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What is the cause and treatment of herpes infection?

Q: My mother had high blood pressure (210 upper reading) and severe headache one day. The next day one of the eyes was swollen and some pimples appeared on half of her face. The doctor diagnosed it as herpes infection. How much time will it take to recover? What kind of complications are expected in future?

A:Herpes simplex viruses (HSVs), causing a wide variety of illnesses, are of 2 types - HSV-1 and HSV-2. The infections may be asymptomatic in up to 80% of patients, but when symptomatic, they cause significant illness and are often recurrent. HSV-1 is transmitted by contact with infected saliva, while HSV-2 is spread sexually or from a mothers genital tract infection to the baby at the time of delivery. The virus is transmitted by close personal contact and spreads when inoculated in the mouth, cervix, conjunctiva or through small breaks in the skin. The virus has certain characteristics, which govern the disease pattern. It has the capacity to invade and divide in the nervous tissue (neurotropism); it can remain quiescent in nerve cells (latency) and it has the capability to reactivate and start dividing when induced by stresses like fever, injury, emotional stress, sunlight, periods etc), resulting in recurrent infection. HSV-1 reactivates more frequently in the oral region while HSV-2 reactivates far more frequently in the genital region. The recurrence rate for HSV-2 is much higher. The clinical features depend on the age and immune status of the patient, the site of involvement, and the antigenic type of the virus. The primary (first episode) infections caused by HSV-1 & 2 are accompanied by systemic illness, longer duration of symptoms, and higher rate of complications while recurrent episodes are milder and of shorter duration. The primary mucocutaneous lesion by HSV-1 may lead to acute herpetic gingivostomatitis (mouth), acute herpetic pharyngotonsillitis (throat) or herpes labialis (lips). The lesions are painful and erupt for upto 2 weeks. They develop into vesicles and systemic symptoms like fever, malaise, loss of appetite and muscle pain are common. The vesicles turn into ulcers and then heal in 5-7 days. Recurrent infection may be subclinical (i.e only the virus is shed without any lesion) or overt (mucosal or cutaneous lesions along with viral excretion). The treatment is by specific antiviral drugs along with treatment of constitutional features and appropriate wound care to prevent secondary bacterial skin infection. Specific antiviral drugs have activity against viral DNA synthesis and inhibit the division of the virus and may suppress clinical manifestations but do not cure the disease. As the virus remains latent in nerve cells, there is no difference is the rate of relapse in treated and untreated patients.

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