How does hsv cause ulcers

Humans are the only known reservoirs. HSV-1 is a large, neurotropic virus which causes mainly oral infections ranging from minor lesions, such as cold sores, to severe lesions, such as meningoencephalitis. HSV-2 is very similar, but it causes anogenital infections or neonatal herpes. In recent years, these data have varied as a consequence of oral sex practices, with HSV-2 manifesting in labial lesions and an increase in the prevalence of HSV-1 in anogenital infections.

In the light of these changes, we need to break with the traditional assumptions that HSV-2 means genital herpes and that HSV-1 is limited to orolabial infections with non-sexual transmission. HSV lesions continue to be the most common cause of vulva ulcers in the sexually active population Fig. A continuous increase in HSV infection has been detected in recent years, due in part to sociocultural changes and risky sexual practices.

The majority of these infections are asymptomatic, which favours transmission. Ulcerative vulvar lesions. Adapted from Garland and Steben. The infectious cycle of the virus starts after contact with the oral or genital mucosa, through abrasions or micro-cracks in the host's skin Fig.

Replication begins in the epidermis and penetrates sensory nerve endings in the skin. Through the axon of these nerves it is transported to the nucleus of the neurons in the sensory ganglia in the spinal cord spinal or trigeminal. HSV can replicate within sensory ganglion neurons or remain dormant for months and even years, and reactivate spontaneously or in response to various stimuli solar radiation, stress, fever, certain medications, acute diseases or immunosuppressive processes.

This ability of the latent virus to reactivate is defined as recurrent HSV disease. When the virus is reactivated, it descends through the sensory nerve to the surface of the initially infected dermatomes orolabial or vulva. Replication continues in the epidermal cells and can cause asymptomatic excretion in oral or genital secretions, or obvious clinical recurrence, resulting in vesicles and inflammation of local lymph nodes.

Primary infection and reactivation. Adapted from Jaishankar and Shukla. The clinical signs and symptoms of genital herpes vary, depending on the type of HSV, gender, age, immune status of the patient and previous exposure to the virus.

Episodes in patients with no evidence of previous HSV infection primary infection may be more severe on average than in patients with previous infection non-primary first-episode genital herpes. However, more commonly, we find asymptomatic primary infections, meaning that most people with either genital or oral herpes are unaware of their infection status.

These proportions vary according to geographical location and socioeconomic status. The most common complications derive from extragenital skin lesions, central nervous system involvement and opportunistic fungal infections. Less frequently, sacral radiculomyelitis with urinary retention, transverse myelitis and neuralgia may occur.

Complications are more common in women than in men. Both local and systemic symptoms are less severe and resolve more quickly in non-primary first-episode genital herpes than in primary infections. The average duration of viral shedding is 12 days in primary disease and 7 days in non-primary disease. Recurrent genital herpes is one of the main problems of this disease, as it depends on the type of virus, the intensity of the first episode and also the host.

There is a great deal of variation in the number of flare-ups, the severity and the natural course of recurrences. Skin manifestations tend to be in the same area of the first episode and are sometimes nonspecific and barely perceptible, such as fissures and cracks, which can lead to mistaken diagnosis. Occasionally, there may be no lesions, making it difficult to diagnose the recurrences.

Systemic symptoms are rare and less severe, although they can be more painful and prolonged in women. The recurrence rate increases during pregnancy, but the course and duration are similar. A clinical diagnosis is enough to start early empirical treatment and this improves the symptoms and shortens their duration.

However, the diagnosis should always be confirmed with laboratory tests in order to deliver a prognosis and choose the optimal treatment. Physical examination involves external and internal examination of genitals, and checking for lymphadenopathy hard, mobile, bilateral and very painful and location of the virus in other areas mouth and eyes , along with the patient's medical history. The initial lesion is one or more grouped vesicles on an erythematous base. These vesicles subsequently open up and lead to shallow ulcerations.

In the area around the labia and rectum the vesicles often burst before they are noticed, and crusts may appear Fig. In primary genital infection, the pain tends to last 10 days and the lesions heal in 2—3 weeks.

They are less painful and of limited duration. Course of symptoms and clinical manifestations in herpetic diseases. The most commonly used diagnostic techniques are: - Tzanck smear, from an unbroken vesicle. Cheap and quick tool, but requires experienced staff and is limited to this type of lesion. It is a sensitive and specific, but lengthy, method.

The characteristic cytopathic effects tend to appear within 12—48 h. Type-specific serology for specific anti-HSV IgG antibodies: relevant in patients with a history of undiagnosed atypical genital lesion, suspicion of partner infection with infected patient and pregnant women at risk of transmission to the newborn. These are also fast, inexpensive techniques, many of which are fully automated or semi-automated. A negative serology result may indicate both the absence of previous contact with HSV and absence of immune response, either due to initial phase of infection primary infection or alterations in the patient's immune system.

In contrast, the presence of total antibodies is evidence of herpetic infection. A negative IgM indicates a non-active infection at the time of analysis, while the presence of IgM shows an evolving infection not always a primary infection, as in some recurrences significant amounts of IgM may be detected.

PCR: use of PCR in clinical practice is booming thanks to the multiplex PCR technique that enables the simultaneous detection of the main organisms present in infectious ulcers of sexual origin Treponema pallidum , Haemophilus ducreyi , Chlamydia trachomatis L serovar , which causes lymphogranuloma venereum, and HSV 1—2. Mainly because of its high sensitivity even in cases with low viral load it is useful for detecting viral shedding in asymptomatic patients and diagnosing lesions which were negative in the culture.

