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Herpes simplex virus (HSV) is a common, contagious infection of the skin which occurs on any part of the body, especially the genital and lip area. It can also affect the nervous system and the brain. Research shows that 1 in 5 Americans suffer from Herpes Simplex Virus. Most people confuse herpes simplex with herpes zoster which causes shingles and chicken pox. The term “herpes” comes from the Greek word “herpein,” which means “to creep” or “to spread”. They are two types of Herpes simplex viruses which are discussed below.

Types of herpes simplex

Herpes simplex virus 1 (HSV-1) - which occurs above the hip mostly on the lips and it can be represented by cold sores and blisters. It cannot be transmitted sexually although kissing and oral sex can transmit HSV-1.  Herpes simplex virus 2 (HSV-2) - which can be found below the hip mostly on the genital area. It can be transmitted sexually and most people suffer from this type of HSV.

When you’re infected by the virus this is what happens as soon as it enters your body (symptoms)?

* Skin outbreaks may show in 2 to 12 days after the virus enters you body
* Then you start to see small blisters or sores.
* Yours skin then becomes inflamed (red and sensitive)
* The blisters start to dry out this happens because they are healing which can take longer if skin is moist. It can cause the lesions to itch and be painful
* The crusts form and the dry areas start to fall off, at this stage the lesions is no longer contagious and the virus can be considered inactive.
* Swelling around the infected area may occur
* You might experience headaches, muscle aches and fever.
* Latency - During this time (latency) the HSV shows no symptoms and it is not transmittable.
* Shedding- The virus is powerful at this stage (shedding), it starts to multiply in your body and it become transmittable even though you show no symptoms.

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Genital herpes, a sexually transmitted disease (STD), is an infection caused by the herpes simplex virus (HSV). HSV is in the same family of viruses that causes chickenpox, shingles and mononucleosis. There are two types of HSV: HSV-1, which infects 80 percent of the U.S. population, usually appears on the lips in cold sores; HSV-2 is usually found in the genital area. However, if a person with HSV-1 oral herpes (cold sores) performs oral sex, it is possible for the partner to get HSV-1 genital herpes. And HSV-2 can infect the mouth through oral sex.

HSV can cause sores, or lesions, to appear in and around the vaginal area and within the cervix in women, and on the penis and scrotum in men. Both males and females may also get lesions in the urinary tract, around the anal opening, on the buttocks or thighs, and sometimes on other parts of the body.

The First Episode

Symptoms of genital herpes can vary in appearance and intensity. Some people have no symptoms or such mild symptoms that they don’t suspect they have an infection. For others, the first episode of herpes (primary infection) can cause one or more very painful lesions to erupt on the skin.

For many people, this primary infection may be more severe and have more generalized symptoms than recurrent episodes. During a first episode, the lesions may be accompanied by flu-like symptoms such as fever, headache and muscle aches. Some people experience painful or difficult urination and swollen glands in the groin area. Women may also have a vaginal discharge.

Genital herpes lesions usually appear within two to 10 days after being exposed to the virus, and can last from two to four weeks. First to appear are small red bumps, which develop into blisters. Then the blisters become open sores, which later dry up, crust over, and heal without leaving a scar. Sometimes a second crop of lesions appears.

Recurrent Episodes

Once HSV infects a person, the virus travels through the nerves and settles at the base of the spine. During this inactive phase, the virus is dormant. But it may wake up later, travel along the nerve paths to the surface of the skin, and cause another outbreak of lesions. This recurrence of HSV usually causes lesions to appear around the same area of the first outbreak.

Some people have only one or two recurrences in a lifetime, while others have them frequently. “The recurrence rate is far lower in HSV-1 than HSV-2,” says Rhoda Ashley, Ph.D., director of the University of Washington’s diagnostic virology laboratory at the Children’s Hospital and Regional Medical Center in Seattle.

Most people diagnosed with HSV-2 affecting the genital area typically have four or five symptomatic recurrences the first year. After the first year, most people have fewer and milder recurrences, lasting a week or less. Many people get warning signals of a recurrence, known as prodrome. With prodrome, there may be a tingling or itching in the genital area, or pain in the buttocks, down the legs, or in the lower back. Sometimes these symptoms go away and no lesions appear.

