Beatadje@email 2007-09-15 13:05:02
Just watch the picture for a 10 minutes.
Beatadje@email 2007-09-16 21:39:49
Last night, after about a little less then 10 minutes, looking
into the mirror, I have noticed that the crust that was on
my right side of the lips was absolutelly completely gone! 100%!
I wanted to post the results here,right away, but I decided I will do
it today, insted.
I had a herpes labialis (oral herpes) on my lips that lasted about
a week and in the final period I had a little crust, as it usually
forms at the end of an OB.
I was checking my lips tens and tens of times on a daily basis, to see
how it looks.
For the first time the crust was, as I’ve above said, completely gone.
That is fantastic news!
Here are now, info’s abot the spleen related problems with the herpes
Just a little bit of information that can be seen as crucial in
what had happened during my reiki experiment. I have capitalised the
ENLARGED SPLEEN in the next paragraph.
Symptoms of HSV-2 in the Newborn.
Clinical evidence of neonatal HSV-2 infection usually becomes apparent
between five to 17 days of life, but it may develop as early as 24
hours or as late as 34 days. About half of infected infants develop
lesions, which may range from raised spots to large isolated blisters.
They can be anywhere on the skin, eyes, or in the mouth. The other
half do not develop lesions until later in the course of the
infection. The absence of lesions, therefore, should not be considered
a guarantee that HSV has not been transmitted. Temperature instability
can be the first indication. Parents and physicians should also watch
for irritability, blotchy skin, discharge in the eyes, sensitivity to
light, tearing, lethargy, jaundice, pallor, coughing, rapid breathing,
ENLARGED SPLEEN, seizures, or tremors. Because this infection can be
life threatening or cause lifelong disabilities, any newborn with an
infected or high-risk mother should be checked carefully for symptoms
[ see How Serious Is Herpes Simplex , below ].
I will repost the whole article in here ( it is about Prunella
Vulgaris or self heal herb used as folk treatment for treating herpes
WHAT IS HERPES SIMPLEX?
Herpes simplex virus (HSV) is a common cause of infections of the skin
and mucous membranes and an uncommon cause of more serious infections
in other parts of the body. The word herpes is derived from the Greek
word “herpein,” which means “to creep.” It is a reference to the
characteristic pattern of herpes simplex skin lesions, which are often
tiny blisters grouped together on an inflamed base. HSV is one of the
most difficult viruses to control and has plagued mankind worldwide
for thousands of years. There are two distinct types of the virus:
herpes simplex virus 1 (HSV-1) and herpes simplex virus 2 (HSV-2). As
a rule, HSV-1 infects the oral cavity and is not sexually transmitted,
while HSV-2 attacks the genital area and is sexually transmitted.
Either type, however, can occasionally be found in either area or at
other sites. Of some concern, in fact, is an increase in genital HSV-1
cases, so that it now causes a quarter of all genital herpes cases.
For purposes of simplicity, however, this report will occasionally
refer to HSV-1 as oral herpes and HSV-2 as genital herpes. (Herpes
simplex is not to be confused with other herpes viruses, including
human herpesvirus 8, now believed to cause Kaposi’s sarcoma, and
herpes zoster, the virus responsible for shingles and chicken pox.)
Once HSV enters the body, it penetrates vulnerable cells in the lower
layers of human skin tissue and busily attempts to replicate itself in
the cell nuclei. This process can destroy host cells, causing
inflammation and fluid-filled blisters or ulcers in these areas. Once
the fluid is absorbed, scabs form and the blisters disappear without
scarring. It should be noted that in the majority of infections, the
virus never causes any symptoms at all.
The viral particles are carried from the skin through branches of
nerve cells to clusters at the nerve-cell ends called ganglia. Here,
the virus persists in an inactive (latent) form, in which complete
viral replication does not occur but both the host cells and the virus
survive. Infection is not apparent during these periods. In many
cases, however, the virus begins multiplying again and in symptomatic
patients, flare-ups often recur. After an initial infection with oral
HSV-1, between 20% to 40% of patients experience recurrent flare-ups.
In patients with HSV-2 genital herpes, the recurrence rate is even
higher: up to 80%. It is not completely known what triggers this
renewed infection, but a number of different factors may be involved,
such as sunlight, wind, fever, local physical injury, menstruation,
suppression of the immune system, or emotional stress. The body does
mount an immune response to HSV, and in healthy people recurring
infections tend to become progressively less severe and less frequent.
The immune system, however, cannot eradicate the virus completely.
Scientists are closer to decoding the genetic structure of HSV and to
discovering how the virus works its way into specific white blood
cells. Scientists have isolated a protein called HveC that seems to
promote herpes simplex infection. It may become a prime target for
preventive or therapeutic interventions against herpes. Similarly, a
protein in the membranes of nerve and other cells has been identified
that may facilitate the entry of HSV into the cells.
WHAT ARE THE SYMPTOMS OF HERPES SIMPLEX VIRUS?
The symptoms of the infection vary during each of the three stages of
the virus: the initial or primary outbreak; latency; and recurrence.
