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Herpes Simplex Type 1 Treatment Guidelines

What Can I Do If I Have Herpes Simplex 2

Herpes Simplex Virus: Guideline Changes and Serology

Many people who find out they have herpes feel depressed knowing they’ll always have the virus and can give it to others. But you arent alone. Herpes is one of the most common STIs, both in the U.S. and worldwide. If you have herpes, you should:

  • Learn all you can about it. Information will help you to manage your disease and feel better about yourself.
  • Talk about your illness with your doctor.

If you have herpes, you can still:

  • Have sex if you use a condom or dental dam , and you tell your partner about your illness. Some couples, who have sexual relations only with each other, may choose not to use condoms even though one partner has herpes. Because each situation is different, you should ask your doctor if this is the right choice for you in your relationship.
  • Have children. People with herpes can still give birth to healthy babies. If you have herpes and plan to have children, discuss your illness with your healthcare provider.

If you have herpes, you should also get checked for HIV and other STIs .

Are You Sure Your Patient Has Herpes Simplex Type

Typical findings of herpes simplex virus-1 infection in children depend on the site of infection.

1. Primary orolabial infection : children present with oral lesions described as small vesicles on the tip of the tongue, gums, and around the lips. These lesions often are accompanied by fever, irritability and tender lymphadenopathy in the sub-mandibular region. The throat usually is spared, but a small number of children with primary HSV-1 infection will have some lesions in the esophagus. Dehydration resulting from refusal to drink and/or eat is the most common reason for admission to the hospital. Recurrences after primary infection can occur, but are generally less symptomatic than the primary infection.

2. Skin infections: in toddlers and small children, infection of the finger tip or nail bed is known as herpetic whitlow. This infection can be secondary to autoinoculation of the virus or inoculation by a different person who bites or sucks on the finger. The lesions are generally vesicular or pustular, and can be confused with bacterial infection due to erythema and swelling that usually accompany the infection. Another type of cutaneous herpes in active athletes involved in wrestling or other contact sports is called herpes gladiatorum. A similar process in children with atopic dermatitis is called eczema herpeticum.

Key Symptoms

1. Muco-cutaneous lesions : vesicular, pustular, and ulcerative are the most common types

2. Fever

Symptoms Of Oral Herpes

Oral herpes is most often caused by HSV-1, but can also be caused by HSV-2. It usually affects the lips and, in some primary attacks, the mucous membranes in the mouth. A herpes infection may occur on the cheeks or in the nose, but facial herpes is very uncommon.

Primary Oral Herpes Infection

If the primary oral infection causes symptoms, they can be very painful, particularly in children. Symptoms include:

  • Tingling, burning, or itching around the mouth are the first signs.
  • Red, fluid-filled blisters that may form on the lips, gums, mouth, and throat.
  • Blisters that break open and leak. As they heal, they turn yellow and crusty, eventually turning into pink skin. The sores last 10 to 14 days and can be very uncomfortable.
  • Blisters that may be preceded or accompanied by sore throat, fever, swollen glands, and painful swallowing.

Recurrent Oral Herpes Infection

A recurrent oral herpes infection is much milder than the primary outbreak. It usually manifests as a single sore, commonly called a cold sore or fever blister . The sore usually shows up on the outer edge of the lips and rarely affects the gums or throat.

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How Can I Prevent Genital Herpes

If you are sexually active, you can do the following things to lower your chances of getting genital herpes:

  • Being in a long-term mutually monogamous relationship with a partner who does not have herpes.
  • Using condoms the right way every time you have sex.

Be aware that not all herpes sores occur in areas that a condom can cover. Also, the skin can release the virus from areas that do not have a visible herpes sore. For these reasons, condoms may not fully protect you from getting herpes.

If your sex partner has/have genital herpes, you can lower your risk of getting it if:

  • Your partner takes an anti-herpes medicine every day. This is something your partner should discuss with his or her healthcare provider.

