HERPES IS CREEPY

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HERPES IS CREEPY !!!!

• Presented by Rose Rop
• and Kathryn McCoy

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HERPES SIMPLEX 1AND2

• Herpes simplex viruses -- more commonly known as
  herpes -- are categorized into two types herpes
  type 1 (HHV-1, or oral herpes) and herpes type 2
  (HHV-2, or genital herpes). Most commonly, herpes
  type 1 causes
• Formerly called HSV, now HHV Human Herpesvirus

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Taxonomy Characteristics

• Family Herpesviridae
• Double-sided linear DNA
• Enveloped
• Capsid symmetry polyhedral
• Specifically icosahedral (having 20 sides)
• Size 150-200 nm

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Route of Transmission and Portal of Entry

• Herpes Simplex Type 1, which is transmitted
  through oral secretions or sores on the skin, can
  be spread through kissing or sharing objects such
  as toothbrushes or eating utensils.
• Herpes Simplex Type 2 - In general, a person can
  only be infected during sexual contact with
  someone who has a genital HHV-2 infection. It is
  important to know that both HHV-1 and HHV-2 can
  be spread even if sores are not present.

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Mechanisms by which Causes Disease

• Attaches to host cells receptor
• Enters cell through fusion of envelope with
  cytoplasmic membrane, therefore intracellular
  pathogen
• Viral genome replicated, assembled in nucleus
• Virion acquires envelope from host cells nuclear
  membrane
• Exits cell via exocytosis or cell lysis

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Mechanisms cont.

• Enters mucous membranes or broken skin
• Then enters sensory (somatic) nerve cells
• HHV1 travels to Trigeminal and Brachial ganglia,
  HHV2 travels to Sacral ganglia, reside in latency
• When reactivated travels back down nerve cell,
  HHV1 to mouth, eyes, face HHV2 to genitalia

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Symptoms

• Sores around the mouth and lips (sometimes called
  fever blisters or cold sores). HHV-1 can cause
  genital herpes, but most cases of genital herpes
  are caused by HHV-2. In HHV-2, the infected
  person may have sores around the genitals or
  rectum. Although HHV-2 sores may occur in other
  locations, these sores usually are found below
  the waist.

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Ocular herpes, Type 1
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Oral herpes Type 1
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Symptoms cont.

• General illness (from mild illnesses to serious
  conditions)
• Fatigue
• Physical or emotional stress

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Causes of Reactivation of Symptoms

• Whenever immune system is suppressed such as
• Aging
• Fever
• Sunlight
• Menstruation
• Disease
• Stress

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Recurrent Symptoms

• Due to immunologic memory
• 1/3 of patients do not experience recurrent
  symptoms
• The 2/3 who do experience much milder symptoms

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How is Herpes Diagnosed?

• Lesion culture
• Blood test
• Immunoassay
• IgM vs IgG
• biokitHSV-2 Rapid Test
• HerpeSelect HSV-1 and HSV-2 tests
• Herpes Western blot
• CAPTIA HSV IgG Type-Specific ELISAs

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How Is Herpes Simplex Treated?

• No cure
• Effective antiviral drugs Famvir (Famciclovir)
  Valtrex (Valacyclovir), Zovirax (Acyclovir),
  iododeoxyuridine, trifluridine (eyes)
• Decrease pain
• Shorten healing time
• Decrease the total number of outbreaks
• Warm baths may relieve the pain associated with
  genital sores.

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Complications

• Pain and burning around lesions
• Difficulty urinating
• Discharge from the vagina or penis
• Whitlow inflamed blisters (fingers, for ex.)

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Whitlow on a Health Care ProviderLesson Always
wear gloves!
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Complications cont.

• Herpetic pharyngitis (when other viruses are
  causing sore throats)
• Herpetic gingivostomatitis lesions in mouth,
  usually from radiation or chemotherapy patients
• Blindness from ocular lesions
• Neonatal morbidity rate of 30-80, survivors
  potentially have severe health complications

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Complications cont.

• May cause other diseases
• Encephalitis
• Meningitis
• Pneumonia
• Believed to be cause of onset of certain cancers

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Vaccines?

• Not currently in USA
• Europe Italy, England, Bulgaria
• DNA vaccines being explored
• (inject minute portion of virus envelope,
  stimulates intense antibody response)

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Can Herpes Be Cured?

• There is no cure for herpes simplex. Once a
  person has the virus, it remains in the body

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QuickStats Percentage of Adults Aged 20--29
Years with Genital Herpes Infection, by
Race/Ethnicity --- National Health and Nutrition
Examination Survey, United States, 1988--1994,
1999--2002, and 2003--2006
www.cdc.gov/nchs/nhanes.htm, National Health
Nutrition Examination Survey, 1988-2006. Also
published in JAMA, 2006 296 964-73
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Statistics graph summary

• The purpose of this graph is to illustrate
  current trends in the rates of infection of the
  genital herpes virus in three ethnic groups of
  young adults in the United States. The most
  vulnerable age group was examined, ages 20-29.
  The objective was to set a goal to reduce the
  rates of infection and improve human health. The
  graph illustrates a decrease in the overall rate
  from 17 in the 1988-1994 period to 10 in the
  2003-2006 period. The goal was to reach 14 by
  2010. This goal has already been reached
  according to this study!

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References

• Sheffield, J.S., Wendel, J.D. Jr., McIntire D.D.,
  Norgard, M.V. (2007). Effect of genital ulcer
  disease on HIV-1 coreceptor expression in the
  female genital tract. Journal of Infectious
  Disease, 196(10), 1509-16.
• Bauman, R. (2006). Pathogenic DNA Viruses.
  Microbiology with Disease by Taxonomy, 2nd
  Edition. 682-692.
• Dr. H., Medical Director, (updated Dec. 1, 2006).
  Vaccines for Herpes Patients. Retrieved April
  2009 from http//www.herpes.org/herpesinfo/vaccine
  s.shtml
• Ashley, M.R., Brown, Z.A., (2005). Learn about
  Herpes Testing, American Social Health
  Association, retrieved April 2009 from
• http//www.ashastd.org/herpes/herpes_learn_testing
  .cfm
• Cory, L., Wald, A., Genital Herpes Fact Sheet,
  (2008) retrieved April 2009 from
  http//www.cdc.gov/std/herpes/STDFact-herpes.htm
• http//www.youtube.com/watch?v_JEwfjvsR2o