Phinney’s outbreaks were so frequent that they made him irritable, he says. “I would get an outbreak, and as that outbreak was fading over a week or so, suddenly a new one would crop up. As a result, I was really only ‘clear’ for as little as one week a month.”

Researchers don’t know why recurrences happen, or why their frequency and severity vary. Some people report that recurrences are triggered by stress, illness, poor nutrition, menstruation, and friction in the genital area, such as that caused by vigorous sex. However, many of these supposed triggers have no scientific basis, says Ashley. “You can’t say stress is a trigger. It’s like the chicken and the egg. Which came first–the herpes or the stress?” Nevertheless, for many people, trying to avoid their triggers seems to work for them, says Ashley.

Stress is a “huge factor” in triggering outbreaks for Pat Adams of Washington, D.C. Adams has had genital herpes for about 20 years. “Anything I can do to calm myself down during a stressful period and take better care of myself can help,” says Adams. She finds that a good diet and exercise help her to keep the virus in check.

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What is Herpes Zoster?

Herpes Zoster, also called herpes zoster or zoster, is a painful skin rash caused by the varicella zoster virus (VZV). VZV is the same virus that causes chickenpox. After a person recovers from chickenpox, the virus stays in the body. Usually the virus does not cause any problems; however, the virus can reappear years later, causing Herpes Zoster. Herpes zoster is not caused by the same virus that causes genital herpes, a sexually transmitted disease.

What does Herpes Zoster look like?

Herpes Zoster usually starts as a rash on one side of the face or body. The rash starts as blisters that scab after 3 to 5 days. The rash usually clears within 2 to 4 weeks.

Before the rash develops, there is often pain, itching, or tingling in the area where the rash will develop. Other symptoms of Herpes Zoster can include fever, headache, chills, and upset stomach.

Are there any long-term effects from Herpes Zoster?

Very rarely, Herpes Zoster can lead to pneumonia, hearing problems, blindness, brain inflammation (encephalitis) or death. For about 1 person in 5, severe pain can continue even after the rash clears up. This pain is called post-herpetic neuralgia. As people get older, they are more likely to develop post-herpetic neuralgia, and it is more likely to be severe.

How common is Herpes Zoster in the United States?

In the United States, there are an estimated 1 million cases of Herpes Zoster each year.

Who gets Herpes Zoster?

Anyone who has recovered from chickenpox may develop Herpes Zoster, including children. However, Herpes Zoster most commonly occurs in people 50 years old and older. The risk of getting Herpes Zoster increases as a person gets older. People who have medical conditions that keep the immune system from working properly, like cancer, leukemia, lymphoma, and human immunodeficiency virus (HIV), or people who receive immunosuppressive drugs, such as steroids and drugs given after organ transplantation are also at greater risk to get Herpes Zoster.

How often can a person get Herpes Zoster?

Most commonly, a person has only one episode of Herpes Zoster in his/her lifetime. Although rare, a second or even third case of Herpes Zoster can occur.

Can Herpes Zoster be spread to others?

Herpes Zoster cannot be passed from one person to another. However, the virus that causes Herpes Zoster, VZV, can be spread from a person with active Herpes Zoster to a person who has never had chickenpox through direct contact with the rash. The person exposed would develop chickenpox, not Herpes Zoster. The virus is not spread through sneezing, coughing or casual contact. A person with Herpes Zoster can spread the disease when the rash is in the blister-phase. Once the rash has developed crusts, the person is no longer contagious. A person is not infectious before blisters appear or with post-herpetic neuralgia (pain after the rash is gone).

What can be done to prevent the spread of Herpes Zoster?

The risk of spreading Herpes Zoster is low if the rash is covered. People with Herpes Zoster should keep the rash covered, not touch or scratch the rash, and wash their hands often to prevent the spread of VZV. Once the rash has developed crusts, the person is no longer contagious.

Is there a treatment for Herpes Zoster?

Several medicines, acyclovir (Zovirax), valacyclovir (Valtrex), and famciclovir (Famvir), are available to treat Herpes Zoster. These medications should be started as soon as possible after the rash appears and will help shorten how long the illness lasts and how severe the illness is. Pain medicine may also help with pain caused by Herpes Zoster. Call your doctor as soon as possible to discuss treatment options.

