Monday, April 9, 2012

Herpes simplex

Alternate names 
Herpes simplex virus should not be substituted by other herpes viruses, including human herpes virus 8 which is believed to cause Kaposi's sarcoma, and varicella-zoster virus which is responsible for the appearance of chicken pox in children and shingles in adults.

It is an infection caused by herpes simplex virus, and is characterized by the eruption of small, often painful blistering of the skin and mucous membranes. Rarely is the cause of serious infections of other organs.

Description of disease
There are two main types of herpes simplex virus. Herpes simplex virus type 1 (HSV-1) is usually associated with infection of the lips, mouth and face, and this form of disease called oral herpes. The disease is very common in children between 1 and 3 The life and often cause damage within the oral cavity and gingivitis. HSV-1 is transmitted through saliva (kissing), and contaminated food and drink (the virus is also transmitted through coughing and sneezing). Primary HSV-1 infection usually occurs during childhood and is not considered a sexually transmitted disease.

Herpes simplex virus type 2 (HSV-2) is associated with damage to the genital mucosa (the lining of the genital organs) and transmitted by sexual contact. This form of disease is also called genital herpes. Although it usually occurs as oral herpes, HSV-1 is also responsible for approximately 5% to 10% of genital herpes. Both types of viruses are highly contagious and the first symptoms appear 1 to 2 weeks after contact with an infected person.

Most people are up to 20 years of age are infected with HSV-1. In addition to oral and genital mucosa, the virus can cause infection of the eye including the eyelids, conjunctiva and cornea. Infections are frequent and fingers affecting health care workers (due to exposure to secretions from the lungs and mouth during procedures) and young children. The herpes virus can infect the fetus and cause congenital abnormalities. Herpes simplex virus type 2 can be transferred to the newborn during vaginal delivery if there is active infection in the mother. Rarely can develop encephalitis (brain inflammation) as a result of infection.

Infection occurs when the virus enters the skin through open wounds or mucous membranes. There is strong evidence that the virus is portable even when no symptoms. The virus is spread within the nerve fibers of the body, until the skin and mucous membranes. The virus remains dormant in the body after an active infection and symptoms can be repeated any time. In 20% to 40% of people are coming back from time to time after the initial symptoms of HSV-1 infection. In patients with HSV-2 genital herpes, the possibility of a return of infections and higher and it is up to 80%. Symptoms usually appear in the same place. No one knows exactly what starts this re-infection, but many factors are associated with this process: exposure to sun and wind, fever, injury, menstruation, a weakened immune system, emotional stress and certain foods and medicines.

Although statistics vary, research shows that approximately 85% of all adults were exposed to HSV-1 infection (oral herpes), and 25% HSV-2 infection (genital herpes). It is estimated that 86 million people worldwide have genital herpes.

Who gets?
Anyone can suffer from herpes. The common incidence of both types of herpes infections in less developed communities can reach almost 100% in more developed socioeconomic communities may be between 30% and 50%. The most common route of transmission of the virus through contact with body fluids of an infected person.

Specific risk factors for genital herpes (HSV-2)
In developed countries, sexually transmitted disease caused by bacteria can be successfully controlled, but caused by viruses are on the rise. HSV-2 is primarily transmitted through sexual contact, which means that the higher incidence of infection in those people who have multiple sexual partners. Women are 1.7 times more likely to be infected with the virus than men. Women also have a 80% to 90% chance of HSV-2 infection after unprotected sex with an infected partner. Moreover, it is estimated that asymptomatic female carriers of the virus make up 10% to 20% of the general population. People who belong to lower socioeconomic strata are more likely to be infected.
Wrestlers, rugby players and other athletes who participate in contact sports without the use of protective equipment, have a high risk of developing abnormal forms of HSV-1 infection by herpes Gladiatorum call.Patients with weakened immune systems are also at greater risk of infection with herpes, which in these cases becomes serious and permanent illness that is difficult to treat.

Symptoms of infection vary during each of three stages:
initial or primary stage of infection;
latent (latent) stage;
return to the stage of infection (recurrence).

Symptoms of primary infection
The initial symptoms are very painful, especially in young children. Bubbles usually occur on the lips and may occur in the language. The bubbles eventually burst and open sores. It then creates a yellowish membrane that everything went in 3 to 14 days. It can also be present and increased drooling and bad breath. In children, infection is usually located in the oral cavity, while in adolescents the most common infections in the upper throat. Rarely the infection can be accompanied by difficulty swallowing, shivering, muscle pain or hearing loss.

Primary HSV-2 infection usually occurs in the genital area 2 to 8 days after exposure to the virus. Fever, itching, pain in lower abdomen, fatigue, difficulty with urination and fungal infection in women may precede or follow the outbreak of the characteristic bubbles. In women, blisters usually appear around the opening of the vagina, anus, the vagina or cervix of the uterus. The bubbles burst at these places very quickly and soon blisters filled with fluid white-gray, and creates a scab. The bubbles are males usually occur on the glans penis or body, and very rarely on the base. During the second week of disease, there is swelling of lymph nodes in the groin. Symptoms can last up to 6 weeks. Many women are not even aware they are infected with HSV-2 because the lesions are located inside the vagina. Lesions in this area can often cause a vaginal discharge, but it can not be seen, and the pain caused is minimal. It is important to review the results and make a woman with vaginal discharge, as much as 23% of infected women can transmit the virus within 3 months from the first episode of infection, even if the lesions are completely healed. After a period of 3 months the likelihood of disease transmission is much lower. In 10% to 18% of lesions occurring elsewhere than in the genital area. In such cases the lesions are usually found in the urethra (urinary tube) and cause painful burning during urination. Inflammation of the lining of the uterus (the endometrium) and fallopian tubes is very rare. If HSV-2 infection is present for a long time, the first active episode can be very mild because the immune system produce antibodies to the virus. In general, these infections are less portable, quickly go and cause fewer symptoms.

