How to Treat Herpes Lesions?

The name "herpes" refers to a group of viral infectious diseases caused by the various viruses of the Herpesvirus family.  This family of cubically symmetric, double-stranded, enveloped DNA viruses (genetic material containing deoxyribonucleic acid) consists of different viruses, mainly herpes simplex viruses type 1 (HSV-1) and type 2 (HSV-2), Epstein-Barr virus, cytomegalovirus and varicella-zoster virus (VZV).

HSV-1 causes mostly cold sores, while HSV-2 causes mostly genital herpes. VZV, in its first infection of the human body, causes chickenpox and, when reactivated, the infection is known as herpes zoster. EBV causes infectious mononucleosis.

This text reviews the infectious skin herpes lesions commonly referred as: cold sores, genital herpes, and herpes zoster.

Three Types of Herpes Lesions

1) Cold Sores

Woman with cold sore touching lips on white background

The external manifestation of Herpes simplex virus type 1 infection are herpes lesions in the form of blisters arranged in a cluster on an excessively reddened area of the skin. The blisters are filled with a clear, almost transparent fluid, which may become more yellowish the closer they are to rupture. Once these herpes lesions break, they release the fluid, and a scab forms over the remaining wound. This wound usually heals within days and usually disappears completely after a few weeks without scarring.

The herpes lesions caused by this virus are usually located around the mouth or directly on the lip. Occasionally they can extend to the nose and other mucous membranes and, in fact, some children develop them inside the mouth, which makes them easily mistaken for canker sores. Recurrences usually occur at the same site where the lesions first appeared and tend to be less severe than when the infection was first contracted.

Treatment - Cold sores heal naturally over a period of days. However, if you have discomfort, you can buy medication to relieve the symptoms. It is important to note that the medicines or products used are used to relieve pain and discomfort and to speed up the healing process, but they do not cure the virus as such.

2. Genital Herpes 

Vector illustration of symptoms of genital herpes.

These herpes lesions are caused by the herpes simplex virus type 2, it is sexually transmitted so it is a STI. You can get genital herpes infection from unprotected vaginal, anal, oral sex or close genital contact with a person who has the infection. HSV-2 is  transmitted by cutaneous-mucosal herpes lesions, but it can be also transmitted through secretions in which the virus is present. Although, genital herpes can be transmitted if there are no herpes lesions or other apparent clinical symptoms. 

When symptoms occur, an infection may have occurred long before, weeks, months, or even years. The appearance of vesicles on the vulva or vagina, penis, anus, rectum, or very rarely in the mouth, is the most characteristic sign of infection. Vesicles appear that rupture, release fluid and may heal into scabs or produce painful ulcerative herpes lesions that take weeks to heal; fissures or abrasions in the genital mucosa may also occur.

Treatment - There are currently three antiviral drugs approved for use in genital herpes: acyclovir, valacyclovir, and famciclovir. The action of oral antivirals occurs by infecting cells acting as nucleoside analogues. Then, they bind to viral thymidine kinase, resulting in its phosphorylation. Subsequently, the antivirals are re-phosphorylated by cellular enzymes and compete with nucleosides for binding to viral DNA polymerase, leading to inactivation of the enzyme and reduced viral replication.

The use of antiviral drugs is beneficial in most patients with symptoms of herpes infection. They achieve faster healing of herpes lesions and attenuation of symptoms, but unfortunately, they do not eradicate the latent virus and therefore relapses, although they do reduce the time and intensity of relapses.

3. Herpes Zoster 

Drugs for herpes zoster treatment

Herpes zoster is caused by a reaction to a primary infection with the varicella-zoster virus. After a primary infection, the virus lies dormant in the dorsal root or ganglion of a cranial nerve. Reactivation causes typical pain with dermatome distribution and vesicular rash.

The patient notices an itching sensation or pain in a cutaneous territory (preferably the trunk) and 4 or 5 days later presents a reddening of the skin in that area on which vesicles sprout and are arranged in clusters. During this phase, the herpes lesions are highly contagious as the virus is inside the vesicles.

After 7 to 10 days, the lesions dry up, forming yellowish-brown crusts that are removed, sometimes leaving a residual scar. The most frequently affected areas are the trunk, the thigh, and the eye region. The latter is more serious as there is a risk of corneal ulcers leading to blindness.

Treatment - Treatment of herpes zoster is aimed at limiting the severity, extent, and duration of the process, preventing the spread of the disease, reducing acute pain, and, finally, preventing postherpetic neuralgia

Antiviral treatment is beneficial in most patients with herpes zoster but is essential in patients over 50 years of age, immunocompromised patients, and in cases of ophthalmic involvement. Treatment is most effective when started within 72 hours after the onset of the rash. However, cases have been reported in which treatment has been initiated up to a week after the onset of herpes lesions and has been effective. Antiviral treatment is mainly based on acyclovir, valacyclovir, famciclovir, and brivudine.

Can It Be Prevented?

To reduce the risk of infection, it is important to know if sexual partners are carriers of the virus. It is also important that if a partner has herpes symptoms such as sores in the mouth or genital area, it is important to avoid contact or sexual intercourse while the outbreak is ongoing.

If you want to reduce the risk of developing or transmitting herpes:

- use condoms when having sex;

- do not have sex while symptoms are present (genital, anal or skin-to-skin contact);

- do not kiss when you have cold sores; and

- do not have multiple sexual partners.

Some people believe that stress, feeling tired, illness, skin friction, or sun exposure can trigger symptom recurrences. Identifying and avoiding these triggers may help reduce the number of occurrences.

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