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Varicella zoster virus, the same virus that causes chicken pox, causes shingles. This virus is in the herpes family. After a person has had chickenpox the virus remains in their body, lying dormant or hidden in part of the nervous system. For some reason, often many years later, the virus travels back down one of the nerves to the skin, where it causes a rash in the area of skin supplied by that nerve. It’s not clear what triggers reactivation of the chickenpox virus but it may be linked to changes in the immune system. Ensuring your immune system is not weakened may help to prevent this occurring.

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Acyclovir is most common Antiviral drugs which is used to treat infection caused by herpes viruses. It slows down the growth and spread of the herpes virus so that body can fight off the infection. Acyclovir will not cure herpes, but it can lessen the symptoms of the infection. Illness caused by herpes viruses includes genital herpes, cold sores, chicken pox, and shingles.

Acyclovir is a medicine recommended as an antiviral prescription to treat genital herpes virus including herpes simplex 1 and 2, chicken pox, shingles and varicella-zoster. It thereby interferes with enzymes being used by viruses to replicate among DNA in cells. As such, the virus is prevented to multiply and the healing of herpes takes place.

There might be certain side effects of Acyclovir depending upon the intake of the dose and the proportion the infection being treated. It is important here that every patient may not necessarily observe such side effects. Some of these effects require proper medical examination in case the patient observes the following:

1. Some sort of allergy or reaction
2. Skin rashes
3. Swelling in parts of body such as tongue, lips or face
4. Injury in the soft tissues or bone of any of the parts of the body or uncommon bleeding
5. Stomach pain
6. Less or no production of urine in the body

Other mild side effects that get away during the course of the treatment may include:

1. Feeling of nausea
2. Vomiting
3. Diarrhea
4. Headaches

Herpes infections are contagious and you can infect other people, even if you are being treated with acyclovir. It will prevent the spread of genital herpes. Avoid sexual intercourse or use a latex condom to prevent spreading the virus to others. Consult your doctor about any side effect that seems unusual or that is especially bothersome.

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They said they had uncovered a stealth mechanism that enables the virus to hide away in facial nerves before it is revived by a trigger such as excessive sunlight or fever.

The virus, known by its initials as HSV1, can hole up for years, out of reach of any drug, before being roused from dormancy. When it revives, it prompts a sore to return to the same location on the mouth as before.

A team led by Bryan Cullen, a professor of molecular genetics and microbiology at Duke University Medical Center in Durham, North Carolina, explored how HSV1 is able to switch between these latent and active phases.

They found that the answer lies in the sole product made by the virus during its slumber, strands of genetic material called LAT ribonucleic acid (RNA).

During the period of dormancy, LAT RNA is chopped up into smaller strands, called micro-RNAs, which block the proteins that switch on the virus’ replication machinery.

The wakeup call causes the virus to start producing lots of information-carrying strands called messenger RNAs. These overwhelm the micro-RNAs and eventually cause the replication machine to crank back into life.

The new supply of viruses then heads down the trigeminal nerve, the nerve that runs down the side of the cheek and provides facial sensation, to the site of the initial infection at the mouth.

In a press release, Cullen said the discovery threw up the prospect of drugs that would activate the virus and then kill it. Activation is an essential step, as a dormant virus is untouchable.

A new drug, currently being tested on lab animals, aims to interfere with the micro-RNAs that keep the virus de-activated.

Once the virus is reawakened, the patient could take acyclovir, a proven drug against HSV1, Cullen hoped.

“In principle, you could activate and then kill all of the virus in a patient,” said Cullen. “This would completely cure a person, and you would never get another cold sore.”

The findings may also be useful in combatting HSV-2, which causes painful genital sores, and chicken pox virus, which can return later in life as shingles.

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Do you remember having chicken pox as a kid? The itchy rash, the oatmeal baths and looking so funny in the mirror?

My sister and I went through this childhood rite of passage for a week each, back to back. My children will most likely never have the experience, though, since there’s now a vaccination to prevent the chicken pox.

However, if you did have chicken pox, you’re not necessarily done with it yet. Now you are at risk for developing shingles.

Once you’ve had the chicken pox, the virus lives in your body, remaining inactive in your nervous system. About 1 million people develop shingles each year in the United States. While it can develop at any time, half of these cases occur in people older than 60. If you are older than 85, you have a 50 percent chance of experiencing the disease.

