During the first Covid-induced nationwide lockdown in 2020, when visiting a hospital was associated with the pandemic, a senior citizen from Guwahati, Assam, had an entirely different reason to meet a doctor. Rajeev (name changed on request) had developed a troubled bowel, gastritis and a few odd pimples on his chest. On seeing the pimples, the doctor made an almost-immediate diagnosis of herpes zoster.
“That’s the first I heard about herpes, which later left me in pain for almost a month,” said Rajeev.
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Symptoms of herpes
Herpes is a contagious viral infection caused either due to reactivation of dormant viruses or transmission through direct contact. It is a localized infection, affecting only a particular site of the body, and usually manifesting in the form of painful blisters with itching and burning sensations.
According to the US government’s National Library of Medicine, more than 100 different herpes viruses have been discovered and only eight of them regularly affect humans. Out of these, two viruses cause the disease commonly referred to as herpes.
Itching, burning and painful blisters are the typical initial symptom of herpes. As the infection spreads, the pain worsens.
“There are two types of herpes,” says Dr Vinay D, infectious diseases specialist, Apollo Hospitals, Bengaluru. “One is herpes simplex, caused by the herpes simplex virus as the name suggests. The other is herpes zoster, caused by the varicella zoster virus; it is the same virus that essentially causes chicken pox.”
What causes herpes zoster?
Dr Grace Swaroopa, senior dermatologist, Kamineni Hospitals, Hyderabad, says varicella zoster virus (VZV) usually causes chicken pox in the early-childhood stage, but it can also happen at any age. In adulthood, reactivation of the same VZV virus, which lies dormant in the nerves, can potentially cause herpes zoster (which is also called shingles) much later in life when the person is immunocompromised.
“While chicken pox is a systemic infection that affects the entire body, herpes is a localised infection that affects a particular site of the body,” Dr Grace says.
Rajeev recalls that the pain he went through was excruciating. “Gradually the blisters spread from the chest to my back,” he says. “It became more swollen and painful as time passed.”
Detection, treatment for herpes
Apart from clinical diagnosis, blood tests confirm the infection of herpes by detecting the presence of the virus. “But serum tests might not be the best way to confirm if one has contracted herpes again after their first outbreak,” says Dr Vinay.
He says there can be asymptomatic carriers of the infection who do not show any symptoms but may actually turn out to be positive for herpes if tested.
Hence blood tests essentially do not correlate well with the disease activity, says Dr Vinay. “We need to understand that blood tests are not definitive. Even if the blood tests are positive, the person might not have active herpes at that point of time,” says Dr Vinay.
According to a study by the department of ophthalmology, Saint Louis University School of Medicine, Missouri, United States, efforts to develop vaccines for herpes have not succeeded since herpes viruses are well-known to cause dormant states — which hamper the formulation of vaccines because a successful vaccination should inhibit not just the active clinical disease but also, potentially, the persistency of the infection.
Prevention of herpes
Herpes might be cunning enough to recur after seemingly disappearing, but the painful encounters can be managed by getting appropriate and adequate treatment.
“It is potentially curable, but there is a chance of recurrence occasionally despite treatment,” says Dr Vinay. “Even though it is treatable, prevention is always better than cure. Especially when it comes to genital herpes, engaging in safe sexual practices is critically important to prevent it.” He says the infected individuals cannot be the one to be blamed always for not getting the appropriate treatment — prescribing the right dose of the right drug at the right time is equally important.
Dr Grace advises that reducing the frequency of recurrence becomes difficult if proper treatment is not sought when the first outbreak occurs. “The recurrence rate is higher in herpes simplex than herpes zoster,” she says. “Furthermore, having a weak immune system favours reactivation of the virus after the initial outbreak. So, when the body’s immune system is not strong enough in critical conditions like HIV, organ transplant surgery or if someone is on immunosuppressants, the chances of re-manifesting herpes increase.”
In Rajeev’s case, when the infection spread to his back, he had difficulty in wearing clothes and even in sleeping. But he recovered, and there has not been any recurrence of herpes.
