How does infection occur and why does herpes come back?
The virus is transmitted through direct contact with skin and mucous membranes: through kissing, through shared dishes, towels, lipstick. You can also become infected from a person without visible rashes, although the risk is higher during the period of active blisters. After the initial infection, the virus penetrates the nerve fibers into the sensitive nerve ganglia and remains there for life in an inactive state. Under the influence of provoking factors, it is activated, descends along the nerve and causes rashes in approximately the same place.
- Colds and other infections with fever
- Hypothermia
- Intense sun and wind
- Stress and lack of sleep
- Menstruation
- Lip trauma, including cosmetic and dental procedures
Symptoms and stages
Primary infection in children often occurs as herpetic stomatitis with fever, mouth ulcers and refusal to eat. Relapses in adults are usually easier. A few hours before the rash, warning signs appear: tingling, itching or burning. Then a group of small bubbles with transparent contents appears on the reddened skin. After 2-3 days they open, forming painful erosions that dry out, become crusty and heal without a scar.
- Precursors: itching, tingling, burning
- Redness and swelling of the lips
- Grouped bubbles
- Weeping erosion
- Crusts and healing
- Sometimes - enlargement of the submandibular lymph nodes
Complications and to whom herpes is especially dangerous
In a healthy adult, herpes on the lips rarely leads to complications. However, the virus can be transferred by hand to the eyes, where it causes vision-threatening herpetic keratitis. People with atopic dermatitis may develop widespread eczema herpeticum, which requires urgent treatment. The infection is especially dangerous for newborns, so adults with active rashes should not kiss babies. Herpes is also severe in immunodeficiency, after chemotherapy and organ transplantation.
- Herpetic keratitis and eye damage
- Kaposi's herpetic eczema
- Attachment of a bacterial infection
- Neonatal herpes
- Herpetic panaritium when fingers come into contact with blisters
Diagnostics
In typical cases, the diagnosis is made by the appearance of the rash and a history of recurrent episodes; no tests are needed. Laboratory confirmation is required in case of an atypical picture, severe or prolonged course, in pregnant women and newborns. The most accurate method is PCR of the contents of the vesicle or erosion discharge. A blood test for antibodies shows only the fact of an encounter with the virus, and not the cause of a specific rash, so it is not very informative for diagnosing an exacerbation.
- Examination by a dermatologist
- PCR of scrapings or contents of vesicles for HSV types 1 and 2
- Antibodies IgM and IgG - for special indications
- Screening for immunodeficiency in cases of frequent severe relapses
- Examination by an ophthalmologist for red eyes
Treatment and prevention
Antiviral creams and tablets suppress the multiplication of the virus and are most effective if started at the first tingle. The doctor chooses the drug and regimen; with frequent relapses, six or more per year, long-term preventive treatment is possible. The crusts are not torn off, the blisters are not pierced, so as not to cause an infection. Cauterization with alcohol and toothpaste does not speed up healing and injures the skin. During the rash period, it is important to maintain hygiene and avoid contact with infants.
- Antiviral drugs topically or orally as prescribed by a doctor
- Separate towel and dishes during an exacerbation
- Do not touch the rash and wash your hands frequently
- Lip balm with sunscreen
- Don't kiss children if they have rashes
- Normal sleep and stress management