In addition to stress, injury and exposure to certain metals as causes for developing shingles, there also seems to be a strong association between shingles and having a blood relative with a history of the disease. According to a study conducted by the University of Texas Medical School at Houston, people with shingles are more than four times likely to have a first-degree relative with a history of the condition.

According to the American Pain Foundation, “Shingles may first appear as tingling, itching or pain on a single area of the body or face. It then progresses as a blistering rash, which can be painful.”

This rash is extremely sensitive and typically takes about two weeks to heal. During this time, even the touch of soft clothing or a light breeze against the skin can be painful.

Long-term nerve pain, skin infection, muscle weakness, scarring and decrease or loss of vision or hearing can be serious long-term complications of shingles. It is important that you contact your physician immediately if you think you may have shingles so that you can start treatment.

Unfortunately, since shingles is a virus, treatment mainly consists of treating the symptoms while the disease runs its course. WebMD offers the following suggestions:

- Painkillers, such as aspirin or acetaminophen, can relieve mild pain.
- Anti-inflammatory drugs, such as ibuprofen (Motrin) or naproxen (Aleve), are also often helpful for pain.
- Antiviral drugs, such as Acyclovir, may help stop progression of the rash, especially if used early in the course of the blister breakout. Similar drugs, such as Valtrex or Famvir, can also be used. These drugs may also help stave off the painful aftereffects of shingles known as postherpetic neuralgia.
- Benzoin, available over the counter, may protect irritated skin when applied to unbroken lesions.
- Antibiotics can keep the infection under control if the area becomes infected by bacteria.
- Tricyclic antidepressants or seizure medication may be prescribed for the pain that lingers after lesions have healed. Antidepressants may also help with depression that can occur with the onset of shingles or as a result of the lingering pain.

In addition, be sure to keep the affected area clean, dry and exposed to air as much as possible.

As with many things, the best cure is prevention. The Food and Drug Administration approved Zostavax, the first shingles vaccine, in May 2006. In October 2006, the Centers for Disease Control and Prevention’s vaccine advisory panel voted to make shingles vaccination routine for everyone aged 60 and older, even if they have already had the disease.

According to the CDC, research has shown that the vaccine reduced the occurrence of shingles in people aged 60 and older by about 50 percent and by 64 percent in people in their 60s.

Talking to your doctor is key. Whether you’re trying to prevent developing shingles or need to treat an outbreak, your health care provider should be involved. As a team, you can eliminate or dramatically reduce shingles’ discomfort.

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Some families may harbor susceptibility to shingles. Having a close relative who has had a bout with shingles puts people at a heightened risk of suffering a similar outbreak, a new study finds.

A herpes virus called varicella zoster causes shingles and chickenpox. Since nearly everyone in the United States over age 25 has been exposed to the chickenpox virus, much of the population is at risk for shingles, which strikes in middle age and beyond. After causing a chickenpox infection, the virus lies dormant in nerves for decades. The virus can resurface as the nasty skin rash, blisters, itching and pain that mark a case of shingles. Some symptoms can last for weeks or months.

But only about one in five people exposed to chickenpox ultimately get shingles, says Stephen Tyring, a virologist and dermatologist at the University of Texas Health Science Center in Houston. Scientists suspect the immune system somehow keeps the virus bottled up in nerves better in some people than in others. People with compromised immune systems face a greater-than-average risk of shingles.

To test for a familial link, Tyring and his colleagues identified 504 people who had shingles and matched them with 523 volunteers who hadn’t. Everyone was over age 25; most fell between 46 and 75 years of age. The groups were matched overall for age, gender and race.

When the researchers compared family histories between the groups, they found that roughly 39 percent of the shingles patients had a close relative who also had had the disease. Only 11 percent of the controls did, they report in the May Archives of Dermatology. The researchers defined a close relative as a parent, child, sibling, uncle, aunt or first cousin.

A vaccine for chickenpox introduced in the United States in 1996 will probably knock down the risk of shingles for future generations, says Tyring. Meanwhile, a vaccine against shingles became available in 2006.

“Those with family members who have had shingles should consider being the first in line to be vaccinated,” he says. Insurance coverage for the shingles vaccine typically starts at age 60, but studies are under way to see whether this should be expanded to include 50-somethings, Tyring says.