Both herpes simplex virus 1 and 2 produce similar symptoms, but they
can vary in severity in different parts of the body [ see Table,
Symptom Stages of All Herpes Simplex Viruses
Symptoms of Primary Infection. Skin eruptions may appear three to 12
days after the initial exposure to the virus. Once HSV gains entry at
a site in the body, the virus spreads to nearby mucosal areas through
nerve cells. This characteristic spreading can cause fairly large
infected areas to erupt at some distance from the initial crop of
sores. For both types of herpes simplex, the first sign is fluid
accumulation (edema) at the infection site, which is quickly followed
by small, grouped blisters, the characteristic HSV lesions. These form
on an inflamed skin base, which is more visible in dry skin areas. The
blisters then dry out and heal rapidly without scarring. Blisters in
moist areas heal more slowly. The lesions may sometimes itch, but
itching decreases as lesions heal. When the crust falls off, the
lesions are no longer contagious. (The virus may still be active in
nearby tissue but such persistence is rare.) The primary skin
infection with either HSV-1 or HSV-2 lasts up to two to three weeks,
but skin pain can last one to six weeks in a primary HSV attack. Lymph
glands near the site may be swollen as well. Primary herpes is often
accompanied by fever rising to about 102 F, muscle aches, headache,
and flu-like malaise. These general symptoms usually resolve within a
Latency and Shedding. During the period known as latency, HSV produces
no symptoms at all and is not transmissible. At times, however, this
latent period ends and the virus goes through a process called
shedding. It begins to multiply and become transmittable, but without
any apparent symptoms. HSV-2, particularly in women, is more likely to
undergo this process. It is estimated that over 50% of people with
HSV-2 shed the virus at some time without having visible evidence of
blisters or inflammation. Shedding is an especially insidious stage,
and studies indicate that asymptomatic shedding with subsequent viral
transmission to another person possibly accounts for one-third of all
Symptoms of Recurring Infections. Recurrent attacks of HSV feature
most of the same symptoms at the same sites as the primary attack, but
they tend to be milder and briefer. Fever is rarely present in
recurrent episodes, although nearby lymph glands may become involved.
The anatomic site and the type of virus influence the frequency of
recurrences. Recurrences may occur at intervals of days, weeks, or
years, but for most people, they are more frequent during the first
year and then gradually decrease in subsequent years.
Symptoms of Oral Herpes
Oral herpes (herpes labialis) is most often caused by HSV-1 and
usually affects the lips and, in some primary attacks, the mucous
membranes in the mouth. A facial herpes infection on the cheeks or in
the nose may occur, but this condition is very uncommon.
Primary HSV-1 Infection . The primary (or initial) HSV-1 infection
does not usually produce symptoms. If it does, the symptoms can be
very painful, particularly in small children. Blisters form on the
lips but may also erupt on the tongue. The blisters eventually rupture
as painful open sores, develop a yellowish membrane before healing,
and disappear within three to 14 days. Increased salivation and foul
breath may be present. In children, the infection usually occurs in
the mouth, in adolescents, the primary infection is more apt to occur
in the upper part of the throat and cause soreness. Rarely, the
infection may be accompanied by difficulty in swallowing, chills,
muscle pain, or hearing loss.
Recurrent HSV-1 Infection. About 60% of HSV-1 infections recur within
a year. Recurrences are usually much milder than primary infections
and are known commonly as cold sores or fever blisters. They usually
show up on the lower lip and rarely affect the gums or throat.
Reactivation can be provoked within about three days of intense dental
work, particularly root canal or tooth extraction.
Symptoms of Genital Herpes
Primary HSV-2 Infection . Primary infection with HSV-2 usually occurs
in or around the genital area two to eight days after exposure to the
virus. Flu-like discomfort and fever, nerve pain, itching, lower
abdominal pain, urinary difficulties, and yeast infections in women
may precede or accompany the eruption of the characteristic skin
blisters. Blisters in men are usually on the head or shaft of the
p**** and only rarely at the base. In women, lesions may appear around
the vaginal opening, on the buttocks, in the v*****, or on the cervix.
These lesions ulcerate almost immediately. Later they become crusted
and fill with a grayish-white fluid. A new crop often occurs during
the second week and is accompanied by swollen lymph glands in the
groin. The symptoms may last as long as six weeks. In many cases,
women whose lesions occur inside the v***** may be unaware that they
have HSV-2. Lesions here can cause a discharge but are not visible and
cause minimal nerve pain. It is very important that women with vaginal
discharge be tested, since as many as 23% are able to transmit the
virus within a three-month period of a first episode, even after the
lesions have healed. The virus is less likely to be contagious after
this period of time. Lesions develop in places other than the genital
region in 10% to 18% of primary HSV-2 infections. In such cases,
blisters and sores in the urethra (the channel that carries urine) are
particularly common and can cause painful burning during urination.
Inflammation of the internal reproductive organs, including the uterus
lining (endometrium) and the fallopian tubes, is rare. If the HSV-2
infection has persisted for a long time without symptoms, the first
active episode may be quite mild because the immune system has
produced antibodies to the virus by that time. In general, such
primary infections are less transmissible, heal faster, and produce
Recurrent HSV-2 Infection. HSV-2 infections recur more often than
HSV-1, and 90% recur within the first year after primary infection.
Many patients report five to eight recurrences in the first year, but
some experience them as often as every two weeks. Others have only one
initial outbreak without any subsequent recurrences. The outbreak of
infection is often preceded by an early group of symptoms known as a
prodrome, which may include itching skin, pain, or an abnormal
tingling sensation. The prodrome, which may be as brief as two hours
or as long as two days, terminates when the blisters develop. After
blisters erupt, they heal in approximately six to 10 days. Men have
20% more recurrences of genital herpes than women, although the
symptoms in men are milder and of shorter duration. Even in women,
recurring symptoms are milder than primary ones. Occasionally, the
symptoms may not resemble those of the primary episode but produce
fissures and scrapes in the skin or general genital inflammation.
Symptoms of HSV-2 in the Newborn. Clinical evidence of neonatal HSV-2
infection usually becomes apparent between five to 17 days of life,
but it may develop as early as 24 hours or as late as 34 days. About
half of infected infants develop lesions, which may range from raised
spots to large isolated blisters. They can be anywhere on the skin,
eyes, or in the mouth. The other half do not develop lesions until
later in the course of the infection. The absence of lesions,
therefore, should not be considered a guarantee that HSV has not been
transmitted. Temperature instability can be the first indication.
Parents and physicians should also watch for irritability, blotchy
skin, discharge in the eyes, sensitivity to light, tearing, lethargy,
jaundice, pallor, coughing, rapid breathing, enlarged spleen,
seizures, or tremors. Because this infection can be life threatening
or cause lifelong disabilities, any newborn with an infected or
high-risk mother should be checked carefully for symptoms [ see How
Serious Is Herpes Simplex , below ].
