@ Skin Condition

HERPES VIRUSES

Herpes simplex causes cold sores, whitlows on the fingers/hands and genital herpes. By adulthood, herpes simplex infection in the UK is around 70%, worldwide it nears 100%. Herpes simplex can be differentiated into two genotypes, type 1 being much more common than type 2. Infection rates are detected by antibody tests since the majority of people infected are unaware of it, being asymptomatic. Recurrences only affect a minority of those infected and occur due to a lowered immune response which may be caused by illness, stress, tiredness, etc. There are nine known human herpes viruses. Herpes simplex and herpes varicella-zoster (chickenpox) cause skin conditions. The other viruses in the herpes family may cause malaise but do not affect the skin.

Cause
Herpes simplex virus types 1 and 2 produce sores: cold sores on the face, herpetic whitlows on the hands and fingers and “herpes” elsewhere on the body, especially on the genitals.

The virus is transmitted by direct skin-to- skin contact with the affected part. The incubation period is usually 2-14 days, however asymptomatic carriers may develop symptoms years after first contracting it.


Symptoms
The primary illness last about 2-3 weeks and is self-limiting: flu-like symptoms followed by blisters (on ordinary skin) which open into sores or ulcers before scabbing over and healing. After the primary infection, herpes simplex virus remains latent in the body and may reactivate at a later date. If herpes simplex recurs, it will only affect the dermatome (nerve region) where infection took place causing one or more spots. These may be preceded by flu-like symptoms. Neuralgia, described variously as scalded skin, deep aches, tingling or shooting nerve pains, may be experienced in the dermatome either before or between outbreaks. Symptoms are not spread to other nerve regions. With time recurrences usually diminish both in frequency and

Treatments
If the primary infection of herpes simplex is severe, a course of antiviral drugs may be prescribed: aciclovir, Famvir or Valtrex. Otherwise all that is necessary is to alleviate symptoms using antipyretics, analgesics and topical anaesthetics as appropriate.

Eye infection: Varicella-zoster virus may affect the ophthalmic division of the trigeminal nerve causing pain in, usually, one eye. Diagnosis is by fluoroscein stain. Treatment with antiviral ophthalmic cream as well as antiviral pills is recommended. Eye infection may damage sight or even, rarely, lead to blindness.

If herpes simplex recurs with a frequency that the patient finds distressing, antiviral treatment may be given prophylactically for a period of six months (minimum useful treatment).

Self-help is also often effective. The Herpes Viruses Association can offer suggestions, as well as counselling, so that the patient's anxiety is ameliorated.

Psychological Effects
A diagnosis of herpes simplex can be very distressing. Since the early 1980s, inaccurate and deliberately misleading information has appeared in newspapers and magazines. Women, in particular, should be reassured in advance by the diagnosing doctor about two myths which they may come across: herpes simplex is not a causal factor for cervical cancer and women who catch herpes simplex prior to conception need not assume they will need a Caesarian section.

A diagnosis of herpes simplex can often cause greater psychological misery than physical suffering. Sexually transmitted conditions carry a stigma, exacerbated in this country by an immature national attitude to sex, characterised by prurience and prudery. The ?reg;herpes hype' and stigma associated with the condition means that most people remain secretive about the condition.

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