Many scientists suspect that good immune system surveillance keeps the virus under wraps and locked indefinitely in nerve tissue in most people. In 2002, Finnish researchers reported evidence suggesting that having a specific variant form of a gene that encodes an immune protein called interleukin-10 might contribute to a person’s susceptibility to shingles. Interkeukin-10 inhibits inflammation in the body, but its role in shingles remains unclear.

The new study may spur more research aimed at sorting out this and other potential biomechanisms that could underlie susceptibility to shingles, Tyring says.

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Shingles is a painful rash caused by the varicella-zoster virus, which is the same virus that causes chicken pox.

Shingles is a painful rash caused by the varicella-zoster virus, which is the same virus that causes chicken pox. At the moment, there are many cases of chicken pox occurring in our local grade schools. Anyone who has had chicken pox may develop shingles.

After an episode of chicken pox, the virus can remain inactive, often for decades, in cells of the nervous system. Shingles is caused by a reactivation of the virus, which can manifest as a painful rash, always on one side of the body. The rash can be found on almost any part of the body, but it is usually a band of blisters from the middle of the back to the middle of the chest. Pain often occurs several days before the rash. Less commonly, one can have just the pain and not the rash.

Most of the time, shingles occurs only once, but if it does happen again, it’s usually on another part of the body.

About 20 percent of people will develop shingles during their lifetime. Shingles can affect people of all ages, but it is more common in those older than 50 and much less common in younger individuals. It is sometimes more common in those who have conditions that weaken the immune system, such as medical treatments involving the use of cortisone, chemotherapy and radiation.

Shingles is not life-threatening. A full recovery is usually expected within a month or two, although one may rarely have a complication called postherpetic neuralgia. This condition causes the skin to remain painful and sensitive to touch for months, or even years, after the rash disappears.

Shingles cannot be passed from one person to another, but a person with shingles can pass the varicella-zoster virus to a susceptible person, causing chicken pox. Transmission usually occurs through direct skin-to-skin contact with the blisters of a shingles rash.

Several treatments are available from your health care provider:

* High doses of an antiviral drug can reduce the duration and intensity of the symptoms. Such medications include acyclovir (Zovirax), valacyclovir (Valtrex) or famciclovir (Famvir). The medicines work best when given within the first 72 hours of symptoms.

* Pain relievers can help control pain. This usually involves some form of a narcotic, such as Darvocet, Vicodin or codeine.

* Also sometimes helpful in more severe cases of shingles is the application to the rash of an ointment containing capsaicin, the compound that makes chiles spicy, or a skin patch containing the numbing drug lidocaine.

* Because shingles affects the nervous system, it may require a prescription of Neurontin for those experiencing severe pain.

Home treatment of the shingles rash involves keeping the rash clean with soap and water, applying cold, wet compresses to the blisters.

Preventatives are available in the form of vaccines. All children should be routinely vaccinated for chicken pox, as should any adult who has never had chicken pox. Although this vaccine doesn’t guarantee to prevent either chicken pox or shingles, it can reduce the intensity of the disease and reduce the chance of complications.

There is also a vaccine specifically for shingles called Zostavax. It is indicated for those 60 years and older. In studies of people who were given the vaccine, the incidence of shingles infection was reduced, and in those patients who did develop shingles, the severity and duration of infection was reduced.

The bottom line is that if you have a painful rash, it is better to seek treatment from your health care provider sooner rather than later.

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Q My new girlfriend has herpes, which is fine as we use condoms when we have sex. But I’m worried that I’ll catch it from kissing her. Is this possible?

A Herpes caused near-panic when the revolutionaries of the 1960s discovered that there was a sexually transmitted disease that couldn’t be cured or treated effectively. It seemed that an inflamed itchy skin that within 24 hours produced a crop of small blisters was retribution from the gods for the pleasures of less-inhibited sex.

Aids drove news stories about herpes off the front pages. Aids, potentially lethal if untreated, was new to human beings and to Europe, whereas doctors had known about the two herpes viruses, types 1 and 2, for generations. They are arguably second only to the common cold as a cause of human viral infections.

