Herpes Simplex Virus

Also Listed As:   Cold Sores
 

Signs and Symptoms
Causes
Risk Factors
Diagnosis
Preventive Care
Treatment Approach
Lifestyle
Medications
Nutrition and Dietary Supplements
Herbs
Acupuncture
 Massage and Physical Therapy
Homeopathy
Mind/Body Medicine
Traditional Chinese Medicine
Other Considerations
Pregnancy
Special Populations
Warnings and Precautions
Prognosis and Complications
Supporting Research


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Herpes simplex virus (HSV) infections are very common worldwide. HSV-1
(often called oral-facial herpes) is transmitted through kissing or
sharing drinking utensils, and HSV-2 (often called genital herpes)
through sexual contact. Both HSV-1 and HSV-2 can cause infections
around the face, mouth, and genitals. The infection may not show
symptoms for a long time, and then become activated by exposure to the
sun, fever, menstruation, emotional stress, a weakened immune system,
or acute illness.

Once you have herpes, it is likely to recur. In between herpes
outbreaks, the virus lies dormant (like it is hibernating or sleeping)
in nerve cells. Recurrent HSV-1 infections on the lip are often mild
and are commonly referred to as cold sores or fever blisters. HSV-2
lesions tend to recur more often and to be more severe than HSV-1
infections.

Herpes infections in infants and in people who have weak immune
systems or herpes infections that affect the eyes are serious and
potentially life-threatening.


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Signs and Symptoms

Small grouped blisters in the infected area like the genitals (namely,
penis scrotum, vagina, cervix, or labia), around the genitals (such as
anus or inner thighs) mouth, lips, tongue, gums, or throat; the
blisters can then become ulcers (raw sores) and later crust over
Burning, itching, pain, or tingling sensations often precedes the
appearance of the blisters
Enlarged lymph nodes near the infected area
Fever, headache, and flu-like symptoms (such as muscle aches and
malaise [generally feeling bad]), particularly when you first contract
the virus
Vaginal or penile discharge
Pain with urination


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Causes

HSV-1 is transmitted through saliva; therefore, kissing someone with
HSV-1, drinking from the same instrument, or participating in
oral-genital sex with someone who has HSV-1 can cause you to contract
the virus.

HSV-2 is a sexually transmitted disease meaning that it is transferred
from one sexual partner to another through genital secretions.

Herpes simplex may be transmitted even if the infected person does not
have active symptoms or visible lesions.

Also, a mother can pass the infection to her baby during vaginal
birth, especially if there are active lesions around the vagina at the
time of delivery.


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Risk Factors

Oral herpes

Everyone is at risk for oral herpes from HSV-1, including children
many of whom are already infected by age three. In fact, studies
suggest that by adolescence 62% of Americans are infected with HSV-1
and by the time one is in the 40's, 90% have been infected.

Genital herpes

All sexually active people are at risk for acquiring genital herpes.
Having multiple sexual partners puts you at even greater risk.
Estimates of how many Americans are infected range from 20% to 30%.

Other factors

Immunosuppressed individuals (see Special Populations) are at
increased risk for severe cases of herpes.


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Diagnosis

In many instances, your doctor is able to make the diagnosis of herpes
from physical appearance of the lesions and no tests are required. If
your doctor is not 100% certain, however, then fluid from the blisters
can be removed and tested for the herpes simplex virus. This can be
done through viral cultures which is very accurate but generally takes
2 to 3 days to get the results and make an official diagnosis. Another
more immediate, but less accurate, approach is to do a Tzanck test of
the skin lesions. This involves taking a sample of fluid from the
blisters, staining the fluid with a dye, and examining the stained
fluid under the microscope looking for a characteristic appearance of
the virus. Finally, there is a blood test that may be helpful for
making a diagnosis, especially if herpes simplex is suspected but no
symptoms are present or if a distinction between HSV-1 and HSV-2 is
needed.


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Preventive Care

Prevention of spread from one person to the next is quite difficult
since the virus can be transmitted even when there are no visible
lesions. Some measures that may help, however, are described below.

