There are two types of herpes simplex viruses (HSV), I and II. Type I usually affects the mouth inside, the lips, and the areas around. That on the lips is common known as cold sores. The transmission is by simple kissing or using shared towels. Type II usually affects the genital areas and is transmitted by sexual contact.

Signs

During the initial infection, there are tiny, clear fluid-filled blisters in the areas affected. It is itchy and painful. The blisters later crust and the skin heals without scarring.

However, the viruses are not eradicated. They will enter the nerve cells and remain in a dormant phase. When the host is in a lower immune status, they are un-checked, and will become active again with the vesicles reappearing in the same site or nearby. There is usually a tingling sensation in that area in the early stage of recurrence.

Diagnosis

Typical history and appearance makes the diagnosis easy. If the diagnosis is not certain, particularly when it happens in the genital areas, when a definitive answer may be requested, then laboratory test such as specific antibody tests, smear and tissue culture may be done.

Management & Treatments

Do not share towels and come into close intimate body contact with someone else, as it is contagious when the disease is active. For simple cold sores, acyclovir cream can shorten the period and speed as recovery. It is best if it can be applied during the “prodrome”, in which case the blisters may be prevented from appearing completely.

For more widespread infection or those in the genital areas, oral treatment is necessary. Acyclovir is a standard regime but it needs to be taken 5 times per day because of poor absorption. Newer generation such as valacyclovir or famciclovir has better absorption and can be taken 2 or 3 times per day, but they are a lot more expensive. The usual period of treatment is 5 to 7 days.

Since the medication cannot penetrate into the nervous system, they can only kill the viruses that are outside. The viruses unaffected will mount another attack when the immune activity of the host is low. If the recurrences are very frequent, then it is reasonable to take a course of lower dose over a period of 3 months.