How to diagnose and treat lip sores / genital herpes / herpes simplex?

A Surprisingly Common Infection

There are a number of herpes viruses that can potentially infect human beings – the most widely known are the herpes simplex virus Type I and II, which cause oral herpes (commonly known as cold sores) and genital herpes (a sexually transmitted disease).

What are Herpes Simplex Viruses I & II?

There are two herpes simplex viruses that infect humans: HSV-I and HSV-II, typically these lead to cold sores and genital herpes. The virus is primarily transmitted by skin-to-skin contact, although it can also be passed from mother to newborn during the course of childbirth. Primary infection is characterized by a group of painful vesicular/fluid filled lesions on a background of redness, and may be associated with systemic upset such as fever and malaise. The blisters will eventually break, forming superficial erosions and then dry up in a couple of weeks’ time. In the vast majority of cases, the virus will find haven inside a local nerve where it remains in a latent state – once inside a nerve the virus is protected from our immune system and escapes destruction.  Reoccurrence can happen at any time causing another outbreak; each time the signs and symptoms may be similar to the first attack, but generally they are milder.

While herpes simplex infection usually occurs around the mouth and genital area, other parts of the body are not immune (although symptoms tend to be milder).  Lesser known varieties include: Herpetic Whitlow, an infection of the fingers and hands commonly occurring in medical or dental personnel, who work in and around the mouths of patients shedding the virus. There have also been cases of cutaneous and eye infection with herpes simplex virus among wrestlers and rugby players – this variety has been labeled herpes gladiatorum. Most likely, skin abrasions during these contact sports allow the virus to spread.  Herpes gladiatorum lesions are most commonly found on the head and neck region, but can also occur on the trunk and arms. Infection of the eye can also be a problem, and with repeated recurrence, scarring can affect vision.

How are Herpes Simplex I & II Diagnosed?

The most reliable way to diagnose a herpes simplex infection is with a viral swab of the vesicular fluid. However, the viral load falls quickly after the first few days of eruption, so the swab may yield a false negative result if taken late in the course of the attack. Patients suffering from herpes infection are contagious to others during an active outbreak, but asymptomatic shedding of the virus is also possible even when there is no obvious lesion seen on the surface of the skin.

What Treatments are Available for Herpes Simplex I & II?

Both primary and recurrent episodes of the condition are usually self-limiting and may require no treatment at all. However, if taken within the first couple of days of breakout, medication can help reduce the length and severity of the attack. Drugs are also useful in decreasing the amount of shedding of the virus, and in preventing relapses in those patients who have frequent outbreaks. While symptoms can be treated, there is no cure for this condition, and the virus will persist for life once a patient is infected.