VIRAL INFECTIONS OF THE ORAL REGION

 Cold sores (fever blisters/herpes labialis) are superficial clear

vesicles on an erythematous (reddened) base, which may appear
on the face or lips.
 They crust and heal within a few days.
 Reactivation may be cause by trauma, fever (hence the name),
physiologic changes, or disease.
 The infection may be severe and extensive in
immunosuppressed individuals.
 Cold sores are usually caused by herpes simplex virus type 1
(hsv-1), although they can also be caused by herpes simplex
virus type 2 (hsv-2).
 Hsv-1 and hsv-2 are also known as human herpesvirus 1 and
human herpesvirus 2, respectively.
 They are dna viruses in the family herpesviridae.
 Either of these viruses may also infect the genital tract, although
genital herpes infections are most often caused by hsv-2.
 Herpes Simplex Virus

Disease and General Characteristics:

Herpes Simplex is a viral infection caused by the Herpes Simplex Virus (HSV). There are
two types of Herpes Simplex Virus, Herpes Simplex Virus 1 (HSV-1) often referred to as fever
blisters and/or cold sores and Herpes Simplex Virus 2 (HSV-2) most commonly known as genital
herpes. The etiologic agent for the Herpes Simplex Virus is Herpesviridae; the Herpes Simplex
Virus is a double stranded DNA enveloped virus with a doughnut shaped capsomere.

Historical Information:
The origin of herpes in human history is unknown but the Herpes Simplex was first
documented by ancient Greeks as sores that seem to “creep” over the surfaces of skin. Vidal, 1873,
first demonstrated the Herpes Simplex Virus to be infections caused by human inoculation. There is
also evident speculation around two thousand years ago the Roman Emperor Tiberius attempted to
curb an epidemic of herpes from the mouth by outlawing kissing during public ceremonies and
rituals.

Reservoirs and Reproduction:

Humans and animals serve as reservoirs for herpes simplex but only humans demonstrate
signs of the disease. The reproduction of herpes simplex is through direct contact and most easily
passed on through genital to genital and/or oral to genital contact. The majority of Type 1
reproduction is through kissing, sharing eating utensils, or by sharing towels while Type 2
reproduction is through sexual contact with an infected person. The herpes simplex virus is very
contagious to where it can be contracted from people who have a chronic HSV infection even when
they are between episodes of exposure.
How is it Obtained in the Laboratory:
Like all viruses, the herpes simplex virus binds to a cells surface through protein receptors
located on the cell membrane. The Herpes simplex virus genome encodes 11 surface glycoproteins
which include gC; gC can bind to the complement C3 protein and deplete it from the host’s serum
thus inhibiting complement-mediated reactions creating an immune escape. Also gE and gI proteins
can bind with the Fc portion of IgG which can coat the virus and therefore be hidden from the
immune system. With genital (HSV-2) herpes the virus enters the body through a break in the skin
during vaginal, oral, or anal sex. The virus then travels through your body and inhabits nerve cells
near the spinal cord where they remain in a latency stage until triggered by factor; the virus then
travels back down towards the nerve axon and the recurrence of the infection with its symptoms
occurs at the same site of the initial infection. Herpes simplex viruses are capable of cell to cell
transmission in the presence of humoral antibodies due to syncytia (mass of cytoplasm that is not
separated into individual cells) formation between infected cells.

Signs and Symptoms:

Many people who are infected with the herpes simplex virus do not have any symptoms, if
they do show symptoms they are varied for each person. The most common first signs and
symptoms of herpes simplex is a tingling, stinging, or burning sensation on the skin followed by an
outbreak of fluid filled blisters which appear on skin and mucous membranes, the site of the initial
infection. For oral herpes, blisters formed on the lips can also transmit to the tongue with an
increase in saliva with the possibility of foul breath. With genital herpes, sores can be found on the
vagina, cervix, penis, and around the genital areas such as the buttocks, thighs, and anus. Initial
outbreaks of genital herpes can cause flu-like symptoms such as fever. Women can have more
severe symptoms from Type 2 outbreaks such as nerve pain, lower abdominal pain and urinary
difficulties. Some people may also demonstrate pre-outbreak or prodrome symptoms such as
muscle aches, headache, flu-like malaise and swollen lymph glands. Herpes outbreaks occur in two
stages: primary and recurrent. During the primary infection the blisters can break and eventually
cause the fluid from the blisters to ooze out and crust leaving sores which can last anywhere from 2
to 4 weeks to heal for the first exposure. As long as the virus (fluid in the blisters) is kept moist it
can remain infectious. In the recurrent phase the outbreaks are far less severe than the initial
primary infection and are initiated by various factors such as stress, excessive sunlight exposure,
and fever.

