Herpes Simplex (HSV) Type 1 and 2
Herpes simplex is a double stranded DNA virus that is responsible for a primary and recurrent infection in humans. Primary infection is acquired in childhood from close contact with infected adults or other children, or in adults from contact through intercourse or kissing an infected individual. The virus is always present in an active blister or ulcer and is also shed in some cases from individuals without a clinical lesion.
SYMPTOMS—The virus is divided into two types. Type 1 is usually associated with a childhood infection and occurs on the lips as a cold sore or fever blister. Type 2 is associated with an adult infection and is usually of the genital type. This classification is not restrictive as either of the viruses can cause an infection on any area of the skin or mucous membranes. The infections are also divided into a primary or initial infection and a recurrent infection. The primary infection of type 1 and type 2 HSV tends to be severe with multiple grouped vesicles on an erythematous base, regional lymphadenopathy, fever, and malaise. The time from exposure to development of symptoms is 3 to 10 days. The duration of the primary infection is from 2 to 6 weeks. Following the primary infection the virus enters a dormant stage, residing in the dorsal root ganglia of the sensory nerve that supplied innervation to the blister site. The virus can remain dormant for many years with the type 1 HSV, but tends to reoccur 3 to 4 times per year with the type 2 HSV. Recurrent lesions may appear without cause or follow trauma, stress, menses, sunburn, or intercourse. The recurrent infection is usually much less severe, manifested by pain locally and some regional adenopathy. The lesions appear in the same location with each recurrent eruption. These lesions resolve spontaneously in 5 to 7 days.
TREATMENT—At the present time there is no cure for HSV infection. In most cases, relief of pain with analgesics or topical anesthetics is adequate, especially for recurrent lesions. Primary infections can be treated with acyclovir. There are topical and oral preparations available. Recurrent infections if very frequent and severe may be candidates for oral acyclovir prophylaxis.
NOTE: DO NOT TOUCH THE LESION OR ANY VESICULAR OR ULCERATED LESION WITHOUT EXAM GLOVES. HSV CAN EASILY BE TRANSMITTED TO YOUR HANDS, CAUSING A HERPETIC WHITLOW LESION.
Herpes Zoster
Shingles is an acute viral infection of the central nervous sytem characterized by vesicular eruptions and neuralgic-type pain in areas supplied with peripheral sensory nerves. This infection is caused by the same virus that causes chickenpox (varicella) and is most commonly encountered in persons over the age of 50.
SYMPTOMS—Chills, fever, malaise, and gastrointestinal disorders may precede distinctive features of the disease. On about the fourth or fifth day, crops of vesicles appear on an erythematous base in the area of the involved nerve. Pain may be present at this time; however, the skin in the involved area is extremely sensitive.
TREATMENT—No specific remedy exists. The disease normally clears with no permanent damage except for scarring or postherpetic neuralgia. A corticosteroid, such as prednisone, may help to shorten the duration and relieve some of the symptoms. Soothing lotions and powders are often effective, and aspirin or other analgesics may be administered for pain. NOTE: Before giving a corticosteroid, rule out herpes simplex.
Verrucae
Warts are very common, contagious, benign epithelial tumors that may persist as single lesions or develop satellites. Occasionally the warts may disappear spontaneously.
TREATMENT—The warts themselves may be easily removed; however, the virus often remains, producing recurrent warts at the same or different sites. Therefore, it is often advisable to leave single warts alone. Trichloroacetic acid should be applied to warts every 3 to 4 days, followed by phenol neutralized with alcohol or nitric acid when the wart whitens. If the warts are in warm, moist anogenital areas, podophyllum resin in tincture of benzoin is often effective. Plantar warts, found on the soles of the feet, are warts that have been flattened by pressure and are usually very painful.