Symptoms of Other Forms of HSV-1 and HSV-2
Location and type
Eye (ocular herpetic infection). Affects only one eye at a time.
Almost always HSV-1.
Primary: Inflammation of cornea (keratitis) causing sudden severe
pain, blurred vision, or corneal lesions. Cloudy layer can form over
the cornea. Swelling may occur around the eyes. Heals within 2-3
Recurrence: Usually keratitis in a single eye, but symptoms may be
present in the other eye as well. Branching, ulcerous lesions of the
cornea may occur later in the disease.
Finger (herpetic whitlow). One finger, usually thumb or index finger
in adults. Any finger in children. Usually HSV-2, but HSV-1 likely if
contracted by medical or dental personnel.
Primary: Itching or pain, swelling, flushing of the skin, localized
tenderness of the infected finger. Clear-yellowish or pus-filled
blisters may appear on fingertip lasting 2-3 weeks. Soft tissue around
fingernail may become painfully infected. Finger blisters may become
secondarily infected with common bacteria, causing fever and armpit
Recurrence: Sometimes intense burning nerve pain or excessive
Brain (HSV encephalitis). Usually HSV-1.
Fever, headache, stiff neck, seizures, partial paralysis, stupor or
coma. Other symptoms: smell and taste disturbances, odd mental states,
bizarre or psychotic behavior, loss of the ability to speak or
understand, memory loss, confusion, emotional volatility.
Lower back. Usually HSV-2.
Numbness, tingling of the buttocks or the perianal area, urinary
retention, constipation, and impotence. Weakness or extreme skin
sensitivity in the lower extremities, possibly persisting for months.
Headaches, stiff neck, and, very rarely, paralysis in lower
extremities caused by inflammation of the spinal cord.
Peripheral nervous system (controls nerves other than brain and
spine). Usually HSV-1.
Portion of the face temporarily paralyzed (Bell’s palsy). Other areas
of the body may exhibit numbness or loss of feeling to the touch.
A***-rectal area (herpes proctitis). Usually HSV-2.
Pain in a*** and rectal areas, constipation, itching, discharge,
desire to defecate when no fecal matter is present (tenesmus).
Inflammation and swollen lymph nodes in the groin. Other symptoms:
fever, chills, an abnormal tingling at the base of the spine,
difficulty in urinating, b***** stools, and impotence.
Other skin areas (herpetic erythema multiforme). May follow any form
of recurrent HSV.
Circular or irregular eruptions on backs of arms and hands.
Recurrence of erythema multiforme common in same areas.
Esophagus. Usually HSV-1.
Difficulty swallowing or burning, squeezing throat pain while
swallowing, weight loss, pain in or behind the upper chest while
swallowing. Herpes lesions difficult to differentiate from other
WHO GETS HERPES SIMPLEX VIRUS?
General Risk Factors for Herpes Simplex Virus
Everyone is at risk for herpes simplex virus. Contact with bodily
secretions of an infected person is the most common mode of viral
transmission. The risk of transmission is lower during latency, but
some chance always exists that the virus is shedding and transmissible
at any time. After the initial episode, the infected person can
transmit later infections by passing the virus on to other parts of
his or her own body (most often the hands, thighs, or buttocks). (This
process, known as autoinoculation, is more common with HSV-2 but it
can also occur HSV-1.)
Specific Risk Factors for Oral Herpes (HSV-1)
HSV-1 is the more common herpes simplex virus and infects nearly
everyone, with highest incidence occuring between six months and three
years old. By the fourth decade of life, in some regions, 90% of
people test positively for the infection. It is easily spread by
direct exposure to saliva or even from droplets in breath. Skin to
skin contact is sufficient to spread it. Transmission most often
occurs through close personal contact, such as kissing or sharing
common eating utensils. This form is rarely caused by sexual
transmission, although the increase in genital HSV-1 cases is most
likely to due to oral s**.
Specific Risk Factors for Genital Herpes (HSV-2)
Genital herpes is usually due to infection from herpes simplex virus
type 2 (HSV-2) transmitted through sexual intercourse, and people with
multiple sexual partners are at high risk. The virus, however, can
also enter through the a***, skin, and other areas. About 20% of
American Caucasian and 65% of African American adults harbor HSV-2,
but only 2.6% have symptomatic infection. Although African Americans
are more likely to test positively for the virus, Caucasians, have a
higher risk for active symptoms, and over the past few years, the
greatest increase in HSV-2 has been observed in white adolescents.
Less than 1% of American children younger than 15 test positive for
HSV-2, and in these cases sexual abuse should be considered. The
highest rates of HSV-2 are seen in women in their early twenties.
Women have an 80% to 90% chance of contracting HSV-2 after unprotected
sexual activity with an infected partner and are 1.7 times more likely
to be infected than men. Men, however, have twice as many recurrent
infections as women.
Risk Factors for HSV in Newborns
Newborns whose mothers have HSV-2, particularly when it occurs at the
time of delivery, are at risk for contracting herpes. The risk
increases if these infants are born prematurely and instruments are
required during vaginal delivery. Transmission can occur if the
amniotic membrane of an infected woman ruptures prematurely or as the
infant passes through an infected birth canal. Very rarely, the virus
is transmitted across the placenta, a form of the infection known as
congenital herpes. Unfortunately, over 60% of women whose infants
develop neonatal HSV have no history of HSV-2 and no symptoms at the
time of delivery; occasionally, lesions on the buttocks will indicate
the presence of the virus. Because herpes in the newborn is generally
an uncommon event, experts are divided over whether the high cost of
testing specifically for HSV-2 before delivery, even in high-risk
groups, is worth the benefit for such a small group of mothers and
Other Risk Factors
Wrestlers, rugby players, and other athletes who participate in direct
contact sports without protective clothing are at risk for an unusual
form of HSV-1 called herpes gladiatorum. Immunosuppressed patients,
including those infected with HIV (the virus that causes AIDS), are at
particular increased risk for very severe herpes.
HOW SERIOUS IS HERPES SIMPLEX?
