Herpes Simplex Transmission

Herpes simplex is a viral infection caused by herpes simplex virus type I and II (HSV-I and HSV-II). HSV-I often attacks the area around the mouth (herpes labialis), while HSV-II is often on the genital area (genital herpes). However, because of oral sex or oro-genital sex then either HSV-I and HSV-II can about the area around the mouth or genitals. Forms of HSV attack on an individual can be a primary infection, non primary first episode, recurrent and asymptomatic.
The incidence of herpes simplex infection increases every year. Data in the United States said that found 1.5 million new cases are caused by HSV transmission through sexual intercourse, in which a woman infected with HSV can transmit to a partner by 4-5%, but if the man who infected the chances of transmitting HSV the spouse of 8-10%. HSV infection in neonates due to vertical transmission from mother to reach 1500-2000 new cases each year.
An individual may be exposed to HSV infection because of transmission from a seropositive individual, where transmission can take place both horizontally and vertically. The difference of the two transmission methods are as follows:

Herpes Simplex Test

Test for Herpes Simplex Virus (HSV) infection can be performed virology and serology, each instance of the investigation are as follows: 

Virology

1. Light microscope. Samples derived from cells at the base of the lesion, smears on the mucosal surface, or from a biopsy, may be found in internuclear inclusions (Lipschutz inclusion bodies). Infected cells may show an enlarged cells resembling balloons (ballooning) and found fusion. In the experiment Tzanck with Giemsa or Wright staining, can be found in many core datia cells and inclusion bodies intra nuclear.
2. Examination direct antigen (immunofluorescence). Cells of the specimens included in the frozen acetone. Then the examination is done by using light electrons (90% sensitivity, 90% specific) but, this examination can not be matched with viral culture.
3. PCR, polymer chain reaction test for HSV DNA is more sensitive than traditional viral culture (sensitivity> 95%, compared with a culture that only 75%). But its use in the diagnosis of HSV infection has not been conducted on a regular basis, most likely because the cost is expensive. This test is commonly used to diagnose HSV encephalitis because the results are faster than culture virus.6
4. The virus culture, viral culture of vesicle fluid in the lesion (+) for HSV is the best way because the most sensitive and specific than other methods. HSV can develop within 2 to 3 days. If the test is (+), almost 100% accurate, especially if the fluid comes from the primary vesicles rather than vesicles recurrence. Growth of virus in the cell indicated by the occurrence of cytoplasmic granulation, balloon degeneration and giant cell core a lot. Since the virus is difficult to develop, test results often (-). However, this method has the disadvantage due to a long examination time and expensive.

Serology

Primary Oral Herpes

Definition of Primary Oral Herpes
Primary herpes refers to the first episode of symptoms after infection, often present with painful wounds on the lips, gums, and mouth.
In some people, the first attack (primary herpes) from herpes associated with fever, swollen glands, and gums that bleed, together with the painful wounds around the mouth (gingivostomatitis). The signs and symptoms may last several days. The difficulty in eating and drinking may lead to dehydration. The wounds healed completely within two to six weeks, usually without scarring. The virus can be recovered in saliva for days after the wounds healed. Primary herpes is usually acquired during childhood.

Herpes Simplex Fact : Neonatal HSV Infection

 Neonatal infection can be divided into 3 clinical types, namely: the spread of infection and generally attacks the liver, encephalitis and infections limited to skin, eyes and mouth. The first and second form often leads to death. Infections are usually caused by HSV 2 but infections caused by HSV1 is also common. The risk of infection in children depends on 2 main factors in the mother; the pad when the gestational age of pregnant women is generating HSV and depends also on whether the infection suffered by secondary infection or primary infection.
Only HSV excretion containing incurred during childbirth are dangerous for newborns with intrauterine infection although rare exceptions may occur. Primary infection in the mother can increase the risk of infection in infants from 3% to 30%, presumably because of immunity in the mother can provide protection.

