Herpes simplex is a virus transmitted by close personal contact that causes infections characterized by an eruption of small fluid-filled blisters (vesicles) or lesions on the skin, accompanied by burning and itching.
There are two types of herpes simplex virus: type I (HSV-I) oral herpes, which usually produces cold sores on the lips; and type II (HSV-II) genital herpes, which usually produces lesions on the penis, in the vaginal area, within the cervix, on the perianal skin, in the urinary tract, or on the buttocks or thighs. However, either virus type can cause oral or genital infection. Herpes can also cause infections inside the mouth (gingivostomatitis), in the eye (keratoconjunctivitis), or on the skin, as well as more serious infections of the nervous system and brain (encephalitis). The most common form of herpes, however, is a cold sore that appears at the edge of the lip. Individuals can be infected with both types of HSV.
After a first episode, the virus has dormant and active phases. When active, HSV usually causes a recurrence of lesions around the same area of the first outbreak. Recurrences vary by individual case, although the rate is lower for HSV-I than HSV-II. When symptoms present themselves, usually indicated by lesions, the virus is active. But the lack of symptoms does not necessarily mean the virus is dormant. This is known as "asymptomatic shedding," and may occur in rectal tissue or in secretions from the penis or vagina. Individuals with new infections are more likely to shed the virus than someone with an infection that is older, and those with more frequent outbreaks may shed the virus more often than those with infrequent outbreaks. HSV-II is more likely to produce shedding.
Recurrence triggers are largely unknown. Some individuals report recurrences due to stress, illness, poor nutrition, menstruation, and high-frequency or vigorous sexual activity.Incidence and Prevalence: There is no case reporting data for genital herpes. Genital herpes is common in the US, with at least 45 million people having some type of HSV infection. Lifetime seroprevalence may be 20% to 80% (Salvaggio). |
Source: Medical Disability Advisor
HSV-II is more common in women than in men (seropositivity to antibodies to HSV-II, 25% vs. 17%) (Salvaggio). More blacks and Mexican-Americans than whites get the disease. Oral-oral contact, penile-vaginal and/or penile-anal intercourse, genital-oral and/or anal-oral contact, and other body-to-body contact are routes of transmission.
HSV increases an individual's risk of contracting human immunodeficiency virus (HIV). |
Source: Medical Disability Advisor
History: Both oral and genital herpes may be asymptomatic; however, infection may be transmitted even in absence of visible lesions. Burning, tingling, stinging, and pain at the site of infection, accompanied by lesions that appear as a group of small blisters (vesicles) on the skin, are the main symptoms of herpes infections. These lesions most frequently occur on the mouth, lips, and conjunctiva of the eye or, in the case of genital herpes, on the genitalia. Lesions typically ooze and crust over in 7 to 10 days, but may last several weeks. A sore throat, fever, irritability, and an indefinite feeling of lack of health (malaise) can also accompany herpes. The primary or initial infection usually produces no symptoms, but the individual may experience fever, a sore throat or mouth sore before the virus becomes dormant. Physical exam: Typically, vesicles may be observed on the skin or mucous membranes where the virus came into contact with the body (mouth, lips, eye conjunctiva, or genitalia). The vesicles may spread together, forming a larger lesion, and usually crust over following rupture of the blisters. The exam can sometimes show enlargement and tenderness of the lymph nodes (lymphadenopathy) in the neck or groin. Tests: The virus can be detected through a viral culture taken from a lesion sample, or from a blood test. A culture will also indicate which type of HSV is present. Microscopic examination of the infected skin cells, or a Tzanck smear, can indicate abnormalities. For rapid diagnosis when encephalitis is suspected, a polymerase chain reaction (PCR) test on cerebrospinal fluid (CSF), or an antibody test on a brain biopsy, can be performed. |
Source: Medical Disability Advisor
There is no cure for genital herpes, but lesions are typically self-limiting, and extensive treatment is not warranted. The lesion should be kept clean and dry to prevent spreading and the development of secondary bacterial infections. For more severe cases of herpes, antiviral medications such as acyclovir, famciclovir, or valacyclovir are given. Since the use of these antiviral medications began, resistant strains of the virus have been reported. Many individuals find over-the-counter remedies such as camphor to be effective. Mouth rinses that contain lidocaine may provide pain relief. No treatment can prevent the virus from becoming dormant in the body.
Using condoms during intercourse and dental dams during oral-vaginal or oral-anal contact can reduce the risk of contracting genital herpes. The risk of oral herpes may be reduced by using a lip balm containing sunscreen or by otherwise decreasing sun exposure. |
Source: Medical Disability Advisor
| Herpes lesions of the mouth or genitals typically clear up in 7 to 10 days. Serious infections that have spread to the brain take longer to treat and can be fatal, but that is rare. |
Source: Medical Disability Advisor
Source: Medical Disability Advisor
- Family Physician
- Infectious Disease Internist
|
|
Source: Medical Disability Advisor
Source: Medical Disability Advisor
| Complications include systemic infections, meaning that the virus spreads throughout the body. Rarely, encephalitis, inflammation of the bone marrow (myelitis), meningitis, and pain in the nerves (neuralgia) can occur. Genital herpes infections during pregnancy can cause infection in the fetus and can result in spontaneous abortion, premature birth, or congenital abnormalities. |
Source: Medical Disability Advisor
| If the disease has spread to become systemic or caused infection of any organs, the disability will be extended. |
Source: Medical Disability Advisor
| Individuals may not be able to use their mouths or lips for a period of time, which may interfere with some types of work. More serious forms of the disease may require more work restrictions. Risk: Transmission between co-workers is very unlikely because it would require direct contact between an open sore of an infected individual and the broken skin or mucous membranes of a seronegative individual. Capacity: Capacity may be influenced by the size and location of the lesions, though this would normally only affect individuals who have multiple mouth sore eruptions and their job requires heavy vocal use. Once the infection has become dormant, capacity should not be affected. Tolerance: Individuals with oral lesions may feel self-conscious about their appearance during an outbreak and may temporarily be unwilling to work in positions that require public interaction. Some individuals with an active HSV-II outbreak may have discomfort with prolonged sitting, which may be improved by wearing loose-fitting clothing. |
Source: Medical Disability Advisor
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Has diagnosis of herpes simplex virus been confirmed?
-
Have other conditions with similar symptoms been ruled out?
-
Does individual have a coexisting condition that may complicate treatment or affect recovery?
Regarding treatment:
- Although usually self-limiting, have symptoms persisted past expected resolution?
-
If complications occurred (such as systemic infections, encephalitis, myelitis, meningitis, neuralgia, or spontaneous abortion), have they responded to treatment?
-
Does individual's condition warrant a more aggressive treatment with antiviral medication?
Regarding prognosis:
- Does individual have a lowered or suppressed immune system, resulting in disease episodes that are more severe, last longer, and often show long-term effects of the infection?
-
Would individual benefit from consultation with an infectious disease specialist?
-
If individual is pregnant, has she informed her obstetrician or health care provider about her HSV history?
|
Source: Medical Disability Advisor
| CitedSalvaggio, Michelle R. "Herpes Simplex." eMedicine. Ed. Burke A. Cunha. 5 Jan. 2012. Medscape. 16 Aug. 2014 <http://emedicine.medscape.com/article/218580-overview>. |
Source: Medical Disability Advisor