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Halitosis or bad breath is known as the set of unpleasant odors that emerge from the oral cavity. This is a fairly common problem in...
Herpes is an infectious disease characterized by the appearance of numerous blisters around the lips or other areas of the face, such as the cheeks and nose.
The causative agent is the herpes simplex virus, which is contracted through saliva, kissing or, more generally, by direct contact with infected persons. After regression of the first infection, the herpes labialis virus has the peculiar characteristic of lodging, through the nerves of the skin, in the neural ganglia closest to the site of infection. In this case, the pathogen goes into latency, i.e. it not only survives the immune system, but is not even eliminated by the use of drugs.
Even after a long time, cold sores can reappear: the virus takes advantage of "weak" states of the organism (lowered immune system, periods of stress, general fatigue, etc.) to reactivate and cause the classic lip lesions.
Cold sores are an infectious disease caused by the herpes simplex virus (HSV), of which there are two types:
Type 1 most commonly affects the lips.
Type 2, on the other hand, is primarily responsible for genital herpes.
While some individuals experience no symptoms following infection, others develop painful blisters on the edges of the lips or adjacent areas just outside the mouth. They may also appear inside the oral cavity, on the roof of the mouth or on the gums. However, it should be noted that this is a completely different disorder from mouth ulcers, which are not contagious.
Unfortunately, there is no definitive cure to eradicate the virus from the body, so after infection one will be subject to develop cold sores more or less frequently, or in some cases never, throughout one's life. Thus, the manifestation may appear in a cyclical fashion, with periods of active disease followed by asymptomatic periods, depending on stress factors (physical or otherwise). The first episode is usually more severe.
As mentioned above, herpes labialis is an infectious disease of viral origin. The predominant causative agent involved is herpes simplex virus type 1 (HSV-1). Although to a lesser extent, cold sores can also be caused by herpes simplex virus type 2 (HSV-2), which is usually responsible for genital infection.
The virus enters the body through the skin and mucous membranes, where it infects epithelial cells and causes their death, resulting in vesicles and other lesions typical of the disease.
After infection and initial manifestations, all herpes viruses evade immune defense, using the strategy of latency. In practice, the pathogen remains in the body, hidden in the nerve ganglia, without giving any sign of its presence. In this case, the immune system and drugs cannot fight it, as the virus does not replicate and does not generate enough derived peptides to signal its presence to cytotoxic T-cells.
Normally, to neutralize an established viral infection, cytotoxic T lymphocytes eliminate the infected cells. For this to occur, some of the peptides presented by MHC class I expressed on the surface of infected cells must be of viral origin. This condition is easily achieved during infections caused by rapidly replicating viruses, as occurs, for example, during influenza (neutralized by the combination of cytotoxic T lymphocytes and antibodies in the blood).
When dormant inside human cells, herpes viruses do not cause problems; their latency can last several weeks, months, years or even a lifetime.
This characteristic is also reflected in the course of herpes labialis, which is usually relapsing; in practice, the disease recurs from time to time, with short episodes and generally less severe than the first infection.
The cold sore virus reactivates in certain favorable situations, giving rise to the typical manifestations of the disease. For example, periods of intense stress or overexertion, immune system downturns, particular times of the menstrual cycle, episodes of fever or intense exposure to sunlight can act as "triggers".
In such circumstances, the virus leaves the nerve ganglia and travels along the path it followed at the time of infection. Thus, it reaches the end of the nerve endings, usually on the lips. Less frequently, herpetic lesions may form on the nose, chin, cheeks or palate.
In some cases, after the first infection, the cold sore virus may remain silent even for life.
The virus responsible for cold sores is easily transmitted by direct contact with the mouth or saliva of an infected person, usually through kissing. As a rule, the first infection usually occurs during childhood, unnoticed, in the form of, for example, a simple stomatitis.
Infection can also occur indirectly, by using contaminated objects such as glasses, cutlery, lipsticks, razors and towels.
Not only that: in the same subject, the cold sore virus, with a kind of autoinoculation, can also be transmitted to other parts of the body. Therefore, during an episode of cold sores, one must be very careful not to bring the hands from the mouth to the eyes. Otherwise, the virus could cause herpetic keratitis, a very serious eye complication that can even lead to blindness.
Primary HSV-1 infection is usually asymptomatic, most adults are, in fact, antibody carriers without having had any overt episode of the disease; in symptomatic cases, the infection presents several possible clinical forms, although the most common is undoubtedly the appearance of painful blisters near the lips.
The key stages of recurrent cold sores are essentially four.
The evolution is usually completed in 7-10 days without treatment, without scarring.
The frequency of onset and severity of symptoms vary significantly from patient to patient, but the general trend is a reduction in the number of episodes and severity as the years pass.
It is possible to obtain relief with the application of zinc oxide creams, but the most effective treatment for this type of infection is an antiviral agent capable of blocking the multiplication of the virus, helping to shorten the healing time. The two most commonly used drugs are acyclovir and penciclovir.
Acyclovir has been shown to be effective when applied in the prodromal phase, whereas it is much less effective when used alone in the vesicular phase. The application of a layer of cream every 4 hours (excluding nighttime) for at least 5 days, up to a maximum of 10, is of utmost importance for adequate therapy.
Penciclovir provides satisfactory results, regardless of the stage of development of the herpetic lesion. Topical application of penciclovir is also able to relieve pain and the cream should be applied to the infected area every 2 hours for 4 consecutive days.
It is recommended to wash hands thoroughly after each topical application.
If herpetic recurrences are frequent, it is advisable to resort to the administration of a systemic antiviral on medical advice.
From a general point of view, to prevent infection by the virus it is necessary to avoid close contact (kissing, sexual intercourse, exchange of cutlery and other objects, ...) with infected persons; unfortunately, this is often not enough or, even more often, the infection goes back to childhood.
To date, there is no vaccine for herpes simplex.
After infection, it is possible to act on some of the factors that seem to favor the onset of symptoms, so it is advisable:
Avoiding these triggers usually prevents or lessens the severity of cold sores, although in severe cases, periodic treatment with oral antiviral medications may be necessary.
Frequent hand washing during herpes outbreaks is of utmost importance to reduce the risk of self-contagion and transmission of herpes simplex to others.
Herpes labialis is an infectious disease caused by the herpes simplex virus (HSV), of which there are two types. Type 1 is the one that most commonly affects the lips; type 2, on the other hand, is mainly responsible for genital herpes.
If left untreated, cold sores usually last 7 to 10 days, but may persist for up to two weeks. Although there is no cure for cold sores, it is possible to control the pain, lessen its severity and speed the healing process.
Diagnosis is clinical; laboratory confirmation can be obtained by culture, PCR(Polymerase Chain Reaction ), direct immunofluorescence or serological tests.
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