The severity of symptoms depends on where and how the virus gains
entry into the body. Except in very rare instances and in special
circumstances, the disease is not life threatening, although it can be
very debilitating and cause great emotional distress.
Pregnancy and the Newborn
Between .01% and .04% of all pregnancies have complications if either
HSV-2 or HSV-1 occur in the mother’s genital area. Complications
include miscarriage, premature labor, retarded fetal growth, or
transmission of the HSV infection to the infant while in the uterus or
at the time of delivery. Studies indicate that the newborn is
threatened only when the mother becomes infected near the time of
labor. Infections earlier in the pregnancy may not pose a threat,
although more research is needed. One study has indicated that HSV-1
in either men or women may be implicated in some cases of infertility.
More research is needed.
Recurrence is common during pregnancy; fortunately, the risk to the
newborn is much lower with recurring HSV-2 infections than with a
primary infection that occurs near delivery. In addition, the symptoms
in babies infected by recurring infection of HSV-2 may be less serious
than those infected by primary outbreaks because their mothers have
developed and passed along protective antibodies to HSV-2. Antibodies
to HSV-1 do not offer similar protection.
Neonatal HSV is a serious condition which, if undiagnosed, can
progress to the central nervous system (CNS), causing meningitis or
encephalitis, and to internal organs, such as the liver, the lungs,
and the adrenal glands. Such disseminated disease is fatal in up to
80% of newborns if left untreated. Even if such infants survive, less
than 10% will develop normally. However, treatment sharply reduces the
mortality rate to 25%. Conditions that indicate severe HSV in infants
include the following: acute infection in the mother at delivery,
prematurity, an abnormal electroencephalogram (EEG) reading of the
infant’s brain, and disseminated intravascular coagulopathy (DIC), a
disorder of the blood-clotting mechanism in response to infection.
Severe problems in infants are unusual in cases that are confined to
the skin, which constitute about 10% of neonatal HSV infections.
Effects on the Brain and Central Nervous System
Herpes Encephalitis. Herpes accounts for 10% to 20% of cases of acute
viral encephalitis, an extremely serious brain disease. Fortunately
the incidence is very rare and affects only 1 in 250,000 to 500,000
people infected with herpes. HSV-1 is almost always the culprit,
except in newborns. In about 70% of infant herpes encephalitis, the
disease occurs when a latent virus is activated. In about one-quarter
of HSV-1 encephalitis cases, the infection may be caused by a new
strain of the virus. Respiratory arrest can occur within the first 24
to 72 hours. If untreated, approximately 60% to 80% of those who
contract this condition will progress to coma and death within a few
days. Recovery from HSV encephalitis is dependent on the patient’s
age, the level of consciousness, duration of the disease, and the
promptness of treatment. Those who recover may suffer some impairment,
ranging from mild neurological impairment to paralysis.
Herpes Meningitis. Herpes meningitis occurs in 4% to 8% of cases of
primary genital HSV-2, and women are more likely to develop it than
men are. Symptoms include headache, fever, stiff neck, vomiting, and
sensitivity to light. Fortunately, herpes meningitis is self-limited,
lasting for only two to seven days. Neurologic consequences are rare,
but recurrences have been reported. HSV-2 may also cause another form
known as benign recurrent lymphocytic meningitis, which is also not
Other Neurologic Diseases. Of interest are studies indicating a higher
risk for Alzheimer’s disease in people who have both HSV 1 and a gene
called apoE4, a known risk factor for Alzheimer’s. Other neurologic
syndromes that have been linked to HSV infection include epilepsy,
multiple sclerosis, atypical pain syndromes, ascending myelitis, and
AIDS and Immunocompromised Patients
Patients whose immune systems have been damaged by disease or
medications are known as immunocompromised. The disease most commonly
implicated in this condition is AIDS, but immune systems can be
damaged by long-term use of steroids and other drugs that suppress the
immune system, severe burns, and cancer therapies. People with these
conditions are extremely susceptible to many infections. Herpes
simplex is particularly devastating for AIDS patients. Not only does
the presence of HSV increase the risk for contracting AIDS in the
first place, but if both viruses are present, there appears to be a
synergy between them, with each increasing the severity of the other.
Herpes simplex in such immunocompromised patients can cause serious
and even life-threatening pneumonia, hepatitis, inflammation of the
esophagus, encephalitis, and destruction of the adrenal glands. Less
serious conditions include stomach and a*** ulcers and inflammation in
the colon. In herpes patients with healthy immune systems, these
complications are unusual, but their incidence is increasing.
Kaposi’s varicellum eruption is a form of eczema caused by herpes that
can afflict immunocompromised patients, including burn victims. The
condition causes severe oral-facial infections, quickly involving
extensive areas of skin, and may spread to other organs of the body.
As many as 400,000 Americans have had ocular herpes. Herpetic
infections of the eye can cause loss of vision and damage to the upper
layers over the cornea that occurs over a period of months to years.
In most cases, visual impairment is very slight. In about 6% of ocular
herpes, however, a condition called stroma keratitis occurs, in which
deeper layers of the cornea are involved, possibly as an abnormal
immune response to the original infection. In these rare cases,
scarring and corneal thinning develop, which may cause the eye’s globe
to rupture and result in blindness. Ocular herpes is the most frequent
infectious cause of corneal blindness in the world.
Other Diseases Linked to Herpes Simplex
A number of other conditions have been linked to HSV infections,
although the association has not been substantiated in most cases.
Arthritis affecting a single joint has been sporadically reported as a
result of HSV infection. Certain kidney and blood diseases have also
been reported in conjunction with HSV infection. One study has also
found an association between HSV-2 and coronary artery disease. People
with HSV-2 may also have an increased susceptibility to
sexually-transmitted hepatitis C. HSV has been implicated as a cause
of cervical cancer, but herpes simplex (as well as other infections
often present with this cancer) may simply be markers of increased
sexual activity rather than causative agents.
Emotional and Social Effects
Not least among the damaging effects of HSV-2 is its impact on the
social and emotional life of patients. In one survey of herpes
patients, 82% felt depressed and 75% were worried about rejection.
