Herpes simplex is an infectious viral disease that is triggered by febrile illness. The disease mainly affects people, and its main symptoms are localized blisters. Herpes simplex virus (HSV) exists as Type 1, which usually affects the face and mouth, and Type 2, which affects genitals and rectum. This is a contagious infection spreads through contact with affected areas and causes blisters in the mouth, eyes, and, sometimes, the brain and genital areas (Pringle, n.d.). Once people are infected, they develop a fever, as well as have a headache and other general feelings of sickness. The physical examination of sores or the analysis of the substance from the sore help doctors differentiate whether it is herpes simplex or another disease (Pringle, n.d.). The current paper provides the information about the causative agent of the disease, its epidemiology, pathology, and treatment.
Causative Agent and History
HSV is a double-stranded DNA virus that has large, complex genomes and four structural elements. They include the core made up of “a single linear molecule of DNA in the form of a torus” (Herpesvirus Family, n.d.). It also has capsid that encircles the core and the tegument that is an amorphous between the envelope and capsid. Its main function is to control chemical processes (Herpesvirus Family, n.d.). The fourth structural element is the envelope that is the outer layer of the virion, usually made up of altered membranes and viral glycoproteins that look like short spikes. The size of the herpes virus is usually between 120 and 230 kpb (Herpesvirus Family, n.d.).
The replication of the genome takes place in the host cell nucleus where the genes replicate in a specific order. The first is the replication of immediate-early genes that encode regulatory proteins. The second is the replication of genes that encode enzymes for the replication of viral DNA. The third is the replication of late genes encoding structural proteins. The acquisition of the tegument and envelope takes place when the virion buds out through the endoplasmic reticulum or nuclear membrane (Dock, 2012). Through the Golgi complex, the virions are then transported to the cell membrane. Afterward, the host cell dies when mature virions are released. In addition, the virus may be kept in a latent state is some cell types, but it can be reactivated at any time.
The disease has existed for a long time and it was well understood in the past hundred years. However, the approach of treatment changed in the last century. Before the 1960s, the disease was not treated (Mandal, 2013). However, after that time, new drugs were introduced that prevented the multiplication of HSV.
The HSV2, which affects both developed and developing countries, causes the highest percentage of herpes simplex infections. Throughout the world, there is an estimated number of people under the age of 50; two-thirds of them are infected with herpes simplex. The disease is the most prevalent in Africa and in Eastern Mediterranean with 87% and 75% of their population being infected in 2012 (WHO, n.d.). The disease may also lead to the lethal outcome. For instance, in 2007, in Sweden, out of 638 patients hospitalized, 8% died, which was a higher percentage than expected (Hjalmarsson, Blomqvist, & Sköldenberg, 2007). The reservoir of the herpes simplex is human beings and it is usually transmitted through direct contact with the infected areas or secretions from the people who are infected (Dock, 2012). It can also be transmitted through respiratory droplets. The genital herpes simplex is spread through sexual contact. The viruses can also be spread when a mother is delivering, though the risk is not high.
There is a need to explain the process of the development of the virus once attached to the mucous membrane. First, it undergoes acantholysis, which results in the formation of vesicle. The roof of the latter is unsafe; thus, it collapses and takes the form of a herpetic ulcer (Hamza, Higgins, & Ruyechan, 2007). The virus spreads within the cells, leading to viraemia, and then spread in the whole body. Usually, the virus disseminates to the craniospinal ganglia. Once people are infected, the virus enters vulnerable cells in the lower layers of the skin tissue and tries to reproduce in the cell nucleus without showing any symptoms. However, it keeps destroying the cells hosting it. Once the virus has multiplied, people start to develop symptoms, mainly watery blisters in the skin area or in the mucous membranes of the mouth, lips, or genitals. Later, the fluid in sores gets absorbed, forming scabs (Hamza et al., 2007). As a result, the sore heals. In this case, the virus keeps surviving in the latent state and after some time it starts multiplying again, undergoes shedding process, and can be transmitted to people through bodily fluids. Usually, this transmission occurs without symptoms. The symptoms show up finally, leading to the outbreak of blisters and sores. Recurrences of genital herpes caused by the HSV2 are overall much less frequent than that caused by HSV2 (Dock, 2012).
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The virus can have a negative impact on infected people’s mental well-being and their personal relationships. People with orolabial herpes symptoms may encounter social stigma and experience psychological distress. Those with weak immune systems, like the people who have an advanced HIV infection, may have more acute symptoms and are more likely to have a recurrent herpes infection (Hamza et al., 2007). At times, HSV1 infection can also result in other complications like encephalitis or ocular disease. The incubation time of herpes simplex is two to twelve days from the time of the contact to the time when the symptoms appear. Averagely, people develop symptoms about six days after the contact and usually they last for about three weeks (Dock, 2012).
Response and Treatment
HSV can be prevented by the use of dental dam when having oral sex. Moreover, one should use water-based lubricants that help to reduce friction when having an intercourse, thus preventing the irritation of the skin and decreasing the risk of outbreak. Finally, a person should use latex condoms during sexual intercourse (Dock, 2012).
The immune system itself protects the body from the HSV through healing and management of symptoms. It suppresses the virus in the body and controls the recurrence of the virus through the formation of antibodies. Herpes simplex usually affects individuals with a weak immune system. When the body fights against the disease, one experiences headaches and fever. When a person is affected by the recurrent disease, the body produces antibodies that lead to fewer blisters which are less painful and heal faster. The recurrence will take place only if the immune system of an individual is weakened (Dock, 2012). It is not easy to control the spread of the virus since many infected people are not aware that they are infected because they do not have open sores.
The drug companies have produced vaccines to prevent the virus. However, none of the vaccines received an approval to prevent the infection of HSV that can be treated by administering of acyclovir pills that are taken orally from two to five times a day (Bal et al., 2013). The treatment may be in the form of valacyclovir that can be taken thrice a day. Famciclovir can also be used to treat HSV. The drugs do not cure the infection but reduce the risk of extreme complications and recurrent outbreaks. Victims of HIV with constant recurrent herpes simplex use maintenance therapy to control the disease and reduce frequency.
Despite the efforts to curb the spread of HSV, there is an increased resistance of microbes, which creates the need for new antibiotics due to mutations of pathogens. This increases costs, especially in developing countries. Migration of people, international collaboration, and social-economic functions also increase chances of spreading the disease. Due to poverty and people being marginalized, the spread rate is high since the poor cannot access the health care. Moreover, substance abuse increases the number of sexual activities, hence contributing to the spread of the disease. The last issue is the stigmatization people go through when others know they are infected. Therefore, they decide not to share nor visit health centers, hence the easy spread of the disease.
There are some practices and policies to help control the spread of the disease. The first one is through increasing the social distance through restrictions given by a community. However, such practice can lead to the disruption of social and economic life system. Another practice is the closure of schools and workplaces, which also leads to financial difficulties. The government should help the poor consistently and ensure that the social distance is maintained. It should also control immigration to avoid the spread of infections. In severe cases, there can be introduced the quarantine and isolation policy where infected people are separated from the rest to avoid reinfection. Another policy is the public health surveillance where screening of persons is conducted. Moreover, there is a need to ensure the infection control, including the use of protective clothes and gloves in hospitals to avoid contact with the infected skin of patients.