Herpes Simplex Virus Infection

2. HERPES SIMPLEX VIRUS INFECTIONS
INRODUCTION
Herpes viruses are a group of DNA viruses that cause a variety of infections in humans
and animals. There are several types of herpes viruses, each capable of causing distinct
conditions. The two most common herpes viruses that infect humans are herpes
simplex virus (HSV) and varicella-zoster virus (VZV). HSV is further divided into
HSV-1 and HSV-2.

3. TYPES
Herpes Simplex Virus (HSV):
1.HSV-1: This strain commonly causes oral herpes, characterized by cold
sores or fever blisters around the mouth and on the lips. However, it can
also lead to genital herpes through oral-genital contact.

4. HSV-2: This strain primarily causes genital herpes, resulting in
painful sores in the genital area. However, HSV-2 can also cause
oral herpes through oral-genital contact.

5. ORAL HERPES (HSV-1):
Cause: Primarily caused by herpes simplex virus type 1 (HSV-1).
Symptoms: Often results in cold sores or fever blisters around the mouth
and lips. Symptoms may include tingling, itching, or burning sensations
before the appearance of blisters. These blisters eventually break, forming
painful sores that can crust over before healing.

6. Transmission of oral herpes: Typically transmitted through
oral contact, such as kissing or sharing utensils, with an
infected person. It can also spread to the genital area through
oral-genital contact, resulting in genital herpes caused by
HSV-1.

7. GENITAL HERPES (HSV-2 OR HSV-1):
Cause: Primarily caused by herpes simplex virus type 2 (HSV-2. Genital herpes
can also result from HSV-1 through oral-genital contact.
Symptoms: Results in painful sores or blisters in the genital area, including the
vulva, vagina, penis, or anus. Symptoms may also include itching, burning, or
tingling sensations before the appearance of lesions. Like oral herpes, these blisters
eventually break, forming ulcers that scab over and heal.

8. Transmission: Primarily transmitted through sexual contact,
including vaginal, anal, or oral sex. It can also spread to the
mouth through oral-genital contact, causing oral herpes
caused by HSV-2.

9. CAUSATIVE AGENT
Both HSV-1 and HSV-2 are DNA viruses with a similar
structure and mode of transmission. These viruses can infect
various parts of the body, establishing latent infections in nerve
cells after the initial infection.

10. PATHOPHYSIOLOGY OF HSV INFECTION
Entry and
initial
infection
Replication
and spread
Establishment
of latency
Reactivation
and recurrent
outbreaks
Immune
response

11. 1. Entry and Initial Infection:
Exposure: HSV is transmitted through direct contact with infected skin,
mucous membranes, or bodily fluids.
Entry Points: The virus enters the body through breaks in the skin or
mucous membranes, where it gains access to epithelial cells.

12. 2. Replication and Spread:
Attachment and Entry: HSV binds to receptors on the cell surface, allowing
entry into host cells. Once inside, the virus releases its genetic material (DNA)
into the host cell's nucleus.
Replication: Viral DNA replicates within the host cell, producing viral proteins
and new viral particles.
Cell-to-Cell Spread: The virus can spread to adjacent cells, causing lytic
infection and tissue damage. This process leads to the formation of characteristic
lesions or blisters associated with HSV infection.

13. 3. Establishment of Latency:
Nerve Cell Invasion: After the initial infection, HSV travels along sensory
nerves and establishes latent infection within nerve cells, usually in
sensory ganglia near the initial site of infection.
Viral Dormancy: During latency, the viral DNA persists within the nuclei
of neurons without causing active replication or symptoms. The virus
evades the immune system during this dormant phase.

14. 4. Reactivation and Recurrent Outbreaks:
Triggers for Reactivation: Various factors, including stress, illness,
hormonal changes, UV exposure, or immune suppression, can trigger the
reactivation of latent HSV.
Viral Replication and Recurrence: Reactivation leads to the transport of
the virus back along the nerve fibers to the initial site of infection, resulting
in recurrent viral replication and the emergence of new lesions or
outbreaks.

15. 5. Immune Response:
Innate and Adaptive Immune Responses: The body's immune system plays a
crucial role in controlling and limiting HSV infection. Innate immune responses
initially combat the virus, followed by adaptive immune responses involving
antibodies and immune cells that help control but do not eliminate the virus.