Over a quarter had suicidal thoughts. In nearly 80% of the
respondents, the disease had a profound effect on their sexual life.
The patient must notify sexual partners, past and present, about their
condition, a deeply humiliating experience. Guilt and anger are common
emotions, and relationships may be shattered. It is important to note
that the condition is often dormant for many years and may not have
been transmitted by a current sexual partner. Support groups or
couples therapy can be very helpful.
WHAT OTHER CONDITIONS ARE SIMILAR TO HERPES SIMPLEX?
The common aphthous ulcers, known as canker sores, are often confused
with HSV-1. These sores can appear frequently on the inside of the
mouth and are usually grayish with a sharp edge. They usually heal in
two weeks without treatment. Other conditions that may be confused
with oral herpes include herpangina (a form of the Coxsackie A virus),
sore throat caused by strep or other bacteria, and infectious
Conditions that may be confused with HSV-2 are bacterial and yeast
infections, genital warts, herpes zoster (shingles), molluscum (a
virus disease which produces small rounded swellings), scabies,
syphilis, and certain cancers.
Simple corneal scratches can cause the same pain as herpetic infection
but these usually resolve within 24 hours and don’t exhibit the
corneal lesions characteristic of herpes simplex.
Skin disorders that may mimic herpes simplex include shingles and
chicken pox (both caused by varicella-zoster, another herpes virus),
impetigo, and Steven-Johnson syndrome, a serious inflammatory disease
usually caused by a drug allergy.
WHAT TESTS ARE USED TO DETECT HERPES SIMPLEX?
Generally, the herpes simplex virus is identifiable by the
characteristic lesion: a thin-walled blister on an inflamed base of
skin. If the diagnosis is uncertain, more tests will be needed.
Patients diagnosed with genital herpes should be tested for other
Although the lesions of herpes simplex virus are distinctive, they can
be confused with other skin infections. An accurate diagnosis of HSV
is best made by taking a fluid sample from the lesions as early as
possible (ideally within the first three days of appearance). A viral
culture from the sample is almost 100% accurate if lesions are still
in the clear blister stage. Results usually take a few days, although
new technology exists that can shorten this period to 24 hours (if
cases of infection are severe). Such tests are not as effective for
older ulcerated sores, recurrent lesions, or latency, since at these
stages the virus may not be active enough to reproduce sufficiently to
produce a visible culture.
Microscopic Examination of Tissue Scrapings
Quicker but less reliable tests use scrapings from lesions, which are
then stained and microscopically examined. Findings of specific giant
cells with many nuclei or inclusion bodies (distinctive particles that
carry the virus) indicate HSV infection. It should be noted that this
test is only accurate in 50% to 70% of cases, and it cannot
distinguish between the HSV types or between herpes simplex and herpes
Other tests are occasionally performed that make use of the properties
of the immune system and the genetic make-up of the virus. One test
produces specific antibodies that hunt out and identify the herpes
virus and often differentiate between types. These tests have been
only 80% to 95% as sensitive as viral cultures and are especially weak
in detecting viral shedding in asymptomatic patients. Their accuracy
is improving however. A test called ELISA (enzyme-linked immunosorbent
assay) is 85% accurate in detecting the herpes virus and 100% accurate
in determining the relevant strain. Results are available in two
hours. A recent form of the test also can distinguish between HSV-1
and HSV-2. This test appears to be very promising, particularly for
newborns at high risk for HSV-although experts do not advise using
this as the sole diagnostic test.
Tests for HSV Encephalitis
Diagnosis of HSV encephalitis may require a number of tests.
Electroencephalography (EEG) traces brain waves and can identify about
80% of cases. Computed tomography (CT) or magnetic resonance imaging
(MRI) scans may be used to differentiate encephalitis from other
conditions. Brain biopsy is the most reliable method of diagnosing HSV
encephalitis, but it is also the most invasive and is generally
performed only if the diagnosis is uncertain. Another test called the
polymerase chain reaction (PCR) assay identifies HSV in cerebrospinal
fluid and gives a rapid diagnosis of HSV encephalitis. PCR uses a
piece of the DNA of the virus and then replicates millions of times
until the virus is detectable. This test can identify specific strains
of the virus and asymptomatic shedding. Sensitivity is almost equal to
viral culture and results are also much quicker, but at this time PCR
should not replace other diagnostic tools for infants with suspected
Tests for the Newborn at Risk
In the asymptomatic newborn delivered from an infected mother,
cultures should be taken between 24 and 48 hours after birth. A
culture taken right at the time of delivery may give a false
indication of infection in the baby, simply because it can carry some
of the mother’s virus from the birth canal. While results are pending,
the baby should be checked regularly for rash and blisters,
particularly in areas where the skin is broken, along with any signs
of illness including fever, lethargy, respiratory distress, and poor
WHAT ARE THE HOME TREATMENTS AND PREVENTIVE MEASURES FOR HERPES
Most herpes simplex infections that develop on the skin can be managed
at home with over-the-counter pain killers and symptomatic relief.
The lesions should be kept clean and dry with an agent such as
cornstarch. Talcum power should never be used because of its
association with an increased risk for ovarian cancer. In general, it
is important not to touch the sores, to wash the hands frequently
during the day, and to keep the body clean and dry. Fingernails should
be scrubbed daily. Wearing sun block helps prevent sun-triggered
recurrence of HSV-1. Tight-fitting clothing should be avoided because
restricting air circulation slows healing of the sores. Local
application of ice packs may alleviate the pain and help reduce
recurrences by suppressing the virus. Lukewarm baths may be helpful,
and for people who have pain in urination, some experts recommend
urinating in the bath water at the end of the bathing time; this
dilutes the urine and prevents burning the sores. S** should be
avoided both during the outbreaks and the prodromes, the early
symptoms of herpes, which include tingling, itching, or tenderness in
the infected areas.