The biggest drawback is the cost and the requirement for laboratories and specialised staff. Commercial kits are now available for the simultaneous determination of several STIs or exclusively herpes simplex infection which can differentiate between HSV types 1 and 2, something that a culture cannot do. For all these reasons, PCR has progressively displaced performing a culture as the diagnostic method for HSV infection.

Such early treatment can lead to faster healing, relief of symptoms and a reduced risk of transmission. It is recommended in patients with genital ulcers suggestive of HSV infection, but has the disadvantage of potentially being inappropriate treatment. It is therefore essential to follow up patients to assess their treatment response and diagnostic tests results and to reassess treatment decisions, if necessary.

In the first episode of genital herpes , antivirals should be used for the first five days from onset of the episode, or during the formation of new lesions. The treatment of choice is oral antivirals, aciclovir, valaciclovir and famciclovir, which reduce the severity and duration of the episode level of evidence Ib, A. The only indication for the use of intravenous therapy is when the patient cannot ingest or tolerate oral treatment.

Famciclovir mg three times a day. Valaciclovir mg twice a day. As treatment support measures, saline baths and the use of analgesics are recommended. In cases of recurrent genital herpes , the choice of treatment is made according to the severity of the symptoms and the time of recurrence.

Famciclovir 1 g two tablets in a single day. Valaciclovir mg twice a day for three days. Famciclovir mg twice a day. In special situations, such as HIV-positive patients, there are no clinical trials for the duration and treatment, so some clinicians opt for 10 days of treatment with twice the dose of any of the above oral treatments IV, C. In pregnant women, treatment regimens and treatment management vary according to the trimester of virus acquisition.

The recommended doses are: - Aciclovir mg twice a day for five days. Therapeutic vaccines are another potential strategy for the management of HSV-positive patients, but few of the earlier trials obtained optimal results. A recently published study 42 calculated the costs associated with HSV infection in hospital accident and emergency units.

The study emphasises the need for continuous prevention and patient sex education to avoid new cases. The author would like to thank Ms Morilla for revising and commenting on this literature review.. Enferm Infecc Microbiol Clin. ISSN: X. Previous article Next article. Issue 4. Pages April More article options. Download PDF. This item has received. Article information. Show more Show less.

Finally, the cost of routine herpes simplex virus infection is analysed. Palabras clave:. Full Text. The author would like to thank Ms Morilla for revising and commenting on this literature review.

Campadelli-Fiume, L. Menotti, E. Avitabile, T. Viral and cellular contributions to herpes simplex virus entry into the cell. Curr Opin Virol, 2 , pp. Bernstein, A. Bellamy, E. Hook, M. Levin, A. Wald, M. Ewell, et al. Epidemiology, clinical presentation, and antibody response to primary infection with herpes simplex virus type 1 and type 2 in young women.

Clin Infect Dis, 56 , pp. McGeoch, F. Rixon, A. The first outbreak is usually the most severe. HSV can easily be spread from one child to another.

If you or another adult in the family has a cold sore, it could have spread to your child and caused herpetic stomatitis. More likely, you won't know how your child became infected. Your child's health care provider can most often diagnose this condition by looking at your child's mouth sores. Use lidocaine with care, because it can numb all feeling in your child's mouth.

This can make it hard for your child to swallow, and may lead to burns in the mouth or throat from eating hot foods, or cause choking. Your child should recover completely within 10 days without treatment. Acyclovir may speed up your child's recovery. Your child will have the herpes virus for life. In most people, the virus stays inactive in their body. If the virus wakes up again, it most often causes a cold sore on the mouth. Sometimes, it can affect the inside of the mouth, but it won't be as severe as the first episode.

Call your provider if your child develops a fever followed by a sore mouth, and your child stops eating and drinking. Your child can quickly become dehydrated. If the herpes infection spreads to the eye, it is an emergency and can lead to blindness.

Call your doctor right away. There's little you can do to prevent your child from picking up the virus sometime during childhood. Your child should avoid all close contact with people who have cold sores. So if you get a cold sore, explain why you can't kiss your child until the sore is gone.

A single episode or recurrent erythema multiforme is an uncommon reaction to herpes simplex. The rash of erythema multiforme appears as symmetrical plaques on hands, forearms, feet and lower legs. It is characterised by target lesions , which sometimes have central blisters. Mucosal lesions may be observed. Rarely, neuralgic pain may precede each recurrence of herpes by 1 or 2 days Maurice syndrome. Meningitis is rare. Complications of herpes simplex infection Dendritic ulcer.

Mild, uncomplicated eruptions of herpes simplex require no treatment. Blisters may be covered if desired, for example with a hydrocolloid patch. Severe infection may require treatment with an antiviral agent. Higher doses of antiviral drugs are used for eczema herpeticum or for disseminated herpes simplex.

Topical aciclovir or penciclovir may shorten attacks of recurrent herpes simplex, provided the cream is started early enough. As sun exposure often triggers facial herpes simplex, sun protection using high protection factor sunscreens and other measures are important. Antiviral drugs will stop HSV multiplying once it reaches the skin or mucous membranes but cannot eradicate the virus from its resting stage within the nerve cells.

They can, therefore, shorten and prevent attacks but a single course cannot prevent future attacks. Repeated courses may be prescribed, or the medication may be taken continuously to prevent frequent attacks. See smartphone apps to check your skin. Books about skin diseases Books about the skin Dermatology Made Easy book. DermNet NZ does not provide an online consultation service. If you have any concerns with your skin or its treatment, see a dermatologist for advice. Herpes simplex — codes and concepts open.

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