Latent (latent) stage
During the period of latency, the herpes virus causes no symptoms and is not portable. Over time, however, this period ends and the virus begins to spread. It becomes portable, but still no obvious symptoms. HSV-2 is often transmitted in the absence of any symptoms, and especially to women. This is a very dangerous stage because there are no warning bubbles. A recent study showed that the spread of asymptomatic women responsible for one third of all HSV-2 infection. Results of other studies indicate that the same is probably true for men.

The symptoms of repetitive (recurrent) infections
Recurrent HSV infection have most of the same symptoms in the same place as the primary infection, but symptoms were milder and shorter duration. The anatomical location and type of virus affecting the recurrence of infection. Fever is rarely present although local lymph nodes may be affected. Recurrent infections may occur at intervals that are measured in days, weeks or years, but for most people is the highest incidence of infection during the first year, to be gradually reduced over time.
The most common symptoms are:
skin rash or itching to change;
tickling sensation or burning before symptoms appear;
sores in the mouth;
genital changes (men and women);
anywhere on the skin;
usually in the mouth, lips, joints (conjunctiva) and the cornea and in the genital area;
- Small bubbles merge into large;

- Yellow scabs that form on the bladder at the beginning of the healing process (7 to 10 days);
mild fever;
increase in the lymph nodes in the neck or groin.
Additional symptoms that correlate with disease:
vaginal discharge;
sore throat.
Herpes virus infections can be very dangerous for people with weakened immune systems (patients with ADS, chemotherapy, radiotherapy, corticosteroids, therapy and so on.). In these patients, the virus can affect any organ, including:
eye (herpetic keratitis);
persistent infection of the lining of the nose, mouth and throat;
esophagus (herpetic esophagitis);
liver (herpetic hepatitis);
the brain (encephalitis).
Symptoms of HSV-2 infection in a newborn
Clinical signs of neonatal HSV-2 infection usually becomes noticeable between 5 and 17 days of life although they may develop very early, after 24 hours or very late, only after 34 days. With only 40% to 50% of newborn babies of infected mothers, actually develops the disease. In half of these children can be seen the development of skin lesions-sluznińćnih, ranging from slightly raised spots to large bubbles. They can be placed anywhere. Symptoms that may be present are:
child shows anxiety;
skin sprinkled with spots;
discharge from the eye;
sensitivity to light;
shortness of breath;
enlarged spleen;
Given the fact that the disease can be life threatening patients or lead to permanent damage, any newborn whose mother is infected or suspected of being infected, it must be thoroughly examined in the search for symptoms.

Some cases are relatively mild illness and treatment is not necessary. Anesthetics dissolved in a liquid mouthwash such as 2% lidocaine solution or baking soda can relieve the pain of lesions that are found in the oral cavity.Mouth rinses on the basis of alcohol may not be used. It is recommended to gently wash skin with soap and water changes. Also, lotions for dry skin can alleviate the pain of skin lesions. Warm baths may relieve the pain of genital herpes.

Oral forms (which are taken by mouth) and famcyclovir acyclovir may be prescribed to suppress recurrent outbreaks of genital herpes. Treatment of genital herpes does not affect the disease itself, but it can alleviate symptoms. Treatment may reduce discomfort and pain and shorten healing time.

Topical (local) administration of acyclovir is also effective, but must be applied more frequently than 5 times a day, which has been commonly prescribed. During the first 24 hours of application of fat each hour (while the patient is awake) can shorten the contagious period for the patient environment.

If the occurrence of secondary bacterial infections of the skin, indicated by a local or systemic antibiotics.

recurrence of disease (often);
Encephalitis (rare);
spread of the virus in other organs of persons with weakened immune systems;
sometimes the inability to control urination.
Changes in general go on their own after 7 to 10 days.
Once a person is infected, the virus remains in her body throughout life and may lead to recurrence of active infection. Some people never came back to infection, and some people have 4 to 5 reps per year. Recurrent infection is more common after exposure to sunlight and stressful events.

Prevention is difficult to implement, given the fact that the virus can spread to the environment when the infected person there are no signs of infection. However, avoiding direct contact with an open lesion will lower the risk of infection. People with genital herpes should avoid sexual contact during the presence of active infection. People who know they have genital herpes, but no clinical signs of infection, it must notify their partners. This will enable both partners to use the permanent protection of the contact in the form of condoms, and will thus prevent the spread of disease. Using condoms is the best protection against genital herpes. Proper use of condoms can help prevent the spread of the disease.
Pregnant women with herpes simplex infection must often be controlled. If the disease is active at the time of delivery terms, it is recommended to do a caesarean section to avoid possible infection of the newborn.

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