HERPES SIMPLEX VIRUS INFECTIONS

DEFINITION

Herpes simplex viruses (HSV-1, HSV-2; Herpesvirus hominis) produce a variety of infections involving mucocutaneous surfaces, the central nervous system (CNS), and visceral organs.

RISK FACTOR

• Oral sex
• Commercial sex worker
• Cigarette smoking
• Sex during menses
• Intrauterine device
• Early age of sexual intercourse
• New or multiple sexual partners
• Women Sexual activity with other women
• Immunosuppressed patients
• Frequent changing of partner

PATHOGENESIS

Exposure to HSV at mucosal surfaces or abraded skin sites permits entry of the virus into cells of the epidermis and dermis and initiation of viral replication therein. HSV acquisition is associated with sufficient viral replication to permit infection of sensory and/or autonomic nerve endings.

The virus enters sensory nerve endings and undergoes retrograde axonal transport to the dorsal root ganglion, where the virus develops lifelong latency. Spontaneous reactivation by various events results in anterograde transport of virus particles/protein to the surface. Here virus is shed, with or without lesion formation. It is postulated that immune mechanisms control latency and reactivation

During the initial phase of infection, viral replication occurs in ganglia and contiguous neural tissue. Virus then spreads to other mucocutaneous surfaces through centrifugal migration of infectious virions via peripheral sensory nerves.

Trigeminal ganglia are most commonly infected, although extension to the inferior and superior cervical ganglia also occurs. With genital infection, sacral nerve root ganglia (S2–S5) are most commonly affected. Autonomic ganglia, pelvic nerves, and vaginal nerve roots are commonly infected.

CLINICAL FEATURES

1.Oral–Facial Infections

Gingivostomatitis and pharyngitis

Fever

Malaise

Myalgias

Inability to eat

Irritability

Cervical adenopathy

2.Genital Infections

Fever

Headache

Malaise

Myalgias

Pain, Itching, Dysuria, Vaginal And Urethral Discharge

Tender Inguinal Lymphadenopathy

3.Whitlow -In HSV infection of the finger, an abrupt onset of edema, erythema, pain, and vesicular or pustular lesions of the fingertips

4.Herpes Gladiatorum Mucocutaneous -HSV infections of the thorax, ears, face, and hands have been described among wrestlers. Transmission of these infections is facilitated by trauma to the skin sustained during wrestling.

5.Eye Infections

HSV keratitis presents with acute onset of pain, blurred vision, chemosis, conjunctivitis, and dendritic corneal lesions. Other manifestations include chorioretinitis and acute necrotizing retinitis, corneal blindness

6.Central and Peripheral Nervous System Infections

HSV meningitis, which is usually seen in association with primary genital HSV infection, is an acute self-limited disease manifested by headache, fever, and mild photophobia and lasting 2–7 days.

Autonomic dysfunction caused by either HSV or VZV most commonly affects the sacral region, resulting in numbness, tingling of the buttocks or perineal areas, urinary retention, constipation, and impotence.

7.Visceral Infections

In HSV esophagitis, present with odynophagia, dysphagia, substernal pain, weight loss, and multiple oval ulcerations on an erythematous base

Hepatic HSV infection occurs primarily in immunocompromised patients and is associated with fever, abrupt elevations of bilirubin and serum aminotransferase levels, and leukopenia

DIAGNOSIS

Microscopic evaluation, viral culture, serology, and PCR

PCR is most sensitive for detection of HSV

TREATMENT

HOMEOPATHY MEDICINE