Herpes simplex viruses simplified

The Herpes simplex viruses can be categorised into two types, namely the herpes type 1 (HSV-1) more commonly known as oral herpes (fever blisters or cold sores¹) and herpes type 2 (HSV-2), known as genital herpes¹.

Both types of the herpes simplex viruses are very common². An estimated 3.7 billion people under the age of 50 (approximately 67% of the population) have HSV-1 infection globally and an estimated 417 million people aged 15-49 (11% of the population) worldwide have HSV-2 infection^2.Contrary to what many people may believe, there is a strong crossover between these two viruses³.

HSV-1 is the usual cause of oral herpes and it is transmitted by oral to oral contact to cause infection in or around the mouth. However, it can also cause genital herpes due to oral sex with an infected partner ^2,3.

Similarly, HSV-2 which usually causes genital herpes, can also cause oral herpes³. In the past, most genital herpes cases were caused by HSV-2, but in recent years, HSV-1 has become a significant cause globally³. This may be due to the increase in oral sex activity among young adults³.

The HSV-1 virus can cause painful sores on the lips, gums, tongue, roof of the mouth, and inside of the cheeks⁴. It is transmitted through oral secretions or sores on the skin, can be spread through kissing or sharing objects such as toothbrushes or eating utensils^1,3.

Historically it was thought that most HSV-1 infections were acquired during childhood². Interestingly, there is now evidence to show that children today are less likely to get cold sores and become exposed to HSV-1 during childhood. If adolescents do not have antibodies to HSV-1 by the time they become sexually active, they may be more susceptible to genitally acquiring HSV-1 through oral sex³.

Most oral and genital herpes infections are asymptomatic² whereby the individual does not demonstrate the symptoms of the infection but has acquired the virus⁵. While these viruses are most contagious when symptoms are present, they can still be transmitted to others in the absence of symptoms².

Alarmingly, approximately 80% of people infected with genital herpes do not know that they have the virus because they have very mild symptoms or no symptoms at all. Furthermore, over 50% of people who have genital herpes get it from people who are entirely unaware that they have it themselves⁶.

There is no cure for either HSV-1 or HSV-2 virus¹ and both viruses are lifelong². This means that once a person has the virus, it remains in the body and lies inactive until something triggers it to become active again¹.

Treatment & Management options:

While there may be no cure for herpes, there are certain medicines that can shorten the outbreaks of both HSV-1 and HSV-2^{2, 5}. In terms of genital herpes, certain medicines can be taken daily, and will decrease the likelihood of passing the infection on to a sexual partner or partners⁵.

An antiviral cream such as Acitop; the market leader in cold sores and fever blisters⁷, can be used to treat a cold sore¹. Acitop prevents the virus from multiplying⁸, helping to relieve the pain in little as 2.9 days⁹ and relieves a cold sore in 5 days^9*. Acitop is active against both herpes simplex virus 1 and 2⁸.

* Individual response may vary. If healing has not occurred, treatment can be continued for up to 10 days.

Scheduling status: S1 Proprietary Name (and dosage form): ACITOP cream. Pharmacological Classification: A 20.2.8. Antiviral agent. Composition: Each gram of cream contains 50 mg of Acyclovir. (5,0 % w/w Acyclovir). Preservative: Chlorocresol 0,12 % m/m. Reg. No. 32/20.2.8/0719. Marketed by: iNova Pharmaceuticals (Pty) Limited. Co. Reg. No. 1952/001640/07, 15E Riley Road, Bedfordview. Tel. No. 011 087 0000. www.inovapharma.co.za. For full prescribing information, refer to the package insert as approved by the SAHPRA (South African Health Products Regulatory Authority). Further information is available on request from iNova Pharmaceuticals. IN3073/19

References:

Web MD. Herpes Simplex: Herpes Type 1 and 2 (2018) at https://www.webmd.com/genital-herpes/pain-management-herpes#1
World Health Organisaton. Herpes Simplex Virus (2017) at https://www.who.int/news-room/fact-sheets/detail/herpes-simplex-virus
Penn State Milton S Hershey Medical Center. Herpes Simplex (2018) at http://pennstatehershey.adam.com/content.aspx?productId=10&pid=10&gid=000052
Web MD. Oral Herpes (2016) at https://www.webmd.com/a-to-z-guides/oral-herpes#1
Center for Disease Control. Genital Herpes CDC Fact Sheet (2017) at https://www.cdc.gov/std/herpes/stdfact-herpes.htm
The New Zealand Herpes Foundation. A guide for people with herpes simplex (2013) at https://www.herpes.org.nz/files/5913/9960/3989/Herpes-The-Guide.pdf
IMS Data D6D Top Viral INF Products. November 2018
Acitop approved package insert, June 2003.
Spruance, S. L. et al. Acyclovir Cream for Treatment of Herpes Simplex Labialis: Results of Clinical Trials. Antimicrob. Agents Chemother. 46, 2238 -2243 (2002).