Herpes Simplex (HSV) Type 1 and 2 Herpes  simplex  is  a  double  stranded  DNA virus  that  is  responsible  for  a  primary  and recurrent infection in humans. Primary infection is  acquired  in  childhood  from  close  contact  with infected  adults  or  other  children,  or  in  adults  from contact through intercourse or kissing an infected individual.  The  virus  is  always  present  in an  active  blister  or  ulcer  and  is  also  shed  in some  cases  from  individuals  without  a  clinical lesion. SYMPTOMS—The   virus   is   divided   into two   types.   Type   1   is   usually   associated   with a  childhood  infection  and  occurs  on  the  lips as  a  cold  sore  or  fever  blister.  Type  2  is associated   with   an   adult   infection   and   is usually   of   the   genital   type.   This   classifi- cation  is  not  restrictive  as  either  of  the viruses  can  cause  an  infection  on  any  area of  the  skin  or  mucous  membranes.  The  infec- tions  are  also  divided  into  a  primary  or initial  infection  and  a  recurrent  infection. The  primary  infection  of  type  1  and  type  2 HSV  tends  to  be  severe  with  multiple  grouped vesicles   on   an   erythematous   base,   regional lymphadenopathy, fever,   and   malaise.   The time from exposure to development of symptoms is  3  to  10  days.  The  duration  of  the  primary infection   is   from   2   to   6   weeks.   Following the  primary  infection  the  virus  enters  a dormant  stage,    residing  in  the  dorsal  root ganglia   of   the   sensory   nerve   that   supplied innervation  to  the  blister  site.  The  virus  can remain  dormant  for  many  years  with  the  type 1   HSV,   but   tends   to   reoccur   3   to   4   times per  year  with  the  type  2  HSV.  Recurrent lesions  may  appear  without  cause  or  follow trauma, stress, menses, sunburn, or intercourse. The   recurrent   infection   is   usually   much   less severe,   manifested   by   pain   locally   and   some regional   adenopathy.   The   lesions   appear   in the same location with each recurrent eruption. These  lesions  resolve  spontaneously  in  5  to 7 days. TREATMENT—At  the  present  time  there  is no  cure  for  HSV  infection.  In  most  cases,  relief of  pain  with  analgesics  or  topical  anesthetics  is adequate,  especially  for  recurrent  lesions.  Primary infections  can  be  treated  with  acyclovir.  There  are topical  and  oral  preparations  available.  Recurrent infections  if  very  frequent  and  severe  may  be candidates  for  oral  acyclovir  prophylaxis. NOTE: DO NOT TOUCH THE LESION OR   ANY   VESICULAR   OR   ULCER- ATED   LESION   WITHOUT   EXAM GLOVES.   HSV   CAN   EASILY   BE TRANSMITTED  TO  YOUR  HANDS, CAUSING  A  HERPETIC  WHITLOW LESION. Herpes  Zoster Shingles is an acute viral infection of the cen- tral nervous sytem characterized by vesicular erup- tions  and  neuralgic-type  pain  in  areas  supplied with peripheral sensory nerves. This infection is caused by the same virus that causes chickenpox (varicella) and is most commonly encountered in persons  over  the  age  of  50. SYMPTOMS—Chills,   fever,   malaise,   and gastrointestinal  disorders  may  precede  distinctive features  of  the  disease.  On  about  the  fourth  or fifth   day,   crops   of   vesicles   appear   on   an erythematous  base  in  the  area  of  the  involved nerve.  Pain  may  be  present  at  this  time;  however, the skin in the involved area is extremely sensitive. TREATMENT—No   specific   remedy   exists. The  disease  normally  clears  with  no  permanent damage   except   for   scarring   or   postherpetic neuralgia.  A  corticosteroid,  such  as  prednisone, may  help  to  shorten  the  duration  and  relieve  some of  the  symptoms.  Soothing  lotions  and  powders are  often  effective,  and  aspirin  or  other  analgesics may  be  administered  for  pain.  NOTE:  Before giving  a  corticosteroid,  rule  out  herpes  simplex. Verrucae Warts  are  very  common,  contagious,  benign epithelial tumors that may persist as single lesions or develop satellites. Occasionally the warts may disappear  spontaneously. TREATMENT—The warts themselves may be easily removed; however, the virus often remains, producing  recurrent  warts  at  the  same  or  different sites. Therefore, it is often advisable to leave single warts   alone.   Trichloroacetic   acid   should   be applied  to  warts  every  3  to  4  days,  followed  by phenol neutralized with alcohol or nitric acid when the wart whitens. If the warts are in warm, moist anogenital  areas,  podophyllum  resin  in  tincture of benzoin is often effective. Plantar warts, found on the soles of the feet, are warts that have been flattened by pressure and are usually very painful. 2-25