If you do not have herpes:

Avoid direct contact with cold sores or genital herpes lesions on
other people. For example, avoid sexual intercourse altogether when
your partner has active lesions. At other times, use latex condoms,
which can help avoid but not eliminate sexual transmission of genital
herpes.
Wash items that may have saliva or other bodily fluid from someone
with oral herpes in boiling water before you use (like razor blades,
drinking cups or glasses, etc.)
Do not share certain items (like a toothbrush, razor, etc.) with an
infected person, especially when herpes lesions are active.
If you do have herpes:

Avoid precipitating causes like sun exposure and try to reduce your
stress level. (See Mind/Body Medicine.)
Avoid performing oral sex when you have active herpes lesions on or
near your mouth.
Use latex condoms even when lesions are not present and avoid sexual
intercourse altogether when you have active lesions.


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Treatment Approach

Herpes cannot be cured, so the goals of treatment include reducing the
number of recurrences and lessening your symptoms when you have an
outbreak.

Even without any intervention, oral herpes lesions generally subside
in no more than 1 to 2 weeks. Using medications may shorten the course
and decrease the discomfort.

Some cases of genital herpes may be quite mild and not need any
treatment. In severe or prolonged cases, however, as well as herpes
infections if you are immunosuppressed (see Special Populations) or if
you have frequent recurrences, medications that fight the virus may be
needed.

In addition to physical relief of symptoms and reducing frequency of
outbreaks, coping with the emotional and social aspects of having
genital herpes is part of treatment. See Mind/Body Medicine.


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Lifestyle

Taking lukewarm baths or applying ice to herpes lesions may help
reduce pain, burning, or other discomfort. It is important to cleanse
the infected area with soap and water, which may help avoid local
spread of herpes from the active blisters to surrounding areas on your
skin. After bathing or washing, it is important to completely dry the
affected area.

Wear cotton underwear and avoid tight fitting clothes as they can
restrict air circulation and slow the healing of lesions.

Coping with the emotional and social aspects of having genital herpes
can be challenging. See Mind/Body Medicine for further discussion.


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Medications

Antiviral medicines may help shorten the duration of a herpes
outbreak. If you have 6 or more recurrences of genital herpes per
year, your doctor may recommend use of antiviral medicines at all
times to prevent such frequent outbreaks.

Medications that your doctor may prescribe include:

Acyclovir
Famciclovir
Pancyclovir
Valacyclovir
For maximum benefit during recurrences, medication should be started
as soon as you experience the tingling, burning, itching, or other
sensations that often precede the appearance of the herpes lesions.

Acyclovir given intravenously (through a vein) in the hospital is
sometimes needed if you have an infection involving the brain, eyes,
or lungs or if you are in a group at high risk for complications (see
Special Populations).

Foscarnet, another antiviral agent that is quite powerful and also
delivered intravenously, may be nececessary if your herpes lesions are
resistent to acyclovir or the other medications listed.


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Nutrition and Dietary Supplements

Because supplements may have side effects or interact with
medications, they should be taken only under the supervision of a
knowledgeable healthcare provider.

Lysine

Although the research to date is not entirely conclusive, lysine
supplements have been used to help treat or prevent mouth and genital
lesions caused by herpes. Taking lysine supplements or increasing
lysine in your diet (from foods like fish, chicken, eggs, and
potatoes) may speed recovery time and reduce the chance of recurrent
breakouts of the herpes infection. If you have high cholesterol, heart
disease, or high triglycerides (type of fatty material in the blood,
generally measured when you have your cholesterol checked), it is
best, at this point, not to use lysine because animal studies suggest
that this supplement may raise cholesterol and triglyceride levels.

Propolis

Propolis, a resin from tree bark and leaves, is loaded with flavonoids
(antioxidants that help fight infection and boost immune function). A
study of a small number of people with genital herpes compared an
ointment made from propolis to acyclovir ointment (a medication
commonly used for herpes). In this research trial, the lesions of
those using the propolis healed more quickly than those using
acyclovir. Research on larger numbers of people would be helpful. In
the interim, it may be worth trying propolis ointment for genital
herpes lesions if your doctor approves.

Spirulina

Test tube studies suggest that spirulina, also known as blue green
algae, has activity against certain viruses including herpes. Whether
this laboratory finding will prove beneficial for people in treating
herpes infections is not known. More research is needed before a
recommendation can be made.

Zinc
Topical preparations of zinc have shown benefit in relieving symptoms
and preventing recurrences of oral herpes lesions.


