Herpes

Herpes is an outbreak of painful sores or ulcers in the mouth or on the genitals. A common virus, the herpes simplex virus, causes it.

Once a person is infected, the virus stays in the body for life. Most of the time, it is not active. A person may not even know that he or she is infected with the herpes virus. Without warning, the virus can become active. Flare-ups may be due to stress, a common cold, an infection or exposure to strong ultra-violet light.

About eight out of every 10 people with HIV are also infected with genital herpes. The open sores of herpes make it easier to become infected with HIV. People infected with both HIV and herpes may have herpes flare ups that happen more often, last longer and are worse. A person who has herpes sores for four or more weeks is considered to have AIDS.

People infected with both HIV and herpes simplex virus need to be very careful during a herpes outbreak. Their viral load usually goes up, which can make it easier to transmit HIV to others. 

Symptoms

The sores that herpes causes around the mouth and the ones it causes on the genitals are actually caused by two different types of herpes virus.

Herpes simplex virus (HSV) 1 causes cold sores or herpes around the mouth. The signs of this type of herpes are tingling or painful spots on the edge of the lip where it meets the skin of the face. Sometimes, these sores can appear on the nostrils, the gums or the roof of the mouth.

HSV-2 causes genital herpes. This type of herpes can affect the genitals, the anus, the thighs or the buttocks. The signs of this type of herpes are:

• A sensation of numbness, tingling or itching. This is a sign that the virus is traveling up a nerve to the skin.
• One or more clusters of small fluid-filled blisters that are red and painful. The sores appear four to seven days after a person is first infected. They burst and crust over before they heal. It takes about a week in a person with a healthy immune system to go away. The outbreak is usually worst the first time. People with HIV usually have outbreaks that are more severe and last longer than people without HIV.
• Sometimes the herpes outbreak also brings fever, headache, muscle aches, swollen lymph glands in the groin and a feeling of not being well when a person is first infected
• Sometimes there is pain on urinating
• Some women have a fluid discharge from the vagina

The symptoms vary from person to person. Some people will get only a mild rash or small bumps on the skin that look like pimples. One person may have an outbreak once a year, while others have one every few weeks. Before an outbreak begins, a person may notice an itching, tingling, or burning sensation in the affected area. There may be sharp pains in the pelvis or down the leg. After the first outbreak, herpes is less painful and goes away sooner.

Herpes can occasionally affect the throat, colon and other organs including the liver, eye and lung. Herpes encephalitis is inflammation of the brain, causing headache, nausea, mental changes, loss of co-ordination and seizures; this is rare in people with HIV but potentially fatal if it does occur. 

Causes and Risk Factors

The virus can be passed from person-to-person by contact between these lesions and mucous membranes. This can happen through kissing or sexual contact.

Herpes may also be spread when sores are not present. This can happen when the herpes virus is multiplying and infectious particles are being shed from the skin or moist (mucous) membranes of the body. The shedding happens more often in people with HIV.

More women than men get genital herpes.

Prevention

It is hard to keep herpes from spreading. Many infected people are not aware they have the virus. Others may know they have the virus, but not realize that they can spread it even without having open herpes sores.

While condoms can make it harder to spread herpes, they cannot prevent it. If people with herpes take anti-viral drugs such as valacyclovir every day, they can reduce the chance of spreading herpes to others.

Diagnosis

HSV is diagnosed by growing (culturing) the virus from a swab taken from a lesion, or by using a fluorescent screening test to detect the virus.

Treatment

Treating herpes is harder if a person also has HIV. Higher doses of antiviral drugs are needed. Acyclovir (Zovirax), valaciclovir (Valtrex) and famciclovir are all drugs used to treat herpes. Acyclovir must be taken five times a day for five to 10 days.  The other two drugs are taken three times a day for five to 10 days.

Acyclovir may be taken regularly to prevent future outbreaks of herpes. Using the drug regularly, however, can lead to the virus becoming resistant to the drug.

Pregnant women with genital herpes need special care. Herpes can cause potentially fatal infections in babies. If a woman has active genital herpes when she is ready to deliver a baby will usually be given a cesarean delivery.

Taking salt baths can help relieve the pain of genital herpes.