Herpes Simplex Causes, Distribution and Incubation

Herpes Simplex Etiology
Causes Herpes simplex virus infection are included in the family herpesviridae, subfamily alphaherpesvirinae. HSV type 1 and type 2 can be distinguished immunologically (especially if you used a specific antibody or monoclonal antibody). And HSV type 1 and type 2 is also different when viewed from the growth pattern of the virus in cell culture, eggs and embryos in experimental animals.
Herpes Simplex Distribution
Scattered throughout the world. Hamapir 50% -90% of adults have antibodies to HSV 1. Initial infection of HSV 1 usually occurs before age 5 years, but now many primary infections are found occur in adults. Infection with HSV-2 usually starts because of sexual activity and rarely occur before adulthood, except in case of sexually abused children. HSV-2 antibody was found about 20% -30% of American adults. Prevalence of antibodies to HSV-2 increased (more than 60%) in lower socioeconomic groups and in people who have multiple sexual partners.
Reservoir - Humans serve as reservoirs.
Herpes Simplex Transmission

Herpes Simplex Fact

Herpes simplex is a viral infection characterized by localized primary lesion, latency and the tendency for recurrence. There are 2 types of virus - the herpes simplex virus (HSV) types 1 and 2 in general lead to different clinical symptoms, depending on the entry road. Can attack the means of genital or oral mucosa. Primary infection with HSV-1 may be mild with no symptoms, occurred in early childhood.
Approximately 10% of primary infection, emerged as a disease with a diverse spectrum of clinical symptoms, characterized by hot and malaise to 1 week or more, may be accompanied by severe gingivostomatitis followed by a vesicular lesions on the oropharynx, severe keratoconjunctivitis, and accompanied by the emergence of symptoms and complications of chronic eczema-like skin, meningoencephalitis or some fatal infection that occurs in newborns (congenital herpes simplex, ICD-9 771.2, ICD-10 P35.2).

Herpes Zoster (shingles)

Herpes zoster (shingles) is a local manifestation of reactivation of latent varicella infection in the dorsal ganglia radix. Vesicular lesions appear as erythema limited basis in areas of skin, which follows the course of a single sensory nerve ganglia or group radix dorsalis. The lesions can appear in the form of an irregular bubble gang during the course of the nerve, usually unilateral. Vesicles located deeper and gather more closely than chicken pox, herpes zoster and varicella are histologically similar to each other. Almost always accompanied by pain and paresthesias once, and about 30% of adults who fell ill suffered from postherpetic neuralgia herpes. 

Herpes Simplex Encephalitis Complications and Prognosis

HSE  Complications
Seizures are common and some authors recommend prophylactic anti-seizure therapy in patients with severe HSE. Brain edema that occurs sometimes can be resolved with steroid therapy, although the use of steroids in the HSE is still a controversy. Adjunct therapy for brain edema include hyperventilation and barbiturates. Other complications that looks similar to all patients and patients with severe pain severe consciousness disturbance (eg, aspiration pneumonia, venous thrombosis profundus, and decubitus.)  

HSE  Prognosis

Herpes Simplex Encephalitis Therapy

Management of HSE
The aim of treatment is to shorten the clinical course of disease, prevent complications and prevent the development of disease recurrence. Drug of choice is acyclovir, which is an antiviral substances that selectively inhibit replication of the virus without damaging normal cells by holding a competition with guanoside for viral DNA polymerase. Acyclovir is said to have the effect of minimum follow-up. The drug is excreted through the kidneys and the dosage should be reduced in patients with renal dysfunction.

Radiological HSE Examination

HSE Radiological examination

MRI is an examination of selected, able to show pathologic changes are usually bilateral, in the medial temporal lobe and the inferior frontal lobe. The existence of lesions in the temporal lobe is significant HSE in the allegation.

Head CT scans can show changes in the temporal and frontal lobes, but less sensitive than MRI. In a third patient HSE found a normal head CT scan.
Other Examination

Herpes Simplex Encephalitis: Lab Examination

Laboratory Examination for Herpes Simplex Encephalitis
CSS Analysis: Typically shows mononuclear pleocytosis with a mild increase in protein levels while the glucose levels normal or decreased slightly. In the early phases of disease, sometimes cell count may be normal, although on serial examination always found an increasing number of cells and proteins. If there is bleeding in the brain parenchyma, the number of erythrocytes is always increasing and the increase was settled on the all tube inspection. HSV CSF culture is rarely found in patients with HSE.