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Herbs

The use of herbs is a time-honored approach to strengthen the body and
treat disease. Herbs, however, contain active substances that can
trigger side effects and interact with other herbs, supplements, or
medications. For these reasons, herbs should be taken with care and
only under the supervision of a practitioner knowledgeable in the
field of herbal medicine.

Aloe (Aloe vera)

Preliminary evidence suggests that aloe gel used topically may improve
the symptoms of genital herpes. Whether this same use of aloe will
apply to oral herpes lesions is not known, but it may be worth trying
in order to reduce the length and severity of your symptoms. Talk to
your doctor about the possibility of using topical aloe vera for
herpes lesions.

Lemon Balm (Melissa officianalis)
Some studies suggest that topical ointments containing lemon balm may
help heal herpes cold sores. In one study of 116 people with HSV, for
example, those who applied lemon balm cream to their lip sores
experienced significant improvement in redness and swelling after only
two days. Although other symptoms (such as pain and scabbing) did not
improve, both the participants and their physicians reported that the
lemon balm ointment was highly effective. Several animal studies also
support the value of topical lemon balm for oral herpes lesions.

Peppermint Oil (Mentha x piperita)
In test tubes, peppermint oil has exhibited antiviral properties
against a number of infectious agents, including herpes. Whether this
would translate into help for relieving herpes lesions is not known at
this point.

Sage-Rhubarb Cream

In one Swiss study, a cream made from sage (Salvia officinialis) and
rhubarb (Rheum palmatum) lessened the length of time that herpes
lesions were present to the same extent as the medication acyclovir.
More research on this topic would be helpful.

Siberian Ginseng (Eleutherococcus senticosus/Acanthopanax senticosus)

Although not all studies agree, one 6-month study of 93 people with
HSV-2 (which, again, generally causes genital herpes lesions) found
that Siberian ginseng reduced the frequency, severity, and duration of
outbreaks. This herb should not be given to children and should not be
taken if you have high blood pressure, obstructive sleep apnea
(repeated, prolonged periods when breathing stops while sleeping),
narcolepsy (frequent day time sleeping), are pregnant or
breastfeeding.

Tea Tree Oil (Melaleuca alternifolia)

Use of tea tree oil, applied topically in gel form, has some
popularity for herpes lesions on the lips. Although more research is
needed before definitive conclusions can be drawn, there is some
scientific basis for this use. First, in test tubes, tea tree oil has
the ability to fight both strains of herpes viruses (HSV 1 and HSV 2).
Secondly, there has been one small study comparing use of tea tree oil
gel to placebo in those with recurrent oral herpes. The herpes lesions
of those who used the tea tree oil healed more quickly than those who
used placebo. Studies of larger numbers of people are necessary,
however, along with studies that compare tea tree oil to medications
used for herpes.

Others

Additional herbs that may be recommended by an herbal specialist for
the treatment of either oral or genital herpes include:

Pau d'Arco (Tabebuia avellaneda)  
Although Echinacea (coneflower) has gained some popularity for the
prevention of herpes, there is no scientific evidence that it works
for this purpose. In fact, despite test tube studies suggesting that
Echinacea has the ability to fight the herpes virus, one study of
people with herpes did not show any reduction in the number of their
outbreaks.

To try to prevent herpes outbreaks, herbalists may also consider
remedies that help strengthen your immune system or act as adaptogens
(substances that help relieve stress).


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Acupuncture

Case reports in the scientific literature suggest that acupuncture may
help reduce the length of time of a herpes outbreak and decrease your
chances for recurrent lesions. Additional research would be helpful.


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Massage and Physical Therapy

Regular massage can help alleviate chronic stress; therefore, in
theory, receiving massage on a regular basis may help avoid recurrent
outbreaks. Aromatherapy, a massage method using essential oils, is one
that has been evaluated for these purposes and results thus far
suggest that this is a useful technique.


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Homeopathy

Although few studies have examined the effectiveness of specific
homeopathic therapies, professional homeopaths may consider the
remedies described below for the treatment of herpes based on their
knowledge and experience. One study of 53 people with genital herpes
did show that the majority experienced improvement in their symptoms
and were less likely to have recurrent outbreaks when treated with
homeopathy. Participants in this study were followed for up to 4
years.

