Herpes |
Herpes simplex virus (HSV) is a virus that is transmitted by skin-to-skin contact. There are two types of Herpes simplex viruses. HSV-1 usually affects the lips, and is often referred to as a fever blister, cold sore, or sun sore. It should not be confused with aphthous ulcers, which are small, white, tender ulcers, which affect the inside of the mouth.
The herpes simplex virus type 2 (HSV-2) is the virus most frequently associated with gential herpes. It affects over 45 million people in the United States. HSV-2 usually affects the genital areas (the penis and the vagina.) Most (80%) HSV-2 positive people have some symptoms of the disease. However, only 20% of patients have the classical symptoms of genital blisters and burning. Most patients (60%) have unrecognized symptoms, which they think of as yeast infections, jock itch, or irritation. Some patients (20%) have no symptoms of the virus at all. These people are called "asymptomatic shedders." Even if patients have no recognizable symptoms, they are still capable of spreading the disease to others. In fact, most HSV-2 appears to be transmitted from infected, but undiagnosed persons, or infected persons without any symptoms, who do not realize they are contagious.
Most cases of oral herpes are due to HSV-1, and most cases of genital herpes are due to HSV-2. But as oral sex has become more common, there are cases of HSV-1 that occur genitally, and HSV-2 that occur orally. However, 85-95% of recurrent genital herpes infections are HSV-2, and over 95% of HSV-2 infections occur genitally.
Diagnostic Laboratory Tests
There are four ways to diagnose HSV using laboratory techniques. The first is called a Tzanck Preparation, in which the roof of an intact blister is scraped, stained, and examined under the microscope for multinucleated cells. Although the results are available immediately, many patients do not have intact blisters, and the test itself cannot distinguish between HSV-1 and HSV-2.
The second test is to culture the fluid from an intact blister. The culture is sent to a laboratory, and after a few days, the results are available. However, the reliability of this test suffers also, because most patients do not have intact blisters.
The third test is called the POCkit HSV-2 Rapid Test. This ten-minute test, which needs only six drops of blood, works by detecting the presence of HSV-2 antibodies. Half the patients will develop detectable antibodies within two weeks of being exposed to herpes, and 80% will develop antibodies within one month. The POCkit test will not detect HSV-1 (cold sore) infections. Since HSV-2 infections can occur both orally and genitally, the test cannot identify the site of HSV-2 infections. But for most people, the benefits of having immediate results, make this test very popular.
The fourth test is a blood test, which is sent from my office to an outside laboratory. This is not an immediate test, and may take more than one week to obtain the results. Unlike any of the other tests, this blood test can distinguish between HSV-1 and HSV-2. This is important, because 70% of the population has had at least one fever blister, and is HSV-1 positive. This test can also distinguish between primary herpes (first episode) and recurrent herpes. By measuring IgM (which tests if herpes is currently present), and IgG (which tests if herpes has ever occured in the patient's life), this test can distinguish between primary and recurrent infections for both HSV-1 and HSV-2, whether a blister is present or not.
Treatment
Valtrex and Famvir are oral medications that have proven to be the most effective in treating HSV outbreaks. If the patient has frequent outbreaks (greater than once every three months), the patient is treated "suppressively", and given medication every day. If the patient has infrequent outbreaks, the treatment is "episodic", and is started as soon as the patient develops any symptom. These two medications have replaced Acyclovir (generic for Zovirax), but Acyclovir is still a very effective medication. Denivir is a topical medication that helps; but when used alone, it is not as effective as any of the oral medications.
