Herpes simplex

Disease Description (Causes and Symptoms)

• Cause: Infection caused by herpes simplex virus (HSV) type 1 (primarily oral herpes) or type 2 (primarily genital herpes). The virus remains latent in peripheral sensory ganglia (e.g., the trigeminal and sacral ganglia) and is later reactivated.
• Pathophysiology summary: After the initial infection, the virus remains latent in the ganglia and is reactivated by triggers such as fever, ultraviolet light, stress, immunosuppression, trauma, and menstruation, causing localized lesions on the skin and mucous membranes. Rarely, complications may occur involving the nervous system (herpes simplex encephalitis), eyes (keratitis), or the whole body (disseminated infection in neonates or immunocompromised individuals).
• Main symptoms: Itching, burning, or tingling before lesions appear (prodromal symptoms); grouped small vesicles (blisters) on an erythematous base; pustules → scab formation and healing. The initial infection may be accompanied by systemic symptoms such as fever, headache, and muscle aches. Recurrences are generally localized and mild and heal within 1–2 weeks. The average recurrence frequency varies greatly between individuals, but about once a year is common.

Treatment Methods

• General principles: Most mild lesions heal spontaneously. Antiviral medications are used to relieve symptoms and prevent complications. Severe initial infections, infections in immunocompromised individuals, and nervous-system, eye, or neonatal infections require active antiviral treatment, often administered intravenously.
• Drug therapy (representative and generally recommended examples)
  • Mild/typical recurrences: Oral antiviral medications (famciclovir/valacyclovir/famciclovir or acyclovir). Examples: valacyclovir 500 mg PO once daily (suppressive therapy) or short-term high-dose therapy for recurrences; acyclovir 400 mg PO TID, etc. (as prescribed by a physician). Topical ointment (acyclovir cream) may be used for symptom relief and mild lesions.
  • Initial, severe, disseminated infection or immunocompromised individuals: Intravenous acyclovir (generally 5–10 mg/kg IV q8h; duration determined according to the patient’s condition). Neonatal HSV is typically treated with high-dose IV acyclovir (e.g., 20 mg/kg q8h for 14–21 days, etc.).
  • Suppressive therapy (for frequent recurrences): Long-term low-dose administration, such as valacyclovir 500 mg PO once daily or 1 g PO once daily (at the physician’s discretion), or acyclovir 400 mg PO BID, to reduce recurrences.
• Non-drug treatment/self-care: Keep lesions clean and dry; use pain relievers (acetaminophen/NSAIDs) for pain; apply local cold compresses; do not squeeze blisters; and maintain thorough hand hygiene. When genital lesions are present, abstain from sexual intercourse until the lesions have healed.
• Special precautions: If eye symptoms (redness, reduced vision, or eye pain) occur, seek immediate ophthalmologic care. Do not use topical steroids on infected areas (prohibited without a physician’s instructions). During pregnancy and in neonates or immunocompromised individuals, follow specialist guidance.

Checklist Before an Outpatient Visit (Preparation and Medical History Examples)

• Items/materials to prepare
  • List of medications currently being taken (including prescription drugs, OTC medications, and supplements) and records of drug allergies
  • Recent test results, if available, and previous HSV test results (antibody/PCR)
  • Date symptoms began and how they have progressed; frequency and duration of previous recurrences; photos of similar symptoms (mobile-phone photos can be useful)
  • Whether pregnant (for women), recent sexual contact, and whether condoms were used
  • Whether immunocompromised (chemotherapy, use of immunosuppressants, HIV, etc.)
• Key points to explain to the doctor during the visit (examples)
  • When symptoms first appeared and how they progressed (including whether systemic symptoms were present)
  • Whether recurrences are frequent (annual frequency) and whether symptoms have become more severe
  • Recent fever, fatigue, eye symptoms, and whether pregnant
  • Whether antiviral medication was recently taken and its effectiveness

General Questions to Ask a Doctor

• What are the main side effects and precautions for this medication (the prescribed antiviral)?
• What is the prognosis in my case, and how can I reduce recurrences?
• Are there any activities I should particularly avoid as part of my lifestyle (e.g., ultraviolet exposure, swimming, or sexual intercourse)?
• Are additional tests needed after the treatment period?

Examples of Disease-Specific Questions

• Genital herpes simplex is suspected during pregnancy. How is the mode of delivery (vaginal delivery vs. cesarean section) determined?
• If recurrences are frequent, is suppressive therapy (long-term antiviral medication) needed? If so, what are the expected duration and side effects?

Additional Brief Guidance (Precautions and Complications)

• Precautions: When lesions are present, avoid direct contact (kissing and sexual intercourse) and sharing utensils, lip balm, or towels, and wash your hands frequently to prevent transmission. Prevent lesions from spreading to the eyes (do not rub your eyes with your hands). Immunocompromised individuals, neonates, and pregnant women should consult medical staff immediately.
• Complications: Herpes simplex encephalitis (especially HSV-1), skin dissemination without vesicle formation and skin spread resembling measles (especially eczema herpeticum in patients with atopic dermatitis), ocular infection (keratitis), severe neonatal infection, and urinary tract or urethral problems caused by infection of the genital area may occur.