Before prescribing a remedy, homeopaths take into account a person's
constitutional type. A constitutional type is defined as a person's
physical, emotional, and psychological makeup. An experienced
homeopath assesses all of these factors when determining the most
appropriate remedy for each individual.

For lesions around the lips and mouth:

Natrum Muriaticum -- for eruptions at the corners of the mouth that
occur during periods of emotional stress and tend to worsen in the
daytime
Rhus toxicodendron -- for eruptions consisting of many small blisters
that itch intensely at night
Mercurius -- for children who drool and may have a fever
Sepia -- for outbreaks that do not improve with other homeopathic
remedies; this remedy is most appropriate for individuals who tend to
have a lack of energy and don't tolerate cold weather
For genital lesions:

Graphites -- for large, itchy lesions in individuals who are
overweight
Natrum Muriaticum -- for eruptions that occur during periods of
emotional stress and symptoms that tend to worsen in the daytime
Petroleum -- for lesions that spread to anus and thighs; symptoms tend
to worsen in winter and improve in summer
Sepia -- for outbreaks that do not improve with other homeopathic
remedies; this remedy is most appropriate for individuals who tend to
have a lack of energy and don't tolerate cold weather


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Mind/Body Medicine

Support Groups

Having genital herpes can impact your social and emotional life and
many find it quite difficult to cope with this. In fact, if you have
herpes, it is quite common to feel depressed, angry, and even guilty.
Worrying about possible rejection by someone with whom you are hoping
to become intimate is also typical. Joining a support group in which
members share common experiences and problems can help alleviate these
stresses associated with having genital herpes. Seeing a couples'
therapist with a committed partner may also be helpful for working
through some of these issues.

Relaxation Techniques

Using relaxation techniques, such as yoga, guided imagery, and
meditation, on a daily basis may help you feel better overall and cope
with your stresses related to having herpes.

Self-Hypnosis

In a 6-week training program to learn how to hypnotize oneself using
guided imagery, participants with frequently recurring genital herpes
were able to reduce their outbreaks by nearly 50% and improve their
mood, including reducing feelings of depression and anxiety.

Other

Individual therapy with a psychiatrist, psychologist, or social worker
as well as biofeedback are other therapeutic approaches that can help
reduce symptoms associated with herpes and reduce one's tendency to
withdraw from social situations if you have genital herpes.


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Traditional Chinese Medicine

A traditional Chinese physician would likely prescribe topical herbal
remedies consisting of a combination of herbal extracts to treat oral
or genital herpes.


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Other Considerations


Pregnancy

Herpes viruses can be transmitted to a newborn during vaginal delivery
in mothers infected with herpes viruses, especially if the mother has
active lesions in the vagina at the time of delivery. If you do have
active lesions at that time, delivery by cesarean section (often
called C-section) will be recommended to avoid infecting your baby.


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Special Populations

Newborn baby – herpes infections contracted during delivery from the
mother can lead to meningitis, herpes infection in the blood, chronic
skin infection, and may even be fatal.

If your immune system is suppressed (from, for example, human
immunodeficiency virus [HIV], receipt of chemotherapy for cancer, long
term use of high doses of steroids, or use of medications that
intentionally suppress the immune system such as following organ
transplant) are more likely to suffer from complications of herpes and
are more likely to have severe, frequent outbreaks.


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Warnings and Precautions

If you are diagnosed with genital herpes, you should be tested for
other sexually transmitted diseases like chlamydia and gonorrhea.


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Prognosis and Complications

Herpes is a chronic, recurrent infection. The initial symptoms usually
appear within 1 to 3 weeks of exposure to the virus and last 7 to 10
days (for oral lesions), 7 to 14 days (for genital lesions). Usually
the number of outbreaks is greatest in the first year and higher for
HSV-2 genital lesions than HSV-1 oral lesions. Each year after that,
the number of outbreaks typically diminishes and they become
progressively less severe. But, you can never completely get rid of
the virus.

Complications of herpes include:

Herpetic keratitis – herpes infection of the eye leading to scaring
within the cornea and possible blindness
Persistent herpes infection, without lesion-free periods
Herpes infection in the esophagus
Herpes infection of the liver which can lead to cirrhosis (liver
failure)
Encephalitis and/or meningitis – serious brain infections
Lung infection
Eczema herpetiform – widespread herpes across the skin


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