Fortunately, herpes is not a big deal for most people - and if the herpes is confined to your girlfriend’s genitalia, you are unlikely to catch it from kissing her. Ninety-five per cent of adults at some time of their lives, and 60 per cent of children by the age of 5, have been infected. Type 1 usually causes cold sores around the lips and mouth; type 2 usually attacks the genital organs, perineum or perianal area. But either type can affect either area.

The severity of attacks varies enormously. They usually start within four or five days of sex with an infected contact and may be so trivial - no more than a pink patch or an itchy spot - that the sufferer is unaware of its significance until a new partner develops sores. Or they may result in extensive painful ulceration. Most people develop a resistance once they have had an attack, but a minority continue to have recurrent bouts that are progressively less severe.

Tracing an attack’s origins may be difficult as the virus can be dormant for years until the patient’s immune system is impaired and troublesome symptoms recur. It is not always justified to assume that herpes has been contracted from a current partner; it may be a recurrence of a patient’s own dormant infection.

The good news is that herpes doesn’t have to be a painful nuisance, even if your immune system makes you liable to frequent attacks. Antiviral agents, which have been available for years, are remarkably effective. They can be used to treat an acute attack or, if normal life is disrupted by frequent bouts, taken in relatively small, regular doses.

As I’ve said, if your girlfriend’s herpes is confined to her genitalia, kissing is unlikely to spread any infection, but oral sex is risky if you haven’t any resistance to her type of herpes. There is a good chance that, unknowingly, you have had herpes types 1 and 2 before and are not susceptible to them.

Various factors, including exposure to too much sun - especially if there’s a drying wind as well - other medical problems, or continuing emotional strain or overtiredness, may cause trouble. I always used to recommend that my patients with a history of herpes took the appropriate antivirals if they went for a holiday involving sun, sea and sand, or if they went skiing and were exposed to sun and snow.

Many patients with dormant herpes find that it is reactivated with a new sexual partner; the combination of excitement, emotional tension and the rough and tumble triggered by initial lust is too much for their immune system.

Worrying about contracting genital herpes through kissing someone you have already had sex with is a bit like shutting the stable door after the horse has bolted.

Condoms don’t provide 100 per cent protection against any sexually transmitted diseases and the widely held belief that herpes can be transmitted only during an outbreak means that many couples use condoms only when the infected person shows symptoms.

This is a mistake because new research from the University of Washington, published in The New England Journal of Medicine, has found that asymptomatic people are just as infectious as those who have the symptoms. It is estimated that only one in five infected people knows that he or she is carrying the virus. In the Washington study, for example, scientists found 53 people who tested positive for type 2 herpes were unaware that they had it. And more than four out of five of those cases were infectious.Both type 1 and type 2 herpes look identical under the microscope, and either can infect the mouth or genitals.

During an outbreak some people feel generally unwell and experience painful blisters, ulcers or crusts in the genital area and the buttocks. After initial infection, genital herpes lurks without symptoms in nerves at the base of the spinal cord and it is only if the disease travels along the nerves to the skin that symptoms reappear. Some people have one outbreak and never have another, but others, as the Washington study demonstrates, never experience any symptoms in the first place.

The infection is almost impossible to contain. Scientists believe that most genital herpes is acquired from a person with no known history of infection and caution that the spread of the disease is likely to continue unabated unless everybody who carries the virus know that they are.

One in four Americans has herpes and although the figures are lower here, between 1997 and 2006 the number of reported infections rose by 31 per cent.

It would help if men took sexual health a little more seriously. A MORI poll in 2000 revealed that only half of the men polled knew that a genitourinary medicine clinic treated sexually transmitted infections; 6 per cent thought it treated elderly people; and 13 per cent that it tackled gum disease.

If you get tested - as you should - and find that you have the virus, the good news is that you cannot be reinfected. Living with herpes is indeed a pain but it is not the end of the world. Condoms with a spermicide provide good protection and outbreaks can be treated with acyclovir, a drug that eases symptoms, speeds healing and, in some users, helps to prevent recurrent attacks.

Relationships do become more complicated. A study by the American Social Health Association found that 18 per cent of herpes sufferers blame their divorce or other break-up on the disease.

And the temptation for herpes sufferers who are symptom-free to avoid sharing their condition with new partners must be enormous. That your girlfriend was honourable enough to tell you in advance is commendable.

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