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“She gallops night by night . . .
O’er ladies’ lips, who straight on kisses dream,
Which oft the angry Mab with blisters plagues,
Because their breaths with sweetmeats tainted are.”
– Shakespeare, Romeo and Juliet, 1.4.74
ike the common cold, cold sores are frequent, worldwide, and unresponsive to present-day treatments. They are also highly contagious, the infection being spread primarily through social and sexual activities, usually involving close person-to-person contact. This, particularly in the case of genital herpes, can be most distressing.
Some people become infected from contact with eating and drinking utensils, from towels, and – yes – even from toilet seats! Close body contact in wrestling, rugby, and other sports can transmit the disease, and health care personnel are at special risk for infection of their fingers. Fortunately, cold sores are more irritating than they are dangerous.
The typical cold sore consists of a small group of water blisters on a red base. This blister group may itch, prickle, or burn. It can vary in size from that of a matchhead to a 25-cent piece or even larger. Although a cold sore can develop on any part of the body, it generally occurs on the mouth, the lips, or on the genital areas.
Up until a few years ago, doctors thought that cold sores of the mouth and lips – transmitted by contact with infected saliva – were invariably caused by a virus called herpesvirus Type 1. They also thought that cold sore-like infections below the waist – genital herpes – were always caused by a closely related organism, labeled herpesvirus Type 2. In recent years, however, due perhaps to our changing mores and the growing popularity of oral sex, the Type 1 viruses can cause genital “cold sores” and the Type 2 herpesvirus can cause mouth and lip lesions.
COLD SORES OF THE MOUTH AND LIPS
hether you call them cold sores, fever blisters, or the medical term herpes simplex, they all describe the same problem – a problem that can literally lead to a pain in the neck.
Cold sores are caused by a virus, and more than 40 million Americans suffer from them. The primary, or initial, infection with the herpes simplex virus usually occurs in early childhood. The infection, however, may not cause any symptoms for years while the virus lies dormant. Then suddenly, a variety of factors can trigger an outbreak of tiny clear, fluid-filled blisters – the visible sign of the infection. These factors include sun exposure, local injury (from dental work, for example), emotional tension, colds and other upper respiratory infections, various foods (chocolate, nuts, seafood), and, in rare instances, menstruation.
Ninety percent of the external lesions of cold sores will occur on the lips, while ten percent will develop on the nose, chin and cheeks. Often there may be tiny blisters over the gums or hard palate.
If left alone, the blisters rupture, the fluid inside begins to ooze and small ulcers develop. The ulcers then form crusts and scabs and finally heal in ten to fourteen days. As a rule, they do not leave scars but the virus that caused it remains in the body and migrates to nerve cells where it remains in a resting phase. If the infection is transmitted to the eyes, it can lead to blindness.
If there is excessive pain or discomfort and the lymph glands in the neck become swollen, it usually means that the virus has caused a secondary infection. When this happens, you may need an oral antibiotic.
Since cold sores are highly contagious, one should avoid kissing and sharing cups and lipsticks.
While we know of no single effective cure for cold sores and fever blisters, the recent introduction of several oral and topical antiviral drugs, that are presently used for the treatment of genital herpes (see below) and shingles, has proven of great value in preventing recurrences of these painful and annoying infections. Many home remedies (a wet tea bag) and over-the-counter remedies are occasionally effective in relieving the signs and symptoms of cold sores of the mouth and lips.
Some common over-the-counter remedies that have been and are being used to ameliorate cold sores are Anbesol Gel, Blistex lip ointment, Campho-phenique, Herpecin-L, Viractin disappearing cream, and Zilactin medicated gel.
A relatively new, over-the-counter preparation called Abreva, has been approved of by the Food & Drug Administration to heal cold sores. While Abreva – the generic name is docosanol – doesn’t attack the virus directly, it apparently alters the skin cells to create a barrier that prevents the virus from doing its harm.
A prescription ointment, penciclovir (Denavir), when used every two hours for four days, will usually alleviate the symptoms of burning and itching and help speed up the healing process for an initial episode of cold sores of the mouth and lips, but for quicker and longer-lasting “cures,” oral anti-viral medications are the treatments of choice.
If your cold sores are persistent or recurring, it would be prudent to consult your dermatologist. In extreme cases, herpes simplex can cause complications and lead to disease in the eyes, brain, and internal organs.
GENITAL HERPES
enital herpes, or cold sores of the genital area, is considered a venereal disease because it is usually transmitted by sexual contact. Affecting more than 500,000 Americans each year, genital herpes is reportedly the most prevalent venereal disease among young Americans today, its incidence being greater than both gonorrhea and syphilis. It accounts for about 15 percent of all sexually transmitted diseases in this country.
The threat of genital herpes has become so widespread that many young, unmarried Americans have altered their sexual behavior to prevent contracting the disease. And since the emotional, social and psychological impact of genital herpes is serious and long lasting, people are becoming more cautious about casual sex and thinking twice about the “one-night stand.”
There has been a 30 percent increase in the prevalence of genital herpes since 1970; 22 percent of Americans over 12 years of age are infected, and is estimated to have affected more than 50 million people in the year 2000.
Like cold sores on the mouth and lips, genital herpes is transmitted by a virus. This virus is usually transmitted by direct sexual contact (genital to genital or mouth to genital) with a person who has an active herpes infection. There is even the risk of contracting the herpes virus from a towel or drinking cup or tester lipstick(!) used by a person with open lesions. Given the opportunity, this virus can infect any portion of the body surface of a susceptible person. What is particularly disturbing are the unpredictable recurrences of these genital infections in the same person – at the same site – with a frequency that can be distressing, embarrassing and, at times, disabling. Fortunately, however, the herpes virus infections have a tendency to become milder with each recurrence.
