Since the Roman Emperor Tiberius tried to quell an epidemic some 2,000 years ago by outlawing kissing in public places, herpes has plagued the human race. The ancient Greeks knew of it; in fact, physicians of that day studied it. Herpes, as we have named it, comes from the Greek verb herpes in, which means “to creep.” Shakespeare was also familiar with the virus. In Romeo and Juliet, he speaks of blisters “o’er ladies’ lips.” The French, due to the prevalence of genital herpes in eighteenth century prostitutes, termed it “a vocational disease of women.”
Herpes, as you can see, has been around for thousands of years. During most of this time, it has not been very well understood. It was not known to be caused by a virus until the 19405. Not until late in the 1960s were two separate viruses isolated. Physicians confidently misdiagnosed the disease until only recently. More has been written and learned about herpes in the last two years than in the last two thousand years put together-
Herpes The Virus
A virus is a minute infectious agent consisting of tiny particles of protein and nucleic acid molecules. In school, most of us at one time or another observed bacteria through a microscope. Viruses are much smaller than bacteria. A virus is so small that it can be viewed only through an electron microscope. Many viruses would have to be clumped together in order to be seen under an ordinary laboratory microscope. Viruses lack an independent metabolism.
This means they cannot function independently outside the living cell. Once inside, however, they provide a far different picture. They are parasitic. This means they live off the host at the host’s expense. Unless you have already been exposed to a particular virus, your body is essentially unable temporarily to prevent viral multiplication inside your body. It takes time for your body to mount defenses in the form of antibodies that attack and kill the virus and the invaded cells. If you are run down and your body resources are somewhat depleted, the job will be more difficult.
Once formed, specific antibodies will be present in your body for the rest of your life. With the first encounter, however, the virus has free rein for awhile. After entering a host cell, the virus is carried to the nucleus. The nucleus is responsible for directing cellular activity. Viruses can do this as well because they are genetic material. The virus goes into action by taking over the helm of a cell and converting it into a tiny manufacturing plant, which makes new virus particles. Once inside the cell, genetic codes that regulate the normal activities of the cell are replaced by those of the virus. When this change of command takes place, the cell is no longer working for the body. It is working for the virus and pays attention only to the genetic instructions of the virus.
When the invasion is complete, the cell will work itself to death for the virus in less than 24 hours. But in that short time, it will produce thousands and thousands of exact reproductions. These thousands of new viruses will move to neighboring healthy cells, which soon fall prey to the virus. It does not take long for a multitude of cells to become infected and die. Sufficient cellular damage in a confined area below the skin will lead to lesions (sores) that are characteristic of the herpes simplex virus (HSV) disease. These lesions will be visible on the skin surface. In other words, this furious replication taking place on a submicroscopic level grows at a geometric pace. As the infection progresses, the sores spread over a larger area. If allowed to continue unabated, in a few days the sores would become large, open ulcerations, and in a few weeks the victim’s life would be in jeopardy. Fortunately this rarely ever happens. The body is capable of fighting back. And fight back it does.
White blood cells are the body’s first line of defense against the invading microorganisms. These white blood cells encircle the unhealthy cells with amoeba-like arms and engulf the dying cells. Once the sick cell is engulfed, the white blood cells essentially digest it with acids and enzymes. When the digestive-like process is finished, the dying cells will have been completely dissolved. The white blood cell army, once organized, rushes to the site faster than the virus can reproduce. Simultaneously, the spleen, liver, and lymph nodes work together to make up our immune system and begin to produce antibodies. Antibodies are the immune system’s most sophisticated killers. Unlike the white cells, which automatically engulf all intruding microbes, antibodies respond to only one specific bacteria or virus. The antibodies attach to the virus and a complicated series of physical and biomechanical events occur that eventually lead to the death of most of the intruders. It takes 10 days to two weeks for the defense (the body’s immune system) to mobilize and bring the enemy under control.
All of this serves to limit the size of lesions and, of course, the very infection itself. In some cases, sores will go unnoticed by the human host while the warfare rages on inside. You might have noticed I said the aforementioned events lead to the death of “most of the intruders.” Unfortunately, since first contact with herpes may result in thousands of viruses penetrating the body, these viruses are carried by the bloodstream and penetrate the body’s nerve cells. They can and do hide there. The viruses may be content to live without causing damage to these particular cells, in which case the body’s defense system will not seek them out or damage them. Viruses may also remain dormant in these nerve cells for years without causing any problems for their host. This latter situation is referred to as a “latent infection.”
These latent virus particles are believed to be responsible for recurrent herpes infections.
In March 1982, the Center for Disease Control (CDC) in Atlanta announced for the first time that the United States government recognized genital herpes infection as a major epidemic in our country. An estimated 20 million Americans now have genital herpes and as many as half a million new cases are expected in the next year. Since doctors are not required by law to report herpes, such as they are required to do with other sexually transmitted diseases, nobody knows for sure just how many people are infected. It has become quite evident that herpes is undergoing tremendous growth in the Western world.
In 1970, according to estimates, about 5% of the sexually active adult population had been exposed to this virus. In 1980, that estimate had increased to 30%.
The figures are even more impressive when one adds those suffering from lip herpes (Herpes labials). It is estimated that anywhere from 80 million to 150 million people in the United States suffer from either lip herpes or genital herpes or both. Fifty-one percent are women. Ninety- five percent are Caucasian. Eighty percent are 20-39 years old. Fifty-three percent have completed at least four years of college. Fifty-six percent have an income of $20,000 a year or more.
Types of Herpes Virus
There are over 50 different herpes viruses. They can be found in species of assorted snakes, oysters, frogs, fungi, birds, rodents, monkeys and household pets. There are only five herpes viruses that infect man. Once they cause a primary infection, all of the herpes viruses have in common the ability to lie dormant in the body. In their dormant state they are found in the nerve tissues, and this is usually a state in which they produce no symptoms. They may remain there trouble- free for a lifetime, or they may be reactivated by some triggering event.
