Healing Herpes

The herpes infection is one of the most common viral infections affecting adults and children. About one in five people suffer from recurring cold sore infections.

Herpes family

Herpes and chicken pox are viruses that belong to the same family. They share a common and unpleasant characteristic. Once infection with one of these viruses has occurred, they are never fully eradicated from the body. These viruses become “latent” (hiding in wait, usually in the nerve roots) and recur from time-to-time.

Know your herpes

Herpes simplex 1 – this virus is responsible for the non-genital form of herpes also known as “cold sores” or “fever blisters” on and in the mouth.

Herpes simplex 2 – this virus causes the genital form of herpes and is a sexually transmitted infection

Herpes zoster (shingles) – this infection is actually caused by the varicella zoster virus (commonly known as “chicken pox”). When chicken pox recurs from the latent viral infection, it is known as herpes zoster infection.

Symptoms of Herpes Simplex Type 1

Symptoms depend on whether the infections are first time or repeat infections. Parents may bring children into your pharmacy who are suffering from a “cold sore” infection for the first time. These children are far more ill than would normally be expected from a simple cold sore.

Symptoms of first time herpes simplex infection includes:

• Fever
• Ulcers on the lips and mouth
• Blisters on the lips and mouth
• Difficulty when eating
• Crying
• Insomnia

Symptoms of repeat infections are less pronounced.

Both adults and children can be plagued by repeat cold sore infections. Symptoms include:

• Blisters and ulcers on the lips, gums, tongue or palate
• Pain in the area of the ulcer

Typically these “repeat” infections tend to occur when the person’s immune system is starting to become a  bit stressed. Cold sores often precede a bout of infection or stress indicating that the person is not in peak condition.

Symptoms of Herpes Simplex Type 2

Like herpes simplex 1, this virus causes painful ulcers or blisters. In the case of herpes simplex  2, this is typically in the genital region.

Eruptions of herpes can occur when the person is stressed or due to other triggers such as menstruation, change in weather or even dietary changes.

Herpes zoster (shingles)

Shingles is an incredibly painful condition caused by recurrence of chicken pox virus in a previously infected adult.

• Typically shingles affects a single nerve-skin region – this can be anywhere in the body
• The area of skin where the shingles erupts can be painful for days before the blisters actually appear
• Blisters tend to appear in a clustered band on a single side of the body
• The area affected can remain painful long after the blisters have subsided

Like other herpes infections, erpes zoster also tends to occur when the individual’s immune system is “run down”. Shingles tends to occur more commonly in elderly clients or those with diabetes or HIV infection.

How does infection occur?

Infection from any of the herpes family occurs from direct or indirect contact with the fluid from the blisters.

• If a client with a cold sore drinks from a glass and someone else then drinks from the same glass (without washing it  in between), the herpes virus will pass on to the uninfected person.
• In the case of the chicken pox virus, infection can also spread through coughing and sneezing by an infected person.
• Genital herpes is normally passed on through sexual activity. Genital herpes can be passed from an infected person to another even when no active blisters are present.

Tips for infection control

You can encourage them to prevent others from becoming infected with these viruses by suggesting they:

• Don’t kiss anyone if they have a cold sore on the mouth
• Ensure they never have unprotected sex
• Don’t touch blisters or ulcers
• Wash hands frequently

Tips for boosting the immune system

There is no definite way to prevent recurrences, however recurrences are most likely to occur when your client’s immune system is run down. By keeping their immune system strong and supported, your clients may be able to prevent recurrences. They can improve their immune system health by:

• Keeping chronic conditions such as diabetes and HIV well controlled
• Eating a healthy balanced diet
• Exercising regularly
• Vitamin supplements such as vitamin A, vitamin C and zinc can help boost the immune system. Make sure your clients do not exceed the maximum recommended daily amount of these supplements.

When to refer to a doctor

You may need to refer your client to a doctor if:

• They have shingles
• They have a first-time bout of genital herpes
• They have repeated genital herpes infections
• They have a high fever
• They have any signs of complications of herpes infections such as coughing, shortness of breath, weakness of the face (on one side), neck stiffness or severe headache

Treating herpes

The bad news for your clients is that there is no permanent “cure” for any of these infections. While you will be able to help them get the infection under control, there is no treatment to prevent recurrences.

Antiviral drugs

• Oral antiviral medications such as acyclovir (e.g. Adco Acyclovir®, Cyclive®x, Zovirax®), valacyclovir (e.g. Zelitrex®), or famciclovir (e.g. Famvir®) can help to relieve the symptoms of infection and shorten the length of infection by a day or two. Treatment normally needs to be taken within a few hours or days of symptoms starting in order to be effective. All antiviral oral medications require a doctor’s prescription. These antiviral drugs are necessary where complications of herpes infections are present.
• Antiviral creams such as Penciclovir (e.g. Fenivir®) and Acyclovir cream (e.g. Activir®, Acitop®) can be given over-the-counter. This cream is normally applied  five times a day to the cold sore (not effective for other types of herpes infections) and can help alleviate pain and reduce the period of infection.

Pain relievers

• Topical analgesics such as tetracaine cream (e.g. Dynexan®) or benzocaine ointment (e.g. Calasthetic®, Viodor®), may help relieve pain.
• Oral analgesics such as aspirin (e.g. Disprin®, Bet-Tabs Aspirin®), ibuprofen (e.g. Betgesic®, Betaprofen®, Ibumed® and Nurofen®) or paracetamol (e.g. Panado®, Painamol®, Prolief®) can also help to alleviate pain symptoms

Alternative treatments

• Herpatch® – A patch applied to the affected area of the mouth which contains beta-glucan and zinc which forms a barrier over the affected area and speeds up recovery
• Ice applied to the affected area can help relieve pain.
• Cornstarch applied to the ulcers can help relieve pain.
• Aloe vera gel (e.g. Bettaway Aloe Vera Gel®) – This can have a soothing effect on blisters and ulcers and apparently speeds up recovery time.

Helping your herpes clients

Herpes zoster and herpes simplex are very unpleasant conditions ranging from mild to serious infections. Fever blisters are a common client complaint for which they will seek help with one of the many over-the-counter remedies available. Make sure you can spot the signs of a potentially more serious infection and refer these clients to their doctors.

By DrKarenKoch (MBChB)