How do you know if you have genital herpes? The average incubation period – that is, from the time of contact to when you first notice the symptoms – is roughly a week. Any number of signs and symptoms may precede or accompany a herpes infection of the genital region. These can include itching, mild burning and prickling sensations, pain during urination and sexual intercourse, fever, headache, and swollen lymph glands in the groin area.
Small groups of blisters commonly appear at the infected site – usually around the vagina or on the penis. These blisters break down in a few days leaving painful, shallow ulcers which, when not complicated by any other infection, heal in about a week to ten days.
For some people, a genital herpes infection is a painful, swollen inflammation. For others, the infection is relatively mild and transient, with few or no symptoms. People who are completely asymptomatic – and there are many – may act as reservoirs, or “carriers,” for the disease, unknowingly affecting their sex partners. And so the question often posed by a spouse or a friend – “Who gave you (me) this herpes infection?” – cannot be answered with any certainty.
If you develop a herpes infection a week after sex relations, you have not necessarily contracted herpes from your sex partner. The friction of intercourse may very well have activated a dormant herpes virus in your body.
And while the primary infection (meaning the first time one is afflicted with the condition) is acquired by direct sexual contact (genital to genital or mouth to genital), recurrences of genital herpes infections generally represent reactivation of a latent, hidden virus, rather than reinfection.
What causes these reactivations – these recurrences – and what are some of the triggering mechanisms? No one really knows.
After an active herpes episode, the virus retreats to and remains quietly hidden in a nerve root, thus making treatment difficult or impossible. After weeks, months, or even years, the virus, stirred up by any number of mechanisms, travels down the nerve path and reappears on the skin, starting up a new batch of small blisters with all the symptoms of the earlier herpes infection. Some of the reactivating mechanisms that have been implicated in provoking recurrences include mechanical injury, masturbation, sexual intercourse, fever, gastrointestinal upsets, sunburn, fatigue, overexertion, sleeplessness, poor nutrition, menstruation, psychic stress, and even sauna baths!
What is particularly disturbing about genital herpes is its serious consequences. Extensive herpes of the genital organs can cause excruciating pain during urination and sexual intercourse.
The consequences for pregnant women are especially grim. Genital herpes is three times more common in pregnant women than in nonpregnant women and results in a higher incidence of miscarriage and premature births.
Newborns who are infected during birth are unable to combat the virus with their immature immune systems. Thus, if an active genital herpes is present at the time of delivery, it can cause a devastating or fatal infection in the newborn as the infant passes through the birth canal. Therefore, most doctors recommend a Caesarean section for women who have an active herpes infection just before delivery.
In addition, women with genital herpes infections run a five times greater risk of cancer of the cervix. And for both women and men, there is a much higher incidence of other venereal infections, such as gonorrhea and syphilis.
There is a new test that takes just four hours to detect herpes simplex virus infections. This will help women avoid unnecessary Cesarean sections and it will help patients with herpes infections of the eye get prompt, often sight-saving, treatment.
While effective treatment for herpes is poor at best, you should consult your physician to try to prevent complications that could lead to severe secondary bacterial infection and spread of the disease.
Treatment of the active infection consists mainly of relieving the symptoms:
As far as specific treatments for herpes, there are as many different kinds as there are doctors. Everything works . . . and nothing works. . . .
Past and present treatments for cold sores have included applying cortisone-like antibiotic creams and ointments, ice cubes, ether, nail polish remover, liquid nitrogen, cortisone-type sprays, and a dozen different other topical (surface) medications. None of these treatments has yet withstood the test of time, but many doctors will still swear by their particular method.
One theory suggests that oral contraceptives help to prevent recurrences. Women taking the birth control pills report fewer recurrences than women who do not. There is also some evidence that the chemicals in most contraceptive foams have an antiviral effect on the genital herpes virus.
Proven treatments for genital herpes, include oral acyclovir (Zovirax), famciclovir (Famvir), and valacyclovir (Valtrex), all prescription medications. They all relieve the symptoms, reduce the shedding of the virus, and shorten the duration of an attack. They may also reduce the frequency and the severity of recurrent episodes of genital herpes. Valtrex has been shown to be far superior than any topical measures for cold sores, since surface medications cannot penetrate the surface of the skin or mucous membranes where the virus is located.
Unfortunately, we cannot eradicate the virus by simply treating the local infection. For those of you who have genital herpes, I leave you with this sobering thought: you have it for life. And every time it recurs, it can potentially infect other people.
Here are a few suggestions, however, to prevent spread of the disease:
What does the future for herpes viral infections hold for us? If we will be able to produce a safe vaccine – such as those given to children in a single dose – then herpes, like polio, smallpox, influenza, typhoid, and diphtheria, will forever be eradicated.
We’re working on it. . . .
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For further information about herpes, write to: Herpes Resource Center American Social Health Association (ASHA) P.O. Box 13827 – Research Triangle Park, NC 27709 800-230-6039; 919-361-8488 www.herpes.org or www.aad.org 1-888-462-DERM x22 |
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| TREATING COLD SORES |
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Before a cold sore blister appears, there may be a tingling and itching sensation of the affected part. To help reduce the size of the cold sore that's sure to show up, apply an ice cube to the area for about 5 minutes every half hour or so.
There are many over-the-counter cold sore preparations that may help if applied early enough. Try either of the following:
Campho-Phenique Liquid or Gel
Blistex Medicated Lip Ointment
Abreva
Follow the directions on the label of each container.
If your cold sores show up when you're exposed to the sun, use a sunscreen lip balm such and take two aspirins a couple of hours before you go out in the sun.
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