Herpes & Potential Complications

Herpes is generally a frustrating, bothersome disease which at its worst can cause inconvenience. Rarely is it considered dangerous. There are, however, several conditions under which the disease is potentially threatening. We have taken a look at the special problems herpes may present for women. Let’s look now at some other special problems that may affect men or women. Keep in mind that these conditions are quite rare, usually treatable, and sometimes preventable.

HERPES KERATITIS

Herpes keratitis, also known as ocular herpes, is an infection of the eye caused by HSV. Estimates of the prevalence of this disease vary widely, but it is thought that 50,000 to 500,000 cases occur in the United States each year. It is the most common cause of infectious blindness, despite the fact that half those who contract it will have spontaneous healing without treatment due to the self-limiting characteristic of the disease.

The conjunctival membranes of the eye line the inside of the eyelid and cover the white portion of the eyeball and the cornea, which is the window of the eye that covers the pupil and iris. Inflammation of the conjunctival membrane in 0110 of these areas is called conjunctivitis, or, if infection is in the cornea, keratitis.

Infection can spread to the eye in two ways, autoinoculation and through the nerve pathways. Autoinoculation means self-inoculation. This happens when you transfer the virus from an active lesion somewhere on your body and then touch or rub one or both of your eyes. Herpes keratitis can be prevented by proper hygiene in the case of autoinoculation. It is easiest to avoid active lesions altogether. If you do touch one accidentally, wash your hands immediately. Many people touch or rub their eyes many times every day. If you touch an active lesion and then think that you will merely refrain from touching your eyes until after you next wash your hands, you’re kidding yourself. Another common mistake is using saliva for a wetting agent for contact lenses. This may transfer the virus as well.

Spreading through the nerve pathways from the trigeminal ganglia is another way for the virus to reach the eye. We have discussed how the virus “hides out” in the trigeminal ganglia between episodes. Sometime during this latent stage, for reasons unknown, the virus may decide to travel to the eye instead of going to its usual place on the lip. There is no known way to prevent this.

One symptom of herpes keratitis is a red color in the eye. Irritation and a scratchy sensation might also be present. You may suffer a discharge that appears as excessive tearing. The patient frequently is photophobic (sensitive to light). If you experience these symptoms, see an ophthalmologist. Herpes in the eye can be easily diagnosed. A special microscope called the slit lamp microscope may sometimes be used with stains to highlight the ulcers, or a culture may be taken from the ulcers so that the causative agent can be recognized.

Like lip or genital herpes, ocular herpes recurs. An estimated 50% to 75% of ocular herpes patients have recurrences. Fortunately there is an effective treatment for the disease. In herpes keratitis, cure can normally be had with one of three drugs: Idoxuridine, vidarabine and trifluorothymidine. DO NOT make the mistake of thinking that you can use these drugs on lip or genital herpes. They do not work.

One major cause of blindness in ocular herpes is corneal scarring or loss of translucency. This causes a decrease or loss of vision. Even if the cornea becomes completely opaque, all is not lost. A corneal transplant may be performed. The secret to avoiding this surgery is to visit an ophthalmologist the minute you experience any symptoms, especially if you have recently had an active herpes lesion. The earlier a case of herpes keratitis is diagnosed, the more successfully it can be treated.

I-IERPES ENCEPHALITIS. Herpes encephalitis is another rare complication caused by HSV as well as other viruses. It occurs when the virus travels from the trigeminal ganglia to the brain by way of the nerve pathways. The disease can also be contracted by infants at time of birth, usually by passage through a contaminated birth canal.

The symptoms of herpes encephalitis are sometimes subtle. Early in the disease the only clinical symptoms may be fever and headache. Later, personality and speech problems manifest themselves. Eventually the symptoms do worsen and may include seizures and coma. Over 70% of cases result in death, and many of those who survive do so with permanent brain damage. This disease does not seem to spontaneously cure like herpes keratitis.

Current approved treatment of herpes encephalitis is with vidarabine. If treated early enough the fatality rate can be reduced from 70% to less than one-third of that. With any delay in treatment the fatality rate climbs rapidly. The problem here is in avoiding the delay. The symptoms are sometimes not only subtle, but worse than that, they can be routine and characteristic of other problems such as a bad cold or the flu. If you came down with headaches, fever, and weakness you would probably assume you were catching the flu. Unless you had recently read something about brain disease, it is unlikely that such a thing would ever cross your mind. While you lie in bed with “the flu,” the encephalitis gets worse by the day.

Another problem with encephalitis is diagnosis. Mon likely than not, the physician will diagnose flu and in most this is exactly what you have with the symptoms. However, if your symptoms progress to the point that personality changes start to develop, brain involvement may be considered. If the brain becomes a possible target for diagnosis, yet another problem crops up. There are an impressive number of different brain disorders to rule out before the correct diagnosis can be made, and of course the correct treatment cannot be prescribed until then. Your doctor knows that the brain disorder requires quick action, but improper action could make things worse.

In some herpes encephalitis cases, the patient will exhibit repeated seizures. This symptom along with the presence of a certain type of cell in the fluid of the spinal cord may tip off the doctor that he is dealing with a herpes infection. Unfortunately this combination of events cannot be counted on. Consequently a brain biopsy may be tried. This is not something that the attending physician likes to perform unless absolutely necessary. A brain biopsy consists of drilling a small hole into the skull. Into that hole a needle will be inserted into which a small bit of brain tissue will be drawn. This may not sound like a complicated procedure, but in addition to having all the risks that any surgery presents, it removes brain tissue, which is something the body cannot regenerate.

The good news here remains the drug adenine arabinoside. It is useful in treating herpes encephalitis as well as another encephalitis caused by a different organism. The potential hazards seem to be outweighed by the benefits of using the drug in cases where diagnosis is relatively sure.

SCIATICA AND HERPES

Compression of the sciatic nerve, which runs down to the foot from the spinal cord, can cause a painful “electrical sensation” in the back of the leg known as sciatica. Normally this pressure is a result of crowding of the nerve’s roots in the spinal canal by a ruptured intervertebral disc, or by arthritis. Now, in addition to disc injury and arthritis, genital herpes is becoming an increasingly likely cause of sciatic pain. The herpes simplex virus, which hides in the sacral ganglia between attacks, can apparently cause the nerve roots to swell, thereby tightening them against their snugly fitting bony surroundings in the spine to produce pressure and pain.

Six women, who suffered from both recurrent genital herpes and from sciatica, were cured of pain with the anti- viral drug amantadine, according to the journal Cutis (29:467, 1982). The drug, although it did halt the sciatic pain, did not prevent recurrence of the herpes.

This condition, like the other two discussed above, is relatively rare in primary episodes and even rarer once the primary episode is behind you. This brief look at the disorders was for informational purposes, and to impress upon you the importance of proper hygiene during the presence of active lesions.

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