Ii Treatment Of Adults With Genital Herpes

Best Of Hsv 1 Treatment Guidelines
  • Key Question 1: What are the most practical treatment regimens for first clinical episode of genital herpes, episodic therapy, and suppressive therapy?

While several dosing strategies of anti-herpesvirus medications have been studied and are FDA-approved for first clinical episode genital herpes, episodic therapy, and suppressive therapy, several regimens are less practical for use than others due to frequency of dosing. Dosing strategies that are most feasible for patient adherence should be prioritized.

Although episodic and suppressive therapy for genital HSV-1 infection have not been studied as comprehensively as for genital HSV-2, the same medication dosages and frequencies are recommended for genital HSV-1 infection.

  • Key Question 2: What are the preferred management approaches to the treatment of genital herpes?

There are 2 important goals for management of genital herpes: prevention of symptoms/recurrences and improvement in quality of life and prevention of transmission to sexual partners. Given these goals, the recommended approaches to management of genital HSV infection differ based on the viral type and the presence and absence of symptoms.

HSV-2: Symptomatic Infection

HSV-2: Asymptomatic Infection

Genital HSV-1 Infection

summarizes the evidence base for episodic and suppressive therapy among those with symptomatic HSV-1 and HSV-2 infection or asymptomatic HSV-2 infection.

Population .
  • Key Question 8: What is the preferred treatment for HSV meningitis?

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Who Gets Herpes Simplex

Primary attacks of Type 1 HSV infections occur mainly in infants and young children. In crowded, underdeveloped areas of the world, nearly all children have been infected by the age of 5. In less crowded places, the incidence is lower for example, less than half of university entrants in Britain have been infected. Type 2 HSV infections occur mainly after puberty and are often transmitted sexually.

HSV is transmitted by direct or indirect contact with someone with active herpes simplex, which is infectious for 712 days. Asymptomatic shedding of the virus in saliva or genital secretions can also lead to transmission of HSV, but this is infrequent, as the amount shed from inactive lesions is 100 to 1000 times less than when it is active. The incubation period is 212 days.

Minor injury helps inoculate HSV into the skin. For example:

  • A thumb sucker may transmit the virus from their mouth to their thumb.
  • A health-care worker may develop herpetic whitlow
  • A rugby player may get a cluster of blisters on one cheek .

Herpes And Newborn Infants

Herpes infection in a newborn can cause a range of symptoms, including skin rash, fevers, mouth sores, and eye infections. If left untreated, neonatal herpes is a very serious and even life-threatening condition. Neonatal herpes can spread to the brain and central nervous system, causing encephalitis and meningitis. It also can lead to intellectual disability, cerebral palsy, and death. Herpes can also spread to internal organs, such as the liver and lungs.

Infants infected with herpes are treated with acyclovir, an antiviral drug. They usually receive several weeks of intravenous acyclovir treatment, often followed by several months of oral acyclovir. It is important to treat babies quickly, before the infection spreads to the brain and other organs.

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Is There A Cure For Herpes Simplex

There is no cure for herpes simplex. Once you have the virus, its a lifelong infection.

What is the outlook for people with herpes simplex?

For many people, the first herpes outbreak is the most severe. Many outbreaks are less frequent and milder after the first year of infection. Some people may have only one outbreak and never have another again.

Herpes infection doesnt usually pose a serious health risk. The risk of a health complication due to herpes is higher in infants and if you have HIV/AIDS, cancer or an organ transplant.

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Treatment Of An Initial Outbreak

Educational video to support the treatment of Herpes Simplex Keratitis

The first outbreak of genital herpes is usually much worse than recurrent outbreaks. Symptoms tend to be more severe and to last longer. Your provider will prescribe one of the three antiviral medications, which you will take for 7 to 10 days. If your symptoms persist, treatment may be extended. An acyclovir ointment may also be prescribed for topical treatment of initial genital herpes.

