Herpes virus infection

Disease Description (Causes and Symptoms)

• Definition: An infection caused by viruses belonging to the Herpesviridae family (typically HSV-1, HSV-2, VZV, etc.) that causes vesicular lesions and inflammation of the skin and mucous membranes and has latent and reactivation characteristics.
• Causes/Pathophysiology: The virus remains latent in peripheral sensory ganglia (e.g., the trigeminal ganglion and sacral ganglia) and is reactivated by stress, immunosuppression, fever, trauma, and other factors, forming lesions on the skin and mucous membranes along the corresponding dermatome. HSV-1 mainly causes lesions around the mouth, while HSV-2 mainly causes lesions around the genital area, although their distributions may overlap. VZV (chickenpox and herpes zoster) is a different type that causes herpes zoster in adults after the initial infection.
• Main symptoms: Localized pain, burning, and itching → a small number of clusters of small vesicles (blisters) → erosions and crusts after the vesicles rupture. Fever and systemic symptoms may occur depending on the case. Transmission and severe disease may occur in immunocompromised individuals and neonates.

Treatment

• General principles: Early administration of antiviral medication is effective in relieving symptoms, shortening the duration of illness, and reducing the risk of transmission. Mild cases are treated on an outpatient basis; hospitalization and intravenous treatment should be considered for severe cases, complications, neonates, and immunocompromised patients.
• Medication
  • Mild/common cases: Oral antiviral medications (e.g., acyclovir, valacyclovir (valaciclovir), famciclovir)
    • Examples (general uses; adjustment according to the patient’s condition is required):
      • Herpes labialis (episodic): Valacyclovir 2 g PO once (or twice at 12-hour intervals) as short-term therapy, or acyclovir 200 mg 5 times/day for 5 days, etc.
      • Genital herpes (first episode): Valacyclovir 1 g PO twice/day for 7–10 days or acyclovir 400 mg PO 3–5 times/day for 7–10 days
      • Suppressive therapy (for patients with frequent recurrences): Valacyclovir 500 mg–1 g PO daily (at the physician’s discretion)
  • Severe disease, disseminated infection, or risk of complications: Intravenous acyclovir (e.g., 10 mg/kg IV q8h) — for encephalitis, systemic infection, immunocompromised patients, neonates, etc.
  • Neonates: IV acyclovir (the dose and duration vary depending on the disease type; follow the guidance of a neonatologist)
• Conservative/supportive treatment: Pain control (analgesics, local anesthetics), local hygiene, moisturizing and protection, antibiotics in cases of secondary bacterial infection
• Surgery/procedures: Usually unnecessary. Consultation with the relevant specialty is required for complications (e.g., ophthalmologic treatment for corneal damage or surgical treatment for severe tissue defects).
• Lifestyle management and precautions
  • Avoid contact during the period of active lesions (kissing, sexual contact, sharing utensils or towels, etc.)
  • Do not touch the lesions with your hands; wash your hands if you do touch them
  • If a first infection occurs close to delivery during pregnancy, obstetric management such as considering cesarean delivery is necessary
  • Early medical evaluation is essential for immunocompromised patients and neonates

Checklist Before an Outpatient Visit (Including Example Questions)

• Items/records to prepare
  • A list of medications currently being taken (including prescription and nonprescription medications and supplements)
  • Allergy history (medications and food)
  • When symptoms began and their progression (photographs of the lesions, if possible)
  • Fever and systemic symptoms, previous similar episodes (frequency and duration of recurrence), pregnancy status, and sexual contact history (if genital lesions are suspected)
  • Whether immunosuppressive treatment is being received and whether underlying diseases are present (e.g., cancer, HIV, diabetes)
  • Recent surgery, hospitalization, and overseas travel history
• Example questions to provide information at the outpatient visit
  • "When did the symptoms first begin?", "Have you had similar lesions before?", "Have you taken immunosuppressants recently?"

General Examples of Questions to Ask the Doctor

• What is the purpose of this medication, and what are its common side effects?
• Are there any precautions I should take because of the medications I am currently taking or my underlying diseases?
• When should I return if my symptoms worsen or complications are suspected?
• What lifestyle habits or preventive measures can help reduce recurrences?
• I am pregnant (or breastfeeding); how might this affect the mode of delivery or treatment?

Examples of Condition-Specific Questions

• (Pregnancy-related) I developed genital herpes for the first time late in pregnancy. How do you decide the mode of delivery (vaginal delivery vs. cesarean delivery)?
• (Frequent recurrences) I have several recurrences in one year. Is suppressive therapy (daily antiviral medication) appropriate for me? What benefits and side effects can be expected?

End.