Herpes Simplex Skin Infection

Herpes simplex is a virus, which causes a skin infection. It spreads from person to person by direct skin, sexual, or mouth contacts. There are two types of herpes simplex viruses (HSV). They are HSV type 1 and HSV type 2.

HSV type 1 is spread by direct contact and contaminated droplets. Most people achieve HSV type 1 in early childhood. However, the infection usually occurs without symptoms. Occasionally, it leads to fever with either clusters of painful blisters on the face or an inflammation and aching blisters in the mouth, including the gums (Gingivostomatitis). The fever is usually self-limiting.

HSV type 2 infections take place generally following puberty and normally affect the genital region. These infections are usually with no symptoms and transmitted sexually. However, HSV type 1 infection occurs in the genital area due to oral sex.

Symptoms of HSV infection

Initial exposure to HSV does not always cause skin symptoms, but viruses can remain dormant in some parts of the sensory nerves called nerve ganglia. Later in life, HSV may become active again and show up as an infection on the skin. The common areas of the infection are the lips (cold sores or fever blisters) and the genital region (genital herpes). Sometimes, the first infection is usually un-noticed as it may simply produce a short-term redness of the skin. However, it can produce a patient feel very ill with fever, inflamed and swollen lymph glands, and painful blisters on the lips and in the mouth or on the skin.

Once the HSV infection is active again, the initial symptom is a stinging or burning pain at the infected site. It is followed by tiny blisters and pink bumps. These blisters rapidly dry and crust over. The infected areas normally heal in a few days.

After a person is infected, an immunity develops against the virus. It usually prevents recurrent infections. In certain people, this immunity is poor, and they get repeated infections of HSV, frequently manifest as fever blisters (cold sores). Cold sores occur as clusters of tiny blisters on the lips and outer edge of the mouth. Repeated infections usually take place in roughly the same area each time. Immunosuppression (for example, HIV, chemotherapy, drugs which cause immunosuppression) can also lead to recrudescence of HSV infection. HSV can enter sites of injury and cause painful blisters, which may be seen, for example, on the fingers of healthcare professionals. This condition is known as herpetic whitlow.

HSV can infect the eye, causing sensitivity to light, pain, and discharge. It may lead to scarring of the eye (corneal ulceration). HSV infection can cause other rare complications like chronic perianal ulceration in AIDS patients, eczema herpeticum and erythema multiforme.

How to diagnose HSV infection?

Normally, the appearance of the infected areas is sufficient to diagnose the illness. Occasionally, a swab is taken from the infected surface. However, it takes a few days to get the result. If you see any suspected lesions in your genital area, you can quickly go to a sexual health clinic or the local Genitourinary Medicine (GUM).

Management of HSV infection

Symptoms of HSV infection usually clear within a few days or weeks with or without medications. However, HSV will remain dormant in the nerves. In most individuals, repeated infections are infrequent and mild. Sometimes, recurrences do not occur at all. Recurrent HSV infections can normally be prevented by oral antiviral medications or lifestyle modifications.

An antiviral drug known as Valaciclovir is used for the initial infection and genital herpes simplex. Cold sores or fever blisters are treated with an antiviral cream called Aciclovir. It should be used early to be effective in shortening the infection. Recurrent cold sores are managed with oral antiviral therapy. Recurrences of genital herpes become less frequent gradually. Aciclovir should be administered directly into a vein (intravenous route) in immunosuppressed people with HSV infection.

Some factors can encourage the herpes simplex virus to become more active. They are:

• Sunburn
• Some infections like flu or colds
• Being tired
• A skin injury, at the area where the herpes simplex virus presents itself at the surface.

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