Herpes simplex recurrence

, Associate Editor(s)-In-Chief: ; Lakshmi Gopalakrishnan, M.B.B.S.

Overview
Genital herpes can cause recurrent painful genital sores in many adults, and herpes infection can be severe in patients with suppressed immune systems. It is important that women avoid contracting herpes during pregnancy because a newly acquired infection during late pregnancy poses an increased risk of transmission to the baby. If a woman has active genital herpes at delivery, a cesarean delivery is usually indicated. Patients infected with herpes are more susceptible to HIV infection; hence, herpes may indirectly play a role in the spread of HIV.

HSV Latency

 * Following active infection, herpes viruses become quiescent to establish a latent infection in sensory and autonomic ganglia of the nervous system. The double-stranded DNA of the virus is incorporated into the cell physiology by infection of the cell nucleus of a nerve's cell body.


 * HSV latency is static, during which no virus is produced and is controlled by a number of viral genes including Latency Associated Transcript (LAT).

Triggers for HSV Reactivation
The causes of reactivation from latency are uncertain but several potential triggers have been documented.


 * Physical or psychological stress can trigger an outbreak of herpes.


 * Local injury to the face, lips, eyes or mouth, trauma, surgery, wind, radiotherapy, ultraviolet light or sunlight are well established triggers.


 * Some studies suggest changes in the immune system during menstruation may play a role in HSV-1 reactivation.


 * In addition, concurrent infections such as viral upper respiratory tract infection or other febrile diseases, can cause outbreaks, hence the historic terms "cold sore" and "fever blister".

Frequency and Severity of Recurrence

 * The frequency and severity of recurrent outbreaks may vary greatly depending upon the individual.


 * Outbreaks may occur at the original site of the infection or in close proximity to nerve endings that reach out from the infected ganglia.


 * In the case of a genital infection, sores can appear near the base of the spine, the buttocks, back of the thighs, or they may appear at the original site of infection.


 * Immunocompromised individuals may experience episodes that are longer, more frequent and more severe.

Treatment

 * Saline bathing, Vaseline, analgesia, 5% lidocaine ointment may be generally adviced.


 * Antiviral medication has been proven to shorten the duration and/or frequency of the outbreaks.


 * You can read more in detail about the episodic and suppressive antiviral treatment for the management of HSV recurrence here