One of the better known herpes viruses in man is the varicella-zoster (VZ) virus. This is the virus responsible for causing the common childhood disease chickenpox, the nation’s third most common ailment. Seventy-five percent of the U.S. population gets chickenpox by age 15. The virus is airborne. Recovery from this childhood disease is almost always complete. Most people will never be bothered by the virus again, even though it will linger as a latent infection in their nervous systems. If the VZ virus becomes active in adult years, it manifests itself as shingles, or herpes zoster.
Shingles is characterized by an area of localized pain and sores along that area of the skin where the sensory nerves are distributed. The rash is often preceded by two or three days of fever and burning or irritation of the skin. The feeling has been described as similar to a localized and severe sunburn. It seems the more elderly the patient, the more severe the symptoms and the longer the duration of the outbreak. The disease occurs more frequently in the elderly and in the immunosuppressed (persons with less than adequate immune systems).
When the virus reactivates in adults, it travels down nerve root pathways. There will be a characteristic distribution of the blisters, usually on one side of the face, the back, the abdomen, or an arm or leg. Sensory nerves exit the spinal cord on either the right or left side. Since the blisters follow the nerve pathways, they are found on one side of the body or the other. No one is certain exactly what causes reactivation of this virus. Eighty percent of adults, it is estimated, will experience a primary episode of herpes zoster. It is fortunate that only a few (less than 5%) will have a recurrence.
It is important to point out here that it is suspected that an adult with herpes zoster can pass the herpes zoster virus to a child who may then develop chickenpox. There is some controversy, however, as to the reverse situation. As with other herpes diseases, analgesics and sympathy are the most effective treatments.
Another human herpes virus is the Epstein-Barr virus. I’m sure you have heard of the affliction caused by the virus. Infectious mononucleosis or “mono” as it is more commonly called, is usually a problem of younger people, though it can affect almost any age. It is characterized by slow-developing headaches, fatigues, chills, and muscle ache. Medical attention is usually sought when the more serious symptoms develop-high fever (101 to 105 Fahrenheit), sore throat, and swollen lymph glands, especially those glands in the neck.
Mononucleosis is known as “masquerader,” since its symptoms may resemble those of other diseases. Other symptoms of mono can include difficulty in swallowing, aching joints, bleeding gums, skin rash and enlargement of the liver or spleen.
It can masquerade as strep infection, appendicitis, hepatitis or leukemia. In most cases, a simple blood test will be all that is necessary to rule out certain of these ailments. It is felt that most people become infected with the Epstein-Barr virus as children, but remain asymptomatic. If a person escapes infection as a child, infection as an adolescent or an adult results in mononucleosis, The disease is passed to a victim through the saliva of a carrier or through respiratory contamination. The incubation period is four to seven weeks.. It is not necessary to keep the patient with mono isolated, as the disease is not contagious if mild precautions are taken. During the illness, direct intimate contact should be avoided as well as sharing of drinking utensils, eating utensils, and food.
Treatment is symptomatic. Bed rest should be enforced during the acute phase of fever and malaise. The body will normally take care of the rest of the cure. Since antibiotics do not affect the virus, they are recommended only if there is the possibility of secondary bacterial infection. If there is enlargement of the spleen, strenuous physical exercise should be avoided to prevent rupture. With the exception of possible complications, mono is rarely fatal and recovery is complete. Once recovered from the mono, you will usually have lifelong immunity from further infection because the body produces antibodies. If too hasty a departure is made from bed rest, however, a relapse may be experienced.
Cytomegalovirus (CMV) is a herpes virus infection occurring at any age and ranging in severity from a silent infection without consequences to disease manifested by fever, hepatitis and severe brain damage in newborn infants. The human cytomegaloviruses have the propensity for remaining latent in man. It is not clearly understood just how CMV is spread, but infected individuals may excrete virus in the urine, saliva, cervical secretions, semen, feces, and human milk. Although it is benign in adults, CMV is a major cause of disease among newborn babies. Infection may be acquired by the fetus from an infected mother or by contact with infected secretions or excretions at any time after birth.
In 90% of infected infants there is no pathology. The remaining 10% suffer cytomegalic inclusion disease: enlargement of the spleen or liver, hepatitis, mental retardation, blindness, deafness and blood abnormalities.
Some 80% of the population have developed antibodies by the age of 40. There is no specific therapy for this disease. Trials of drugs that interfere with the genetics of the virus have not given the medical world anything concrete.
Herpes Simplex Virus
Herpes simplex viruses are divided into two types. Herpes simplex virus type 1 (HSV-1) is associated with diseases of the lips or eyes and in rare occasions with diseases of the brain. Herpes simplex virus type 2 (HSV-2) is associated with genital herpes and generalized infections of newborn infants exposed to herpes in the birth canal.
While historically it was felt that HSV-1 occurred above the waist and HSV-2 below the waist, the picture has now changed somewhat. The 1980s have ushered in a change in these statistics. Now about 15% of genital herpes is caused by HSV-1. Similarly, about 15% of lip herpes is caused by HSV-2. It is now known that HSV-1 can cause sores anywhere on the body and HSV-2 can do likewise. In the last 30 years, less- crowded living conditions of the middle and upper-middle classes have actually led to a decrease in the incidence of facial herpes.
HSV-1 and HSV-2 are transmitted by direct physical contact with a sore on an infected person. Facial or lip herpes is most often contracted by kissing someone with a cold sore. Genital herpes is most often contracted during sexual intercourse with a person who has an active genital sore. Genital herpes can also be contracted during or genital sex if a partner has labial herpes.