| Herpes simplex virus (HSV) is a common virus that can cause cold sores and fever blisters, gingivostomatitis (mouth ulcers), genital ulcers and other skin infections. It can also cause serious infections in newborns and encephalitis (an infection of the brain). Once you are infected with the herpes virus, it lies dormant in your body and can become reactivated at any time, especially in times of stress.
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| The herpes virus is transmitted by person to person contact through infectious lesions of the skin and/or secretions |
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There are two types of herpes simplex virus, HSV - 1, which usually causes oral infections, and HSV - 2, which usually causes genital herpes. The herpes virus is transmitted by person to person contact through infectious lesions of the skin and/or secretions. Herpes can also be transmitted to a baby and cause neonatal herpes, either in utero (before the baby is born) or as the baby passes through the birth canal.
Although people are most infectious when they have an active lesion, it is also possible to shed the herpes virus and be contagious to others when an infected person does not have any symptoms. A person is usually most contagious after their first outbreak.
Children with a herpes infection most commonly have gingivostomatitis, which is usually caused by HSV - 1 and causes fever, irritability, pain, decreased appetite and ulcers in the mouth. The most common complication is dehydration secondary to a refusal to drink fluids because of mouth pain and difficulty swallowing. Treatment is usually not required and symptoms generally improve in 3-5 days.
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| symptoms of herpes infections include cold sores or ulcers on the lips |
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Other symptoms of herpes infections, especially HSV - 1, are cold sores or ulcers on the lips (oral/labial lesions), which also usually go away without treatment. These cold sores may recur frequently in some children.
Genital herpes infections are usually caused by HSV - 2. Symptoms can include ulcers, pain, itching, discharge, pain with urination (dysuria), and enlarged and tender inguinal lymph nodes. Symptoms may also include, especially with the first or primary infection, fever, abdominal pain, headaches and aseptic meningitis. Genital herpes is a sexually transmitted disease.
A more serious infection can occur in newborns who develop neonatal herpes infection. Neonatal herpes is usually acquired from a mother with a primary infection and active lesions during the delivery (which usually prompts a cesarean section to decrease the risk of infection). Early treatment is necessary to prevent worsening of the infection and progression to a disseminated herpes infection (with spread to multiple organs of the body) or encephalitis. Because the primary infection may be without symptoms in the mother, this disease can be hard to prevent. While neonatal herpes is usually from HSV - 2, it is also possible to get an HSV - 1 infection, either from a HSV - 1 genital infection in the mother or from contact with cold sores or fever blisters.
Neonatal herpes infections can cause an infection just on the skin, eyes and mouth (SEM disease), or it may spread to the central nervous system (CNS disease, including encephalitis), or become disseminated to other parts of the body (usually the liver and the lungs). Herpes infections of the skin, eyes and mouth are the most easy to recognize, and usually begin in the first few weeks of life with a vesicular rash on an erythematous (red) base, typically on areas of skin trauma, such as the site of a scalp electrode. Central nervous system infections usually present in the second or third week of life with fever, irritability, focal or generalized seizures, and they sometimes also have skin lesions. Disseminated herpes infections are usually more serious, but fortunately less common than the other types of neonatal infections, and typically occur in the first week of life, with symptoms including fever, difficulty breathing, seizures, lethargy, and irritability.
Since many infants in the first month of life can have a herpes infection and not have skin lesions, a high index of suspicion is required to diagnose and treat infections early. Herpes should be considered in any acutely ill newborn, especially if bacterial cultures are negative and the baby isn't improving after 2-3 days.
Testing for neonatal herpes infections may include Tzank smears and/or viral cultures, blood antibody levels and polymerase chain reaction (PCR) testing of spinal fluid. Cultures will usually be obtained from skin vesicles, eyes, mouth, rectum, urine, stool and blood. Treatment is usually with intravenous, high dose (60mg/kg/d) acyclovir for 14-21 days.
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| Herpes lesions are very contagious and you should avoid direct contact with newborn infants while you have a herpes outbreak. |
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Severe infections in older infants and children after the newborn period and most genital infections can also be treated with acyclovir. Herpes lesions are very contagious and you should avoid direct contact with newborn infants while you have a herpes outbreak.
Treatment may also be recommended as prophylaxis in children who frequent episodes of recurrent herpes infections.
Although acyclovir is the most commonly used medication to treat herpes infections in children, an alternative medication that may be used instead is foscarnet. In adults, valacyclovir and famciclovir are also used.
Herpes gladiatorum refers to a herpes skin infection that occurs in adolescent wrestlers. It usually occurs on the head, most commonly the jaw area, and can easily be spread during tight wrestling holds. A once a day dosage of Valacyclovir (Valtrex) may prevent recurrences.
Herpes Internet Resources
- Herpes Resource Center - "Finding Answers and Support for Herpes," with information on symptoms, transmission, treatment, talking with a partner, and pregnancy.
- Herpes Fact Sheet - from the Center for Disease Control, information about genital herpes.
- Herpes Questions and Answers: "Herpes is one of the most common of the more than 30 different sexually transmitted infections in America today. The following information will help you understand herpes, how to avoid it, and how to live with it — if you have to."
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