Types Of Herpes , Causes, Symptoms and Treatment

To person who has suffered from any manifestation of the Herpes virus, no experience could be any worse and no memory more remarkable! From Shingles to Simplex, excruciating pain is the hallmark of Herpes.

Classification Of Herpes Group Of Viruses

Herpes virus is a double stranded DNA virus sub grouped as follows:-
Alpha Viruses – Herpes Simplex 1, Herpes Simplex 2, Herpes Zoster (Varicella)
Beta Viruses- Cytomegalovirus (CMV), Herpes Virus 6 & 7
Gamma Viruses- Ebstein Barr Virus, HHV – 8

Manifestations Of Herpes

HERPES SIMPLEX- HSV causes myriad afflictions as listed under.

Genital Herpes

Genital Herpes consists of grouped vesicles and papules developing around the penis and anus associated with pain, fever and dysuria (painful urination). Vesicles often burst giving rise to shallow excruciatingly painful ulcers.

Herpes Orolabialis (Oral Shingles/ Cold Sores

Painful vesicles to shallow ulcers around the mouth and lips.
HSV Encephalitis (Brain Fever), HSV – Keratitis (Ulcers in the eye/cornea) and Herpes Whitlow (Finger infection) are other manifestations.

Herpes Zoster Virus Or Varicella Virus

causes the exanthem Varicella or ‘Chicken pox’ as well as the notoriously common Shingles.

CHICKEN POX

Fever and a centripetal rash which is highly contagious characterize this condition. The infection is self resolving but heals with residual scabs that mostly disappear with time.
It is preventable by a live attenuated vaccine (VARIVAX) that can be used by all except pregnant women. Pneumonia and meningitis constitute its rare but life threatening complications.

Herpes Zoster Or Shingles

It is the secondary infection wherein the HZV lies dormant in the outer/dorsal root ganglia of the spinal cord following a primary infection of chicken pox. The dormant virus can get reactivated at any time ranging from a few months to years after the initial episode of Chicken Pox. This gives rise to a Serpiginous red rash laden with clusters of packed shallow vesicles on the skin corresponding to the area of the nerve root supplied by it.
Severe shooting or stabbing/ jabbing pain, fever, loss of limb function and prostration are notable. Rarely there may be facial palsy (Ramsay Hunt Syndrome) or involvement of the eye (ophthalmic shingles). Post Herpetic Neuralgia / Herpangina or pain that persists in the affected dermatome long after shingles has gone is a difficult condition to treat.

CMV – Cytomegalovirus

Cytomegalovirus is a serious infection acquired by direct contact, blood transfusion and organ transplantation. Congenital infection is known to cause jaundice, purpura, liver and spleen enlargement in the neonate as well as calcific deposits in the brain, mental retardation, deafness and eye problems.

HHV 6 And 7

These cause ‘Roseola Infantum’ a self limiting infantile exanthem that is known by many names viz ‘Three day fever’, ‘Fourth Disease’ &‘Exanthem Subitum’.

EBSTEIN BARR VIRUS

EBSTEIN BARR VIRUS is the cause of ‘Glandular fever’ or ‘Infectious Mononucleosis’ and cancers such as ‘Burkitt’s Lymphoma and Nasopharyngeal Ca.

HHV 8

This virus classically causes the ‘Kaposi Sarcoma’ a skin cancer afflicting immunocompromised hosts such as AIDS patients.

Treatment For Common Herpes Conditions

ACYCLOVIR (ZOVIRAX/ ACIVIR)

It is the prototype antiviral that inhibits viral DNA synthesis and replication via ‘Herpes virus specific thymidine kinase’ activation.
It is effective in patients with normal as well as deficient immune status. It can be used as Oral tablets given in five divided doses as well as a topical ointment. For serious infections such as encephalitis or infections in immunocompromised hosts it can be given intravenously 5-10mg/kg/8 hrly for at least 7 to 10 days.
It can be used in pregnant women with chicken pox to reduce viral load and minimize complications such as pneumonia and meningitis. Varicella immunoglobulin although more expensive is preferred for use where possible.

Genital Herpes Treatment Using Valacyclovir (Valtrex)

Valtrex is the valyl ester of Acyclovir which has the advantage of twice a day dosing and is used in the treatment of Genital Herpes or Herpes Simplex as well as Herpes zoster infection or Shingles .
Valtrex Capsules in Doses of 1 to 2 g twice daily are employed depending on the severity of the condition.
Single day treatment of 2g twice daily is used in oral shingles/cold sores or Herpes Orolabialis. Zoster or Shingles may need 1g thrice a day for seven days.
Genital Herpes needs 1g twice daily for up to 10 days.

Adverse Reactions Of Valtrex

Headache, nausea, vomiting, diarrhea, rash, photosensitivity, LFT abnormalities, psychiatric reactions (e.g. confusion, hallucinations and thinking disorders) especially at high doses have been documented.

Famciclovir (Famvir)

It is an ester prodrug of ‘Penciclovir’(DANAVIR).

How Does Famvir Work

FAMVIR inhibits viral DNA synthesis and replication.

Comparison Of Famvir With Zovirax

FAMVIR has good oral bio availability and needs only thrice a day dosing. It is useful as an alternative to ZOVIRAX only in mild disease and cannot be administered intravenously.

Efficacy Of Famvir

Famvir inhibits Herpes Simplex (Genital Herpes) and Herpes Zoster but not Acyclovir resistant strains. It has been shown to have some activity against Hepatitis B Virus.

Side Effects Of Famciclovir (Famvir)

Adverse reactions include headache, nausea, loose motions, itching, rashes and mental confusion.

Other Drugs For Treatment Of Genital Herpes

GANCICLOVIR (CYTOVENE)

Cytovene is more effective than ZOVIRAX for the treatment of Cytomegalovirus (CMV) FOSCARNET (FOSCAVIR) – This highly toxic drug is useful in treating Acyclovir (ZOVIRAX) resistant types of Herpes Simplex (genital) infections and those involving immunocompromised patients.

Treatment Of Genital Herpes - Conclusion

Shingles indeed gives one the jingles and rarely, long lasting tingles! But with the advent of and advances in antiviral drug therapy, Herpes infection need no longer be dreaded as the harbinger of horrendous pain and sequelae.