Herpes Simplex Virus: HSV-1 and HSV-2

Herpes simplex virus (HSV) is a viral infection of the skin and mucous membranes. Lesions can occur in many different areas, especially in or around the mouth, lips, genitals, and eyes. There are two types of HSV that exist: HSV-1 and HSV-2. HSV-1 is responsible for the development of your typical “cold sore”; it therefore has a predisposition for the mouth and lips, but it can also cause genital herpes in a small number of cases. Meanwhile, HSV-2 is the main herpes virus that affects the genital area ^[1]. HSV-1 and HSV-2 are ubiquitous, large double-stranded DNA viruses ^[2]. HSV-1 is commonly transmitted through saliva and skin-to-skin contact with an individual who carries the virus. On the other hand, HSV-2 is transmitted through sexual contact with an infected person ^[3]. The likelihood of becoming infected with HSV-2 increases with the number of sexual partners, having unprotected sex, and having a partner with genital herpes ^[4]. HSV-1 and HSV-2 must enter the body through broken skin or a mucous membrane in order to become infectious ^[5].

HSV can be present within the body anywhere from 2 to 12 days before displaying any sign of infection. ^[1] The virus typically produces symptoms within a week of incubation ^[4]. Once the initial infection clears, the virus remains dormant within the body. HSV can become reactivated under the “proper” circumstances. Infections, trauma, stress, fever, menstrual periods, and sun exposure are all common triggers for a recurrent outbreak ^[3]. HSV has an affinity for the nerve cells; it infects the sensory and autonomic nerves before ascending to the nerve ganglia in the spinal cord. It is within the nerve ganglia that the virus can remain dormant and become reactivated at a later time. Once reactivated, the virus migrates from the ganglia to the target site (usually the skin or mucous membranes) where it can either cause an outbreak or shed ^[4]. The severity of the herpes infection varies, depending upon whether the episode is primary or recurrent. The first episode of genital herpes generally tends to be the most severe. These lesions may take one to six weeks to heal. The initial symptomatic episode is usually followed by a greater likelihood of clinical recurrences as well as shedding of the virus. Shedding is subclinical, and occurs when the skin tissue harbors the virus and literally “sheds”; transmission of the virus is simplified through the shedding process. Recurrences of the infection typically occur four to five times a year in those with symptomatic outbreaks. Meanwhile, many herpes infections are subclinical and go undetected. Asymptomatic individuals are likely to sexually transmit the infection to others without awareness ^[4]. The classic herpes lesion begins as a small red papule that evolves into a vesicle containing clear fluid. This vesicle will eventually form a pustule. Burning pain occurs following ulceration of these lesions. Lesions ulcerate more rapidly in moist areas than on dry skin, thus lesions on mucous membranes tend to be more painful ^[4]. These ulcerative lesions eventually form a crust ^[2]. HSV is one of the most prevalent sexually transmitted infections. The black population has a higher HSV prevalence than do whites, which may be accounted for by the fact that developing countries are less educated on safe sexual practices. The highest annual incidence of genital herpes among women occurs at 20 to 24 years of age and is estimated to be 210 per 100,000 women. Meanwhile, men are more likely to have asymptomatic HSV-2 infections ^[4]. Individuals with genital HSV-1 infections have a much lower risk of viral shedding and symptomatic recurring outbreaks than do those who are infected with HSV-2 genital herpes ^[2].

Diagnosis

HSV outbreaks are often preceded by a tingling, burning, and itching sensation in the affected area ^[5]. HSV is recurrent and presents as single or multiple painful clusters of blisters on top of a red base, which eventually ulcerate and form a crust. Lymph nodes are often tender and inflamed in the presence of infection ^[1]. Systemic symptoms may also be present, and include fever, malaise, body aches, headaches, and nausea. Meningitis-like symptoms, such as stiffness of the neck and sensitivity to light, are also common. Women can also present with vaginal discharge and inter-menstrual spotting when HSV infects the cervix. Swollen groin lymph nodes are common and discomfort during urination occurs when herpes enters the urethra or urine comes into contact with lesions on the vulvar surface ^[4]. A practitioner can best make a diagnosis based on medical history, laboratory tests, and inspection of the infected area by means of a physical examination. The physical examination involves inspecting the lesions and examining the genital area. If systemic symptoms are present, then a more thorough neurological examination needs to be performed ^[4]. Meanwhile, laboratory testing to confirm the diagnosis is indicated for most people having their initial eruption. A tissue culture is the best way to isolate the herpes virus for diagnostic purposes ^[1]. Polymerase chain reaction (PCR) is the diagnostic standard method for HSV infections of the central nervous system. HSV PCR, with its consistency and substantially higher rate of HSV detection, could replace viral culture as the gold standard for diagnosis in those with active lesions ^[2]. Many individuals also test positive for the virus in their blood. A positive blood test, however, does not necessarily mean that the individual had any previous symptomatic indications of a herpes outbreak. Other acceptable testing methods include direct immuno-fluorescent assay (DFA), enzyme-linked immunosorbent assay (ELISA), and antigen detection tests. The Centers for Disease Control (CDC) state that isolation of HSV in a cell culture followed by DFA antigen testing can help distinguish HSV-1 from HSV-2 ^[4].