Over-the-counter medications such as aspirin, acetaminophen (Datril,
Panadol, Tylenol), or ibuprofen (Advil, Medipren, Motrin, Nuprin), can
be used to reduce fever and local tenderness. Children should take
acetaminophen; they should never be given aspirin. For severe itching
in anyone, diphenhydramine (Benadryl) may be useful or a physician can
prescribe drugs such as hydroxyzine (Atarax or Vistaril). Topical 5%
lidocaine jelly can be used as a local anesthetic for pain.
In one study stress management techniques developed using
cognitive-behavioral methods were not only effective in reducing
depression in those with HSV-2 but blood test results also revealed
lower levels of HSV-2 antibodies. In any case, reducing stress using
relaxation techniques does no harm.
Special Diets or Foods
No special diet has been proven to reduce symptoms of herpes virus .
Some people take supplements of L-lysine to prevent cold sores and
claim that taking 1,000 mg per day helps sores heal rapidly. There are
also unproven claims that eating foods high in L-lysine and low in
arginine (both are amino acids) will help prevent outbreaks of oral
HSV-1. They include most dairy products (especially yogurt), beets,
apples, pears, mangos, oily fish (such as salmon, haddock, snapper,
and swordfish), soybean sprouts, chicken, and tomatoes. Many of the
foods with the reverse ratio (low L-lycine and high arginine) are very
important for health, and no one should avoid them because of any
unsubstantiated claims. Such foods include nuts, many fruits, garlic,
onions, whole grains, and green vegetables. (Some people have even
found that garlic capsules are helpful.) Caffeine has some
anti-herpesvirus properties, although it is not known whether drinking
caffeinated beverages would have any effect on HSV-1.
Herbal and Other So-called Natural Remedies
There are many unproven claims for numerous alternatives and
unconventional remedies for herpes simplex. Among those that have
shown no benefit are vitamins, minerals, and light therapy. Some
people report benefits from using a cream made from Melissa, an herb
from the mint family, or applying a dropper-full of the herbal extract
echinacea to the sores every few hours after the onset of symptoms.
Anecdotal reports have indicated that applying tea tree oil on mouth
sores was effective for both prevention of new sores and healing
existing ones. Some studies are finding anti-HSV-1 properties in a
number of traditional Chinese herbal medicines. It should be noted,
however, that many herbal treatments are not harmless and can be very
potent. Few have been tested for benefits or side effects. No untested
treatment should be tried without discussing it first with the
physician. An extract from the plant Prunella vulgaris is showing
promise for stopping HSV 1 and 2 viral growth in cells, even in
acyclovir resistant strains. More research is warranted on this
When lesions are present, persons infected with any form of herpes
virus should carefully wash their hands after contact with the primary
infection site so as not to transmit the virus to other sites on the
body. The virus can live for up to two hours on cloth and for four
hours on plastic. Although transmission from objects such as toilet
seats and towels is unlikely, keeping personal items separate during
an active infection may help to reduce transmission to other household
members. It is almost impossible to defend against the transmission of
oral HSV-1, however, since it can be transmitted by very casual
Infection with genital herpes is easier to prevent. If active lesions
are present, infected persons should abstain from sexual intercourse.
Unfortunately, viral shedding and transmission may occur when no
lesions or symptoms are present. Women with HSV-2 who have frequent
attacks are at particular risk for transmitting the virus during
asymptomatic periods (with shedding most likely occurring a week
before or after symptoms erupt). Most new cases of infection are
spread during these asymptomatic periods, so noninfected partners
should wear condoms during all sexual activity with an infected
person. The use of latex condoms will reduce transmission of HSV-2 but
does not constitute complete protection unless it covers the entire
infected area. Even then, a small tear could permit passage of the
virus. Condoms made from animal membrane are to be avoided; although
they prevent pregnancy, the herpes virus can pass through them.
Plastic condoms, such as the Avanti male condom, are an alternative to
those allergic to latex, but studies indicate that they break or slip
6% of the time. The female condom may be a superior form of protection
because it covers a large area. Laboratory and small studies suggest
that the female condom is quite effective against HIV and other
sexually transmitted diseases, although major studies are not yet
available to confirm these findings. It is not clear whether a
spermicidal gel offers any additional protection against sexually
transmitted disease. It should be stressed that at this time no form
of contraception is 100% fool-proof against the virus. An experimental
spermicide containing an extract of red seaweed and nonoxynol-9, a
common spermacide, is showing promise at protecting against HSV-2.
Vaginal gels (PRO 2000) that may prevent HSV-2, HIV, and other
sexually transmitted diseases are also in development.
WHAT ARE THE DRUGS BEING USED AND TESTED FOR HERPES SIMPLEX?
Acyclovir and Other Antiviral Drugs
General Considerations for All HSV Types . Drug therapy for HSV
depends on the site of the infection and whether the attack is primary
or recurrent. The best class of drugs developed to date against herpes
simplex are called nucleosides and nucleotide analogues, which are
able to block viral reproduction. Acyclovir (Zovirax) is the standard
drug for treating many HSV infections. It penetrates most body
tissues, including cerebrospinal fluid but has little or no harmful
effect on healthy cells. Although most effective against an active
infection, acyclovir may also reduce the frequency of shedding. It is
not known if limiting shedding will also prevent transmission of the
virus, so the use of condoms during asymptomatic periods is still
essential, even when patients are taking acyclovir. Acyclovir is
available in a number of forms, including oral, injected, and topical.
The form used depends on site and location of the infection. The
primary downside of oral administration is the need for multiple
doses. Higher doses with less frequent preparations may help reduce
this problem. Possible side effects from acyclovir include nausea and
vomiting, rash, headache, fatigue, tremor, and very rarely, seizures.
Intravenous administration increases the risk for kidney problems and
blood clots at the injection site. The topical ointment version is the
least effective and may cause some pain, mostly because of other
chemicals used in the preparation of the ointment.