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How Does Suppressive Treatment Work

Some people may have regular, more serious outbreaks of genital herpes, more than six times a year. In this case, you could get a low-dose antiviral treatment, which you would take daily for about 6 or 12 months. This is known as suppressive therapy and it helps to either stop the outbreaks completely or make symptoms less serious.

If you use this treatment, you would be asked to stop afterwards to see if your outbreaks happen less often and are less serious. If the outbreaks have not improved, you may be offered another long-term, daily dose of antiviral medication.

Episodic Therapy For Recurrences

For a recurrent episode, treatment takes 1 to 5 days, depending on the type of medication and dosage. You should begin the medication as soon as you notice any signs or symptoms of herpes, preferably during the prodrome stage that precedes the outbreak of lesions.

In order for episodic therapy to be effective, it must be taken no later than 1 day after a lesion appears. If taken during prodrome, episodic therapy may help prevent an outbreak from occurring or reduce its severity. If taken at the first sign of a lesion, it can help speed healing.

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What Questions Should I Ask My Doctor

You may want to ask your healthcare provider:

  • What is the best treatment for me?
  • What happens if I dont treat a cold sore?
  • What are the side effects of antiviral medications?
  • How can I reduce the risk of future outbreaks?
  • Whats the best way to prevent getting another STI?
  • How can I protect my partner from getting genital herpes?
  • Should I lookout for signs of complications?

Herpes Pregnancy And Newborn Infants

Preventing the Spread of Herpes Simplex Type 1

Herpes can pose serious risks for a pregnant woman and her baby. The risk is greatest for mothers with a first-time infection because the virus can be transmitted to the infant during childbirth. Guidelines from the American Academy of Pediatrics recommend using specific diagnostic tests for women in labor to determine the risk of transmission. Babies born to mothers infected with genital herpes are often treated with the antiviral drug acyclovir, which can help suppress the virus.

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Do Symptoms Differ Depending On Location

Youll most likely notice similar blisters and prodromal symptoms, no matter what type of the virus you have or where it shows up. The two different types of HSV .

The only major difference, of course, is where you experience symptoms:

  • If HSV affects your genitals, you might notice pain or burning during urination.
  • If HSV affects your mouth, you might have difficulty eating spicy or acidic foods while you have open sores.

Theres also a slight difference in where oral blisters appear, depending on whether theyre primary or recurrent. During the first episode, blisters may appear on your mouth and lips, but during later episodes, theyre more likely to

Herpes Simplex Virus Infection In Pregnancy

Gianluca StrafaceAcademic Editor: Received

Abstract

Infection with herpes simplex is one of the most common sexually transmitted infections. Because the infection is common in women of reproductive age it can be contracted and transmitted to the fetus during pregnancy and the newborn. Herpes simplex virus is an important cause of neonatal infection, which can lead to death or long-term disabilities. Rarely in the uterus, it occurs frequently during the transmission delivery. The greatest risk of transmission to the fetus and the newborn occurs in case of an initial maternal infection contracted in the second half of pregnancy. The risk of transmission of maternal-fetal-neonatal herpes simplex can be decreased by performing a treatment with antiviral drugs or resorting to a caesarean section in some specific cases. The purpose of this paper is to provide recommendations on management of herpes simplex infections in pregnancy and strategies to prevent transmission from mother to fetus.

1. Introduction

A first primary infection develops when a susceptible person is exposed to HSV.

Indeed, a first nonprimary episode occurs when a person with preexisting HSV antibodies experiences a first episode with the opposite HSV type.

2. Epidemiology

In recent years, genital herpes has become an increasing common sexually transmitted infection. From the late 1970s, HSV-2 seroprevalence has increased by 30%, resulting that one out of five adults is infected .

3. Diagnosis

7. Therapy

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Transmission Of Genital Herpes

Genital herpes is a sexually transmitted disease spread by skin-to-skin contact. The risk of infection is highest during outbreak periods when there are visible sores and lesions. However, genital herpes can also be transmitted when there are no visible symptoms. Most new cases of genital herpes infection do not cause symptoms, and many people infected with HSV-2 are unaware that they have genital herpes.

