LET’S TALK ABOUT ORAL HERPES
The other day someone approached me with a small sore on the lip and, after a short conversation and evaluation, we concluded it was herpes. Not even 5 minutes had passed, and the proper treatment was recommended… But after being approached to write this text, I started to think a little more: What does it mean to have herpes? So I went to review some of the knowledge of virology and briefly investigate the subject so here I presenting the summary of my incursion.
1- What is it?
It’s a virus. This means that a herpes infection is caused by an extremely small pseudo-organism, and it lacks the ability to reproduce without resorting to host cells (as opposed to fungi and bacteria that can often do so even though they are not to infect anyone). What is commonly referred to as “herpes” is an infection caused by one of two virus species – HSV-1 (herpes simplex virus 1) or HSV-2 (herpes simplex virus 2) – which in turn belong to the virus family Herpesviridae (which also includes many other viruses, such as chickenpox). Usually, HSV-1 is responsible for oral herpes, also known as cold sores, and HSV-2 for genital herpes, but occasionally the opposite may also happen.
The infection by these viruses has no cure.
It is characterized by some short periods of activation, usually with symptoms of a burning sensation and the formation of vesicles in infected areas.
2- How do we get infected?
Skin contact of an infected region with an uninfected skin in a humid environment. And anything that might imply some similar contact. Herpes does not survive long outside the body and it needs some sores (even microscopic ones are enough) to get through the skin. The mucosal areas are always more vulnerable.
One way to avoid infection is to have no contact with an active herpes area, which is where there is a greater amount of virus reproducing. Despite this, sometimes the virus is released from the infected area after a period of activation that did not show any symptoms (which may complicate this prevention process). So, it is important to say that anyone who has the virus can transmit it, even though the person does not appear to have any active infection.
3- Is it dangerous?
Yes and no. Usually, HSV-1, responsible for oral herpes, is only an occasional nuisance which can be easily controlled. Despite this, there is a possibility of transmitting the virus to other areas, of which the eye is perhaps the most striking, as it causes an eye infection that can lead to blindness. It is simple to avoid it: Do not touch the eye after touching the affected area. In fact, it is good policy simply to not touch the affected area in general. Those vesicles that form will eventually dry out, form a crust, and fall.
HSV-2, on the other hand, has the potential to cause neonatal herpes to the babies of pregnant women with active infection during childbirth. With proper monitoring and medication, this is controlled.
4- How does oral herpes develop?
There are many theories about the reactivation of the virus. Although there is no hard evidence for the next statements, here is a list of the things that usually activate it: menstruation, concomitant infections (constipation, flu, tonsillitis, and the like), poor nutrition, excessive sun, medication or radiotherapy, and stress. For some of these things there is little that can be done, but others can be corrected, so it may be worth taking advantage of a reactivation to do a reevaluation of our “health status” in the last days or weeks…
5- How do I treat it?
As already mentioned, there is no definitive cure. Once caught, the virus is stored in our cells, always threatening with the possibility of causing us inconvenience and being transmitted. Regarding the treatment of oral herpes in particular, the virus activations are self-limiting, so they will stop and heal over time. However, if a topical formula with an antiviral (whose name usually ends in “-cyclovir”) is applied at the beginning of the activation (when it is still only red and itching…), its duration is significantly reduced.
In case it causes strong pain or discomfort, there are several alternatives on the market. To control pain you can use paracetamol or an NSAID (non-steroidal anti-inflammatory), but there are now several formulas in cream, ointment or skin patch (so many new ones come out!), which have some compounds intended to help the skin recover and reduce the discomfort. I do not have much hard evidence about their efficacy in treatment, but people report to me that they often actually relieve the symptoms and reduce the healing time of the vesicles.
As it has also been mentioned, a herpes virus infection does not always only produce this “minor” manifestation. For this reason, there are antivirals to take in tablet form, syrup or the like, which are designed to prevent its advance, control symptoms, and still drastically reduce the possibility of spreading the infection. However, as they are also somewhat toxic, their use needs to be supervised by a doctor.
It reduces the likelihood of infection if we are not in contact with an active infection. But the possibility is not completely eliminated. Although the estimates vary considerably from region to region, I can say that a large percentage of the population (at least 40%) are already infected and carry the inactive virus for most of the time, without causing much discomfort. In most of its manifestations, the herpes is but an inconvenience. Nevertheless, it may cause some more serious complications for which we must be informed.
Text written by João.