Nutrients:
Nutritional requirements for the production of herpes simplex virus. Influence of glucose and
glutamine on herpes simplex virus production by HeLa cells. J. Bacteriol. The importance of
glucose and glutamine in herpes simplex virus production by HeLa cells was evaluated by variation
of the composition of Eagle's basal medium. Simultaneous omission of glucose and glutamine from
the serum-containing medium resulted in marked curtailment of viral synthesis. The effect was
attributable neither to decreased survival time of infectious particles or of cells, nor to decreased
rate of viral adsorption or penetration in the presence of the deficient medium. Therefore, the effect
was probably on intracellular viral replication.
When the requirements for glucose and glutamine were determined separately, it was found that
viral production was reduced in glucose-deficient medium. In contrast, a medium which was
complete except for restriction of the glutamine content to that occurring naturally in the serum
component supported significantly greater viral multiplication than did the complete medium.
Limited viral replication occurred with medium which lacked both glutamine and serum. Viral
multiplication in the presence of serum-free medium was stimulated by the addition of glutamine.
Process of death:
Cannot be cured/die but it can just penetrate one body without knowing it and transmit it
through reproduction in lesion (a region in an organ or tissue that has suffered damage through
injury or disease, such as a wound, ulcer, abscess, tumor, etc.).
Nursing Interventions:
There is no cure for the herpes simplex virus, but it can be treated with oral anti-viral
medications such as acyclovir, famciclovir, or valacyclovir. These antiviral medications assist in
treating outbreaks and if used constantly can suppress outbreaks. The best way to prevent the
spreading of herpes is to avoid contact of the infected area from other people. For HSV-1 avoid
kissing, sharing lip balms, and drinking cups; for HSV-2 abstain from sexual contact with others
but if you choose to have sexual relations always be sure to use a condom as the virus is not
capable of crossing the condom barrier.

Key tests for Identification:

Usually the appearance of herpes simplex is often typical, and no testing is required to
confirm. If diagnosis of herpes simplex is uncertain a swab from the infected skin for culture is
taken to the laboratory. Blood tests can also be used to detect the presence of herpes simplex
antibodies. Though effective this test cannot be used to confirm an active case of herpes or whether
you can pass it to others.

Global and Local Cases:

The Herpes Simplex virus affects millions of people worldwide annually. For people from
the ages of 15 to 49 years old, an estimated 536 million were living with HSV-2 in 2003 and of that
23.6 million were newly infected. In 2006, 371,000 people in the United States had genital herpes
(HSV-2) compared to initial reports in 1966 of only 19,000. The majority of genital herpes cases in
the United States are caused by HSV-1, contracted through oral sex, and more women were
infected than men. Age is also a factor in contracting herpes as the number of people infected
increased with age. A large portion of the population has HSV-1; about 50 to 80 percent of
American adults have oral herpes. In underdeveloped countries with poor hygiene, HSV-1
antibodies are found in more than 90% of children.

References:

1. American Academy of Dermatology. “Herpes Simplex.” 2008.

URL: http://www.aad.org/public/publications/pamphlets/viral_herpes_simplex.html accessed on
12/2/08.

2. “The Big Picture Book of Viruses: Herpesvirdidae.” 2007.

URL: www.virology.net/Big_Virology/BVDNAherpes.html accessed on 12/2/08.

3. Dr. Richard Hunt. “Herpes Viruses.” November 6, 2008.

URL: http://pathmicro.med.sc.edu/virol/herpes.htm accessed on 12/2/08.
4. Dr. Marguerite Urban. “Herpes Simplex Virus Infections.” February 2007.
URL: www.merck.com/mmhe/sec17/ch198/ch198e.html accessed on 12/5/08.

5. American Social Health Association, Inc. “Learn about Herpes >Fast Facts.” 2007.
URL: www.ashastd.org/herpes/herpes_learn.cfm accessed on 12/5/08.

6. Centers for Disease Control & Prevention. “Genital Herpes”. February 6, 2008.
URL: www.cdc.gov/std/Herpes/default.htm accessed on 12/8/08.

7. The American College of Obstetricians and Gynecologists. “Genital Herpes Patient Education
Pamphlet.” January 2008.
URL: www.acog.org/publications/patient_education/bp054.cfm accessed on 12/6/08

8. Herpes-Coldsores.com. “What is Herpes? And other basics…” 2008. URL: www.herpes-

coldsores.com/herpes_information.htm accessed on 12/8/08.

9. Division of STD Prevention. “Table 42. Selected STDs and complications…” November 13,
2007. URL: www.cdc.gov/std/stats/tables/Table42.htm accessed on 12/3/08.

10. Looker, Katherine J et al. “An estimate of the global prevalence and incidence of herpes
simplex virus type 2 infection.” October 2008. URL: www.who.int/bulletin/volumes/86/10/07-
046128-ab/en/accessed on 12/3/08.

11. Texas Department of State Health Services. “Herpes.” July 29, 2008.
URL: www.dshs.state.tx.us/hivstd/info/herpes/default.shtm accessed on 12/3/08.

12. University of Maryland Medical Center. “Herpes simplex.” October 1, 2006.

URL: www.umm.edu/patiented/articles/what_symptoms_of_herpes_simplex_virus_000052_2.h
tm accessed on 12/5/08.