To help prevent genital herpes transmission:

  • Use a condom for sexual intercourse.
  • Use a dental dam for oral sex.
  • Limit your number of sexual partners.
  • Be aware that nonoxynol-9, the chemical spermicide used in gel and foam contraceptive products and some lubricated condoms, does not protect against STDs.

Is There A Cure Or Treatment For Herpes

Eye Herpes, Causes, Signs and Symptoms, Diagnosis and Treatment.

Theres no cure for the herpes virus yet. A herpes vaccine doesnt currently exist, as the herpes virus has more complicated DNA than most infections, creating challenges for researchers.

However, medication can help with symptoms, like sores, and outbreaks. Medication also lowers the risk of transmission to others. You can take most medications for herpes orally, though you may also apply some as a cream or receive them by injection.

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How Is Herpes Simplex Treated

Some people have few to no herpes outbreaks and choose not to have treatment. But many people prefer to use medications that shorten outbreaks and reduce symptoms.

During an outbreak, you may use an antiviral ointment or cream to help lessen your symptoms and help them go away faster, but it only works if you start it soon after you start an outbreak. Many people with HSV-2 take daily oral medications to keep outbreaks at bay.

Your provider may prescribe a topical medication or oral medication such as:

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What Is The Evidence

Gilbert, S, Corey, L, Cunningham, A. An update on short-course intermittent and prevention therapies for herpes labialis. Herpes. vol. 14. 2007. pp. 3A-18A.

Whitley, RJ. Therapy of herpes virus infections in children. Adv Exp Med Biol. vol. 609. 2008. pp. 216-32.

Anderson, BJ. Managing herpes gladiatorum outbreaks in competitive wrestling: the 2007 Minnesota experience. Curr Sports Med Rep. vol. 7. 2008. pp. 323-7.

Corey, L, Wald, A. Maternal and neonatal herpes simplex virus infections. N Engl J Med. vol. 361. 2009. pp. 1376-85.

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Valacyclovir Penciclovir And Famciclovir

Besides ACV, there are other alternatives to treat skin lesions caused by herpes simplex viruses, such as valacyclovir, penciclovir, and famciclovir, which are also considered first-line drugs to treat HSV-1 and HSV-2 and thus, are frequently used .

These drugs are nucleic acid analogs, similar to ACV with a shared mechanism of action that interferes with the function of the viral DNA polymerase . These compounds differ from each other mainly in their bioavailability, half-life in the body and dosing , yet similar to ACV they reduce herpetic lesions and associated pain in approximately 13 days, as compared to untreated groups when used topically .

To increase the bioavailability of acyclovir, an L-valine ester of acyclovir was developed. Valacyclovir is a prodrug of ACV with enhanced absorption at the intestinal level . Later, penciclovir was developed with the aim of being phosphorylated more rapidly than ACV, and consequently has a higher half-life than acyclovir . While acyclovir has a half-life of 0.7 h for HSV-1 and 1 h for HSV-2, penciclovir has a half-life of 10 h for HSV-1 and 20 h for HSV-2 . Famciclovir is a prodrug that derives into penciclovir and has increased oral bioavailability . Clinical benefits granted by these drugs have also generated discussions on the recommendation of their use to treat skin lesions caused by herpes simplex virus infections .

Management Of Sex Partners

Herpes Simplex Keratitis Guide to Diagnosis and Treatment

The sex partners of persons who have symptomatic genital herpes can benefit from evaluation and counseling. Symptomatic sex partners should be evaluated and treated in the same manner as patients who have symptomatic genital herpes. Asymptomatic sex partners of patients who have symptomatic genital herpes should be asked about a history of genital symptoms and offered type-specific serologic testing for HSV-2. For partners without genital herpes, no data are available on which to base a recommendation for PEP or PrEP with antiviral medications or that they would prevent acquisition, and this should not be offered to patients as a prevention strategy.

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