Herpes Simplex Encephalitis Clinical manifestations

Clinical manifestations HSE

HSE is acute or subacute with focal and general signs of cerebral dysfunction. Are sporadic and not associated with the pattern of a particular season. Although fever, headache, behavioral changes, confusion, focal neurological abnormalities and abnormalities in CSF supports the HSE, there are no clinical signs patognomonis to distinguish HSE from other neurological diseases (eg non-HSV encephalitis, brain abscess or brain tumor). Confirmation of the diagnosis depends on identification of HSV from CSF examination by PCR or in brain tissue with brain biopsy.

Herpes Simplex Encephalitis Patofisiology

HSE pathogenesis has not been understood. Part of the brain affected by ptekie very diffuse and scattered necrosis of the medial lobe asymmetry in the inferior temporal and frontal lobes. The exact mechanism is not clear cell damage and affects either directly or indirectly virus immune mediated process.
Brain infection is often a primary infection because of direct transmission of virus through neuronal path from the peripheral to the brain via nerve trigeminus or olfactorius. Factors that accelerate the HSE is not known. Although HSE is often found in patients with decreased immune system, most people have never experienced immune system suppression.

Herpes Simplex Encephalitis

In the last 2 decades there is rapid development of antiviral drugs, but the Herpes Simplex Encephalitis (HSE) remains a severe disease with high morbidity and mortality.In children and adults, HSE found in temporal and frontal lobe and is caused by herpes simplex virus type 1 (HSV-1). In neonates, brain damage caused greater and is caused by HSV-2 are usually obtained at delivery. HSE must be distinguished from herpes simplex meningitis, caused by HSV-2 and is often associated with genital herpes infections that occur simultaneously.

Genital Herpes Sign and Phase

The incubation period ranges from about 3-7 days. Based on whether someone had contacts with Herpes Simplex Virus (HSV-2), genital herpes infections have 2 phases, namely:
Phase of infection (lesions) Primary, characterized by:

• Can occur without symptoms (asymptomatic)
• Beginning with a burning sensation, burning and itching on the affected area.
• Then the resulting vesicles (spots) clusters, easily broken, giving rise to injury (similar ulceration) on the surface of skin redness (erythema), and pain.
• Furthermore, to be followed by fever, malaise whole body (malaise) and muscle pain.
• Happened enlarged lymph nodes around the infected area genital herpes.

Genital Herpes Simplex

Genital herpes simplex is an acute infection (STD = sexually transmitted disease), caused by Herpes Simplex Virus (HSV = Herpes Simplex especially virus type II), characterized by the onset of vesicles (vesicle = elevation of the skin firmly bounded by less than 1 cm in diameter and can be rupture causing erosion as small sores) on the mucosa surface of the skin (mukocutaneus), clustered on the basis of reddish skin. In general, occur in parts of the body below the navel, especially the genital area and surrounding areas. The most common cause is HSV genital Herpes simplex type II.

Herpes Simplex Info

Herpes is a viral infection of the skin. Herpes simplex virus is a herpes virus that causes disease in humans. Noted there are seven types of viruses that can cause disease in humans are herpes Herpes Simplex Virus, Varizolla Zoster Virus (VZV), cytomegalovirus (CMV), Epstein-Barr Virus (EBV), and Human Herpes Virus type 6 (HHV-6), type 7 (HHV-7), type 8 (HHV-8). All herpes viruses have the same size and morphology and everything to replicate in the cell nucleus.

General signs and symptoms of genital herpes

average people who are infected with HSV-2 did not know they are infected. But the signs and symptoms during the first infection usually can be expressed clearly by them. HSV infection occurs usually after 2 weeks after infection, and wound healing usually occurs within 2 to 4 weeks. at the primary stage appears a second crop of sores, and flu-like symptoms, swollen glands and fever. But, half of patient with HSV-2 infection  have signs of very mild that they did not even realize the mistake or that they are for insect bites or other skin conditions.