Similar drugs showing great promise include famciclovir (Famvir),
valaciclovir (Valtrex), and penciclovir (Denavir), which are
metabolized by the body into acyclovir. These drugs are as effective
and safe as acyclovir, but they have the advantage of better
absorption and slower metabolism, so fewer doses are required each
day. An animal study indicated that famciclovir may be the most
effective of these new agents, although comparison studies with
acyclovir have shown no differences in healing or relief of symptoms
in patient groups. A gel containing another new drug, cidofovir, may
be a safe and effective treatment in AIDS patients whose condition is
resistant to acyclovir.
No drug, to date, can actually cure herpes simplex virus. The
infection may recur after treatment has been stopped, and during
therapy, a patient can still transmit the virus to another person. As
with antibiotics, physicians are concerned about signs of increasing
viral resistance to acyclovir and similar drugs, particularly in
immunocompromised patients (such as those with AIDS). Some experts
believe, however, that the prevalence of drug-resistant viruses would
be low for many years, and making such treatments more widespread
would prevent many cases of herpes from developing in the first place.
Foscarnet (Foscavir) is a powerful anti-viral agent known as a
pyrophophate analogue, and is the first choice for treatment for HSV
strains that have become resistant to acyclovir and similar drugs.
Administered intravenously, the drug can have toxic effects and impair
kidney function (which is reversible) and cause seizures. Fever,
nausea, and vomiting are common side effects. It can also cause ulcers
on genital organs. As with other drugs, it does not cure herpes.
Other Drugs Being Used for HSV
Brivudin (also referred to as BVDU) and sorivudine (BVaraU ) are
nucleoside analogues being tested for varicella zoster virus (the
cause of shingles). They may also be very effective for HSV, although
reports of lethal interactions between sorivudine and the
chemotherapeutic drug 5-fluorouracil (5-FU) make approval in the US
problematic. Cidofovir and adefovir are proving to be active against
many viruses and may be useful for HSV. In one study, intravenous
cidofovir was effective against herpes virus strains that had become
resistant to both acyclovir and foscarnet.
Developing vaccines against herpes virus or drugs that boost the
immune system currently offers the best hope for preventing the
disease. Of interest is the use of certain mutated strains of herpes
virus that cannot replicate. While they are safe for the patient, they
still can provoke an immune response against the active virus. In one
study, a vaccine using an inactivated herpes virus helped to
significantly reduce recurrence of ocular herpes. Researchers are also
investigating DNA vaccines that use genetic fragments of the virus to
trigger an immune response to the actual virus.
WHAT ARE THE TREATMENT APPROACHES TO SPECIFIC HERPES SIMPLEX TYPES?
Treatment of Oral Herpes
Acyclovir is often taken orally for a severe primary attack of HSV-1
and may even be beneficial for children. Taken preventively, it
reduces frequency and severity of recurring infections. Acyclovir
ointment does not appear to be useful at all in HSV-1. The first
antiviral cream to be approved for cold sores, penciclovir (Denavir)
heals HSV-1 sores an average of one day faster than without treatment,
stops viral shedding, and reduces the duration of the pain. The
patient should apply the cream within the first hour of symptoms, and
for four consecutive days it should be reapplied every two hours
during times awake. In one study, a cream using foscarnet (Foscavir)
reduced the size and hastened healing of sunlight-triggered HSV-1. In
another, a cream containing a new anti-HSV drug, n-docosanol
(Lidakol), reduced the duration and severity of symptoms. Ascoxal, a
solution that combines ascorbic acid (vitamin C) with substances that
fight the symptoms of HSV-1, is showing promise in the fight against
oral herpes. On the first day only, patients soaked a cotton pad in
the drug and pressed it on the sores using three soaks applied for two
minutes each every 30 minutes. Even this brief treatment resulted in
less intense symptoms and a quicker resolution of the scab.
Researchers strongly recommended testing a more intensive regimen.
Interferon is also being tested for HSV-1. One study found that an
ointment using a combination of caffeine and interferon improved
healing time for HSV-1 sores compared to interferon alone.
Treatment of Genital Herpes
Treatment for Primary Attacks. Acyclovir is usually administered
orally for genital HSV. Ointments are available for a primary attack
but are not as effective as the oral form and have no benefit for
recurring infection. There is no additional benefit derived from the
simultaneous use of both types. Oral acyclovir may be prescribed for
seven to 10 days during primary infections; benefit occurs within one
to three days if the drug is started promptly. When taken early
enough, acyclovir reduces the duration of the infection, its pain, and
new lesion formation, and also reduces viral shedding. The newer drugs
are also effective. In one study, patients who took 500 mg of the oral
form of valaciclovir twice daily for five days experienced faster
resolution of pain, a shorter shedding stage, and less severe lesions
than those who did not take the drug. Another study reported that a
three-day course of valaciclovir might be equally effective.
Treatment for Recurrence . Most recurrent infections are mild enough
so that treatment is not needed. When it does, acyclovir, famciclovir,
or valacylovir are all useful. Some patients may take intermittent,
short-term preventive ( prophylactic) therapy of acyclovir or
famciclovir during periods when outbreaks are likely. Daily long-term
preventive therapy, called suppressive therapy, may be appropriate in
certain patients to prevent severe long-lasting recurrences and to
reduce the risk for transmitting the virus. In such cases, suppressive
therapy may be prescribed for up to a year or even longer. In one
study, patients who started treatment with an average annual
recurrence rate of 13% experienced only an 0.6% recurrence rate after
10 years on suppressive study. Side effects did not differ
significantly from patients taking a placebo (sugar pill). In other
studies, suppressive therapy using acyclovir has reduced the frequency
of recurrence in 80% of patients and prevented recurrence altogether
in up to 30%. Suppressive therapy using famciclovir and valaciclovir
are also showing promise. In one study of famciclovir, after a year,
up to 80% of patients had no recurrences. Other studies have reported
that suppressive therapy using famciclovir was effective in reducing
recurrence, even in people who were HIV-positive. If an infection
occurs during suppressive therapy, healing time is quicker and
symptoms are less severe. Suppressive therapy may also reduce the risk
for development of drug-resistant viruses compared to intermittent
treatments. In general, people stop taking suppressive therapy after
about two years. Experts warn, however, that unless suppressive
therapy becomes widespread and prolonged, transmission of the virus
will remain a major health problem and the prevalence of HSV-2
infection will not significantly decrease.