18. CLINICALMANIFESTATIONS
Primary Infection:
•Oral Herpes (HSV-1):
• Painful blisters or cold sores around the mouth, lips, gums, or
throat.
• Fever, swollen lymph nodes, and general malaise.
• Pain or soreness during eating or drinking.
• Sometimes, lesions can spread to the inside of the mouth or on
the tongue.

19. Genital Herpes (HSV-2):
•Painful blisters or sores in the genital area, including the vagina,
penis, buttocks, and anus.
•Painful urination.
•Fever, headache, muscle aches, and swollen lymph nodes in the
groin area.
•Lesions may cause discomfort or itching.

20. Recurrent Infections:
•Recurrent episodes are typically less severe than the primary
infection.
•Individuals often experience prodromal symptoms (tingling,
burning, or itching sensation) before the appearance of lesions.
•Lesions tend to be milder and heal faster than during the
primary infection.

21. Systemic Symptoms:
•Some individuals may experience flu-like symptoms
during primary or severe recurrent infections, including
fever, headache, fatigue, and muscle aches.

22. Neonatal Herpes:
•Neonates born to mothers with active genital herpes can develop
severe infections.
•Symptoms can include skin, eye, mouth, or central nervous
system involvement.
•Neonatal herpes can be life-threatening and requires immediate
medical attention.

23. Herpetic Whitlow:
•A herpes infection on the fingers, often seen in healthcare
workers or individuals who come into contact with active
lesions.
•Painful lesions on the fingers, causing redness, swelling, and
sometimes blistering.

24. DIAGNOSTIC EVALUATIONS
Viral
Culture
Polymerase
chain
reaction
Direct
fluorescent
antibody
test
Serological
tests

25. MANAGEMENT OF HSV INFECTIONS
Anti viral medications
• Topical
medications(Acyclovir,
penciclovir)
• Oral medications ( acyclovir,
valacyclovir, and famciclovir )
Pain Management
• Acetaminophen or Ibuprofen

26. Supportive Measures:
•Keeping the affected area clean and dry can aid in preventing
secondary bacterial infections.
•Applying cool compresses or ice packs to the lesions may
provide relief from pain and inflammation.
•Adequate hydration and maintaining good hygiene are essential
during an outbreak.

27. Prevention of Transmission:
•Avoid direct contact with active lesions to prevent transmission
to other individuals.
•Practicing safe sex, including the use of condoms, can help
reduce the risk of transmitting genital herpes.

29. COMPLICATIONS OF HSV INFECTIONS
Recurrent
outbreaks
Spread of
infection
Complications
in pregnancy

30. Complications in Pregnancy: Pregnant women with genital
herpes can transmit the virus to their babies during childbirth.
This can lead to neonatal herpes, a serious condition that may
result in brain damage, developmental issues, or even death in
newborns. Caesarean section delivery may be recommended
for women with active genital lesions close to delivery to
prevent transmission.

31. Systemic Infections: In rare cases, especially in
individuals with weakened immune systems, HSV can
cause systemic infections that spread throughout the
body. This can lead to conditions like disseminated
herpes infection, affecting multiple organs and potentially
becoming life-threatening if not treated promptly.

32. Meningitis and Encephalitis: HSV can cause
inflammation of the brain (encephalitis) or the
membranes surrounding the brain and spinal cord
(meningitis). Herpes simplex encephalitis is a severe
and potentially life-threatening condition that requires
immediate medical attention.

33. Increased Risk of HIV Transmission: HSV infection,
particularly genital herpes, can increase the risk of
acquiring and transmitting the human immunodeficiency
virus (HIV) due to the presence of open sores or lesions
that serve as entry points for HIV.

34. Psychological Impact: Living with recurrent herpes
outbreaks can lead to psychological distress, stress,
anxiety, and social stigma due to the contagious nature
of the infection.

35. Regular testing
and
communication
Avoiding
direct
contact
with lesions
Safe sexual
practices
Antiviral
medications
Stress
management
and healthy
lifestyle
Maintaining
good
hygiene
PREVENTION
OF HSV
INFECTIONS