HOW SERIOUS IS HERPES SIMPLEX?


The severity of symptoms depends on where and how the virus gains entry into the body. Except in very rare instances and in special circumstances, the disease is not life threatening, although it can be very debilitating and cause great emotional distress.


Effects of Herpes Virus on Pregnancy

One study has indicated that HSV-1 in either men or women may be implicated in some cases of infertility. More research is needed. Pregnant women who are infected with either HSV-2 or HSV-1 genital herpes have a higher risk for miscarriage, premature labor, retarded fetal growth, or transmission of the HSV infection to the infant while in the uterus or at the time of delivery. Recurrence in women previously infected with HSV is also common during pregnancy. It should be noted, however, that about one million pregnancies occur each year in women who have been infected with HSV-2, but complications occur in only .01% to .04% of all infected pregnant women.


Effects on the Brain and Central Nervous System

Herpes Encephalitis. Herpes accounts for 10% to 20% of cases of acute viral encephalitis, an extremely serious brain disease. It is fatal in over 70% of untreated cases. Those who recover nearly always suffer some impairment, ranging from mild neurological damage to paralysis. Fortunately, treatment with acyclovir significantly improves both survival rates (up to about 80%) and reduces complication rates (to nearly 40%). It should also be noted that herpes encephalitis is very rare and affects only about 1,250 people in the US each year. The incidence is even lower in Northern Europe. HSV-1 is almost always the culprit, except in newborns. In about 70% of infant herpes encephalitis, the disease occurs when a latent virus is activated. In about one-quarter of HSV-1 encephalitis cases, the infection may be caused by a new strain of the virus. Respiratory arrest can occur within the first 24 to 72 hours. Recovery from HSV encephalitis is dependent on the patient's age, the level of consciousness, duration of the disease, and the promptness of treatment.

Herpes Meningitis: 
Herpes meningitis occurs in 4% to 8% of cases of primary genital HSV-2, and women are more likely to develop it than men are. Symptoms include headache, fever, stiff neck, vomiting, and sensitivity to light. Fortunately, herpes meningitis is self-limited, lasting for only two to seven days. Neurologic consequences are rare, but recurrences have been reported.

Alzheimer's Disease:
Studies indicate a higher risk for Alzheimer's in people who have both HSV-1 and a gene called apoE4, a known risk factor for Alzheimer's. Further research suggests that interaction with the gene and herpes simplex virus may contribute to Alzheimer's disease. For example, a protein found in HSV-1 has been shown to mimic and behave just like beta-amyloid, a protein now strongly believed to be a critical player in the Alzheimer's disease process.

Other Neurologic Diseases:
Other neurologic syndromes that have been linked to HSV infection include epilepsy, multiple sclerosis, atypical pain syndromes, ascending myelitis (inflammation of the spinal column), and neuralgias (severe stabbing pain along a nerve or group of nerves).


Eczema Herpeticum:
Eczema herpeticum, also known as Kaposi's varicellum eruption , can afflict patients with preexisting skin disorders and immunocompromised patients. The disease tends to develop into widespread skin infection and resemble impetigo. Symptoms appear abruptly and can include fever, chills, and malaise. Clusters of dimpled blisters emerge over seven to ten days and spread widely. They can become secondarily infected with staphylococcal or streptococcal organisms. The lesions heal in two to six weeks.


Ocular Herpes and Vision Loss:
Herpetic infections of the eye can cause loss of vision and damage to the upper layers over the cornea that occurs over a period of months to years. In most cases, visual impairment is very slight. In about 6% of ocular herpes, however, a condition called stroma keratitis occurs, in which deeper layers of the cornea are involved, possibly as an abnormal immune response to the original infection. In these rare cases, scarring and corneal thinning develop, which may cause the eye's globe to rupture and result in blindness. Ocular herpes is the most frequent infectious cause of corneal blindness in the world.


Gingivostomatitis:
HSV can cause multiple painful ulcers on the gums and mucous membranes of the mouth, a condition called gingivostomatitis. This condition usually affects children between the ages of one and five, and typically subsides after a week. In rare cases, it can progress to a systemic viral infection. Children with gingivostomatitis commonly develop herpetic whitlow, which is herpes that occurs in the fingers.


Other Disorders Linked to Herpes Simplex

A number of other conditions have been linked to HSV infections, although the association has not been substantiated in most cases. Arthritis affecting a single joint has been sporadically reported as a result of HSV infection.


Certain kidney and blood diseases have also been reported in conjunction with HSV infection.

HSV can affect the liver and in rare cases it may cause hepatitis. This is an uncommon complication in people with healthy immune systems, but in rare cases can cause life-threatening complications. It is important to be aware of its possibility, since this emergency condition is treatable when diagnosed promptly. Early symptoms may include nausea, vomiting, and abdominal pain. People with HSV-2 may have an increased susceptibility for sexually transmitted hepatitis C.

Some studies have reported an association between HSV-1 and 2 with a higher risk for coronary artery disease.

Emotional and Social Effects:

Not least among the damaging effects of HSV-2 is its impact on the social and emotional life of patients. In one survey of herpes patients, 82% felt depressed and 75% were worried about rejection. Over a quarter had suicidal thoughts. In nearly 80% of the respondents, the disease had a profound effect on their sexual life. The patient must notify sexual partners, past and present, about their condition, a deeply humiliating experience. Guilt and anger are common emotions, and relationships may be shattered. It is important to note that the condition is often dormant for many years and may not have been transmitted by a current sexual partner. Support groups or couple therapy can be very helpful.


Herpes in the Immunocompromised Patients

Herpes simplex is particularly devastating when it occurs in immunocompromised patients. These include people who are HIV positive, cancer or burn patients, or patients who are using immunosuprresant drugs (those used after organ transplantation, long-term or high-dose steroids).

Patients with HIV, the virus that causes AIDS, are particularly vulnerable to complications. When both viruses are present, there appears to be a synergy between them, with each increasing the severity of the other. (The presence of HSV also increases the risk for contracting AIDS.)

Herpes simplex in any patient with a seriously compromised immune system can cause serious and even life-threatening complications, including the following:

Pneumonia. Liver damage, including hepatitis. Hepatitis caused by primary or recurrent HSV can sometimes develop into a life-threatening condition called fulminant liver failure.

Inflammation of the esophagus.

Encephalitis.

Destruction of the adrenal glands.

Increased risk for disseminated herpes and herpes encephalitis. Less serious conditions include stomach and anal ulcers, inflammation in the colon, and eczema herpeticum.

Information from:
http://www.mpwh.net/herpesinfo/severity.html
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Nidus Information Services Inc

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