Treatment of HSV Encephalitis
Intravenous acyclovir is the treatment of choice for encephalitis and
should be started immediately if this complication is suspected. It
must be administered for at least 10 days.
Treatment of Eye Infections
Ocular HSV should be treated carefully since certain treatments may
aggravate the condition. At this time, the drug of choice for this
condition is trifluridine (Viroptic), which is applied topically and
helps prevent stromal keratitis, the severe condition that can lead to
corneal destruction and blindness. Major adverse reactions include
burning or stinging, swelling, and deterioration of the cornea.
Cidofovir may be as effective as trifluridine in preventing this
condition. Neither drug, however, has any effect once stromal
Acyclovir ointment helps resolve HSV ocular infections within five to
nine days. Taking long-term oral acyclovir after an initial episode of
ocular HSV also may reduce recurrences of this difficult condition.
Other acyclovir-like drugs should be tested for preventing recurrence
of ocular HSV. A combination of an acyclovir ointment with a topical
steroid may effective for severe forms of ocular herpes, including
stromal keratitis. (Acyclovir alone was not useful for these severe
In addition to medications, patients with ocular HSV may require
debridement, in which the surgeon scrapes away the injured tissue with
a cotton swab. A patch or soft contact lens may be worn afterward.
Patients with HSV who show scarring in the cornea may require surgery.
In rare cases, a corneal transplant may be necessary.
Treatment Approaches for Specific Individuals
Treatment of the Pregnant HSV Patient. The approach to a pregnant
woman who has been infected by either HSV-1 or 2 in the genital area
is usually determined by when the infection was acquired and the
mother’s condition around the time of delivery. The infection occuring
before time of delivery appears to pose no risk to the newborn. The
most dangerous time for infection is in the last term. Lesions that
erupt shortly before the baby is due require that the mother be
cultured at three- to five-day intervals prior to delivery to
ascertain whether viral shedding is occurring. If lesions are present
at birth, Cesarean section is usually recommended. If no lesions are
present and cultures indicate no viral shedding, the delivery is
normal and the newborn is examined and cultured after delivery.
Systemic (oral or injected) use of acyclovir is generally not used
during pregnancy for either primary infection or to suppress
recurrences unless the HSV infection is life threatening. One study
found, however, that women who had their first episode of HSV-2 during
pregnancy and were given acyclovir did not require cesarean section
and the drug did not harm the fetus. Another study suggests that
giving preventive oral acyclovir in late pregnancy to any woman with a
history of recurrent genital herpes is more cost-effective than the
current strategy of cesarean sections for all women who develop
genital herpes at the time of delivery.
Treatment of Newborns. Intravenous acyclovir treatment should begin
immediately if neonatal HSV is suspected, since the potential dangers
of the condition far outweigh any risks associated with the drug. If
the central nervous system is affected, treatment should be for 21
days; otherwise it is given for 10 to 14 days. Vidarabine (Vira-A) is
sometimes used as an alternative to acyclovir, but it is much less
effective and should be used only if the baby is resistant to
acyclovir. For infants where the virus is limited to the skin, eyes,
and mouth, a six-month trial of oral acyclovir limited the recurrence
of symptoms in these areas. Experts are concerned, however, that this
treatment will not prevent neurologic problems; more studies are
Treatment of Immunosuppressed Patients. For patients with damaged or
suppressed immune systems, oral acyclovir is used for primary and
recurrent infections at higher doses than in patients with healthy
immune systems. Intravenous acyclovir is used for serious or
disseminated infections and for infections of the central nervous
system. Resistant strains of the virus are being seen in
immunosuppressed patients, and some experts are recommending
continuous infusion of acyclovir instead of intermittent therapy for
these patients. Alternative drugs are vidarabine (Vira-A), available
only in intravenous form, and foscarnet (Foscavir) in ointment or
intravenous forms. Foscarnet has been found to be superior to
vidarabine for primary infection but was totally ineffective for
recurrences at the same site.
WHERE CAN HELP BE FOUND FOR HERPES SIMPLEX VIRUS?
The American Social Health Association (ASHA), Herpes Resource Center,
PO Box 13827, Research Triangle Park, NC 27709. For the National
Herpes Hotline call (919-361-8488) to speak to a counselor and call
(800-230-6039) to order information. Or on the Internet
The organization provides up-to-date practical information, publishes
a newsletter, and coordinates self-help groups across the country.
National Women’s Health Network, 514 10th St. NW, Suite 400,
Washington, DC 20004. Call (202-347-1140) Excellent organization on
many conditions affecting women.
Centers for Disease Control and Prevention, 1600 Clifton Road, NE,
Atlanta, GA 30333. Call (404 639-2709) or on the Internet
On the Internet
Lists foods high in lysine and low in arginine
Well-Connected reports are written and updated by experienced medical
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Board of Editors
Harvey Simon, MD, Editor-in-Chief, Massachusetts Institute of
Technology; Physician, Massachusetts General Hospital
Stephen A. Cannistra, MD, Oncology, Associate Professor of Medicine,
Harvard Medical School; Director, Gynecologic Medical Oncology, Beth
Israel Deaconess Medical Center
Masha J. Etkin, MD, PhD, Gynecology, Harvard Medical School;
Physician, Massachusetts General Hospital
John E. Godine, MD, PhD, Metabolism, Harvard Medical School; Associate
Physician, Massachusetts General Hospital
Daniel Heller, MD, Pediatrics, Harvard Medical School; Associate
Pediatrician, Massachusetts General Hospital; Active Staff, Children’s
Paul C. Shellito, MD, Surgery, Harvard Medical School; Associate
Visiting Surgeon, Massachusetts General Hospital
Theodore A. Stern, MD, Psychiatry, Harvard Medical School;
Psychiatrist and Chief, Psychiatric Consultation Service,
Massachusetts General Hospital
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