Natural Treatments

Supplements

1. Vitamin C and Bioflavonoids (600mg of each three times daily for three days after onset of symptoms) may help reduce the duration of a HSV outbreak ^[4]. Vitamin C and bioflavonoids have anti-inflammatory and antiviral properties which can help speed up the healing time of blisters and cold sores ^[6].
2. Vitamin E (15 minute topical applications in and around lesion) may provide pain relief when applied topically to lesions ^[4]. Vitamin E is a neuro-protective element which helps relieve nerve pain during recurrences^[6].
3. Lysine (1g per three times per day during outbreaks; 1g per day to limit outbreaks and recurrences) has been shown to help resolve and prevent HSV outbreaks involving the mouth, lips, and genital areas. Lysine is thought to have inhibitory effects on HSV replication, and is antagonistic to arginine, which promotes HSV growth. The HSV virus requires the manufacture of proteins rich in arginine in order to replicate. Limit arginine intake if you want to prevent an outbreak or hasten healing ^[1]. Foods high in lysine include vegetables, beans, fish, turkey, and chicken. High-arginine foods include almonds, cashews, and sunflower seeds ^[4].
4. Vitamin B12 (1000mcg per day intramuscularly) is suggested to have antiviral activity against herpes viruses. Vitamin B12 is also good for the treatment of nerve-related conditions; it is good for overall nerve health and function in general. Thus, vitamin B12 is a good option to help prevent HSV infections from occurring ^[1].
5. Zinc (50-75mg per day, combine with 2mg of copper to reduce frequency, duration, and severity of HSV infections) enhances cell-mediated immunity and has been shown to inhibit HSV replication. It can also be applied topically as a zinc sulfate (4%) solution to reduce pain and increase healing time ^[1].

Botanicals

1. Lemon balm (topical applications 2-4 times per day) topical ointment applications have been used on cold sores. Studies show that lemon balm significantly reduces the likelihood of recurrent infections as well as healing time ^[4]. Lemon balm seems to exert its antiviral effects on HSV following viral entry into cells – viral binding assays show that the extract does not prevent HSV-2 entry ^[7].
2. Licorice (apply ointment or gel to lesions several times daily) is known for its immune system supporting properties. It is also antiviral by inhibiting growth, activity, and replication of the herpes simplex virus. Topical application of licorice gels or ointments reduces both healing time and the uncomfortable symptoms of HSV-2 ^[4]. Licorice also appears to be effective against HSV-1 by reducing membrane fluidity which inhibits fusion of the virus with cells ^[8].
3. Siberian Ginseng (500-3000mg dried root capsules per day) has been shown to decrease the severity of HSV infections ^[4]. The active ingredients in his herbal preparation help to stimulate the immune system and also reduce the number of outbreaks ^[9].
4. Aloe vera (0.5%) cream contains constituents which inactivate HSV-2, both when used alone and synergistically with acyclovir. Studies reveal that aloe cream shortens healing time and decreases severity of symptoms ^[4]. Aloe has the ability to soothe, heal, and protect against symptoms of HSV ^[6].

Conclusion

Herpes simplex viruses are ubiquitous in the environment. HSV is also the most common sexually transmitted infection. HSV-1 is mainly responsible for causing outbreaks in and around the mouth and lips; HSV-2 is the main type responsible for genital outbreaks. HSV infections can also be asymptomatic, and they will recur under certain circumstances. It is there important to control for environmental factors which may precipitate an outbreak. Meanwhile, an infected person is considered contagious, even when asymptomatic. HSV does not leave the body, but instead lies dormant within the nerve ganglia. HSV outbreaks are characterized by papules that eventually form fluid-filled vesicles, which ulcerate and crust-over. Several nutritional and botanical treatments exist which can decrease healing time and prevent future outbreaks. Please consult with your doctor or a licensed health professional prior to taking any supplements, botanicals, or medications. A professional can help determine which supplement is best suited for your unique presentation and circumstances.