. Care must be taken to use kitchen utensils (plates, cutlery, glasses) designated for the patient – but only when he has active lesions. This way you can reduce the risk of infecting others. Likewise, washing your hands after contact with a runny nose or with saliva reduces the risk of infection .
  4. To prevent flare-ups, lip sunscreen should be used when exposed to the sun/wind/cold (each patient must protect himself according to the factor that causes a flare-up).
  5. In very frequent flare-ups or in flare-ups that cause a lot of suffering, the possibility of permanent preventive drug treatment for an extended period can be considered, but expected benefit versus potential harm must be taken into account.
  6. A mother who suffers from genital herpes can prevent the infection of the newborn through  a caesarean section – which prevents the baby from passing through the birth canal.

Any pregnant woman suffering from a genital herpes infection must report this to her attending physician in order to prevent the newborn from a life-threatening disease. A decision on drug treatment during pregnancy is at the discretion of the attending physician.

Is there a vaccine for herpes?

No.

Can a child suffering from herpes go to kindergarten or school?

In the first event, which is usually characterised by multiple lesions in the oral cavity, and the child salivates a lot, it is forbidden to send him to kindergarten or school. 

In repeated incidents, where there are usually only “heat sores” on the lips, there is no objection to sending him to the institution where he is educated.

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