health.enotes.com/childrens-health-encyclopedia/herpes-simplex
Parental concerns Definition Herpes is an infection caused by a herpes simplex virus 1 or 2, and it primarily affects the mouth or genital area. Description There are two strains of herpes simplex viruses. Herpes simplex virus type 1 (HSV-1) is usually associated with infections of the lips, mouth, and face. It is the most common herpes simplex virus among the general population and is usually acquired in childhood. Herpes simplex virus 2 (HSV-2) is sexually transmitted and is usually associated with genital ulcers or sores. Individuals may harbor HSV-1 and or HSV-2 and not have developed any symptoms. Transmission HSV-1 causes lesions inside the mouth that are often referred to as cold sores or fever blisters, and it is transmitted by contact with infected saliva. By adulthood, up to 90 percent of the population has antibodies to HSV-1. HSV-2 is sexually transmitted and not everyone develops symptoms when they have it. Up to 30 percent of adults in the United States have antibodies against HSV-2. Cross infection of type 1 and 2 viruses may occur from oral-genital contact. Herpes viruses can be transmitted to a newborn during vaginal delivery in mothers infected with herpes viruses, especially if the infection is primary (first occurrence) and is active at the time of delivery. The virus can lead to complications such as meningoencephalitis, which is an infection of the lining of the brain and the brain itself. It can also cause eye infections, in particular, of the conjunctiva and cornea. Demographics The prevalence of herpes simplex in the United States is as follows: * Seventy to ninety percent of adults test seropositive (present in blood serum) for HSV-1. Causes and symptoms A primary infection of HSV-1 typically occurs between six months and five years of age and is systemic (affecting the whole body). Transmission is generally via respiratory droplets (HSV-1) or direct contact (HSV-1 and HSV-2). The virus enters the body through mucosal surfaces, replicates in the cell nucleus, and then kills the host cell. The initial infection is self-limiting, but the immune system does not destroy the virus. The virus migrates along nerves to an area of regional ganglia (nerve centers) and then typically enters into a latent (sleeping) phase. Reactivation of the virus occurs in 50 percent of patients within five years, and it can be triggered by various factors: * fatigue * stress * trauma * immunocompromise (lack of normal immune response) * illness, such as a cold * fever * sunburn * menstruation * sexual intercourse The symptoms of a herpes infection can vary tremendously. Many infected individuals have few, if any, noticeable symptoms. Those who do have symptoms usually notice them from two to 20 days after being exposed to someone with HSV infection. Symptoms can last for several weeks, but the first episode of herpes is usually worse than subsequent outbreaks.
There may be painful urination, and swollen and tender lymph glands in the groin. More often than not the blisters disappear without treatment in two to 10 days, but the virus remains in the body, lying dormant among clusters of nerve cells until another outbreak is triggered. Many people are able to anticipate an outbreak when they notice a warning sign (a tingling sensation, called a prodrome) of the approaching illness. It is when they feel signs that an outbreak is about to start that they are particularly contagious, even though the skin still appears normal. Most people with genital herpes have five to eight outbreaks per year, but not everyone has recurrent symptoms. Oral herpes can recur as often as monthly or only one or two times each year. Sores typically come back near the site of the first infection, but there are fewer sores with recurrences that heal faster and are less painful. When to call the doctor Anyone who has a history of herpes infection and current lesions should notify the physician if the lesions do not resolve after seven to ten days or if a condition exists that weakens the immune system. Children with a herpes infection most commonly have sores in the mouth usually caused by HSV-1.
dehydration secondary to a refusal to drink fluids because of mouth pain and difficulty swallowing. Treatment is usually not required, and symptoms generally improve in three to five days. If, however, the child does not improve, develops a fever, and becomes lethargic, the pediatrician should be called immediately. Herpes infections that spread throughout the body in a newborn are usually more serious, but fortunately less common than the other types of neonatal infections. They typically occur in the first week of life, with symptoms including fever, difficulty breathing, seizures, lethargy, and irritability. Since many infants in the first month of life can have a herpes infection and not have skin lesions, it takes a great deal of time and effort to diagnose and treat these infections early. Herpes should be considered in any acutely ill newborn, especially if bacterial cultures are negative and the baby is not improving after two to three days. Parents should be informed to watch the baby closely if either one of them has a history of herpes infections. Diagnosis Testing for neonatal herpes infections may include special smears and/or viral cultures, blood antibody levels, and polymerase chain reaction (PCR) testing of spinal fluid. Cultures are usually obtained from skin vesicles, eyes, mouth, rectum, urine, stool, and blood. For older children and adults, if there is a question as to the cause of a sore, a tissue sample or culture can be taken to determine what type of virus or other microorganism is responsible. For herpes, it is preferable to have this test done within the first 48 hours after symptoms first show up for a more accurate result. Treatment There are three drugs proven to treat genital herpes symptoms: acyclovir, sold under the brand name Zovirax, Famvir, and Valtrex. Formulas applied to the surface of the skin provide little benefit, and they are not recommended. Drug therapy is not a cure, but it can make living with the condition easier. For an initial outbreak with symptoms such as sores, a doctor should begin a brief course of antiviral therapy to relieve the symptoms or prevent them from getting worse. Seven to ten days of treatment is recommended but if the lesions do not heal, a longer period of time may be required. Following the initial outbreak there are two options to consider for further outbreaks. One is intermittent treatment, which involves the physician prescribing an antiviral drug to keep on hand in case an individual has a flare-up. The pills can be taken for three to five days as soon as sores are noticed or when an outbreak tingling sensation occurs. Sores heal and disappear on their own, but taking the drugs helps to alleviate the symptoms. For individuals who have frequent outbreaks, a suppressive treatment may work better. This treatment involves taking an antiviral drug every day. For example, someone who typically has more than six outbreaks a year, suppressive therapy reduces the number of outbreaks by 70 to 80 percent.
A false-color transmission electron microscopy (TEM) image of a herpes simplex virus. Vaccines will only function to prevent the infection in new patients. Those who already have the simplex virus disease will probably not benefit. Nutritional concerns Diet is a very important factor in keeping herpes in remission. It has been found that foods high in arginine may cause herpes outbreaks. Supplementation with free-form lysine has shown to be beneficial in controlling herpes along with a diet high in lysine and low in arginine. The amount of lysine required to control herpes varies from case to case, but a typical adult dose to maintain remission is 500 mg daily, and active herpes requires 1-6 g between meals to induce healing. Once it is contracted, it is always in a person's system. However, with treatment therapies, the problems previously encountered are lessened considerably. Prevention Whereas it is almost impossible to keep a baby or child from being exposed to herpes simplex due to its universal pres...
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