The original Li Qingchao returned to the park and was included in the topic # Virus Supertalk 5.
Herpes virus is one of the most widely distributed viruses in human beings, and it can not be eliminated by human body, which will harass you for life and even give you a fatal blow. What’s more, herpes virus is hard to prevent, so we have to be prepared for the onset, and some preparations are particularly important.
Have a sexual partner? Have pets? Have a baby? Are you pregnant? Old? Have other immune diseases? (Nothing is contagious …) Please read aloud and recite the full text with emotion to find out.
Author | Li Qingchao (Shandong Normal University)
People generally refer to small things, problems and troubles as "little kiss case", and our people also have a saying called "little bubble". Small blisters refer to blisters or pustules on the skin or mucosa, which can be caused by burns or infections. In this issue, we introduce a kind of "blister-loving" virus: herpesviruses.
The word "herpes" comes from the Greek word "herpein", which describes the feeling that insects crawl slowly on the skin and is extended to "spread". Common lip blistering is often a herpes attack, and chickenpox, which is itchy and painful and can’t be scratched, is also a ghost of herpes virus. Of course, you may have heard of these. However, the distribution of herpes virus is much wider and more kinds than you think, and the possible consequences of ordinary "small bubbles" are much more serious than you think. Dr. House once diagnosed a case of encephalitis caused by herpes simplex virus.
Figure 1. Although this line is not o(╯□╰)o 丨 from House, S02E19.
On the occasion of a beautiful holiday, we mainly pay attention to those little bubbles in sexual life, as well as those that will exist without sexual life, and then get to know their brothers and sisters.
Herpes virus: the virus in you.
Herpes virus is a large class of enveloped viruses with double-stranded linear DNA genome (Figure 1), which can be divided into three subfamilies: α, β or γ, and 107 species have been confirmed (data of ICTV in 2019). There are 8 kinds of Human herpesvirus (HHV) that can infect people (HHV1~8), among which HHV1~5 is the most common herpes virus in people, and more than 90% of adults are infected with at least one kind. They mainly cause spreading vesicular lesions on skin or mucosa (HHV1~3), and also cause symptoms such as mononucleosis, nasopharyngeal carcinoma and retinopathy (HHV4~5).
Figure 2: Typical Structure of Herpes Virus: Ekaterina E. Heldwein, Science, 2018
Herpes virus infection is characterized by ① high infection rate, ② latent infection, ③ lifelong infection, incurable, ④ repeated activation, ⑤ inconspicuous infection symptoms and ⑤ opportunistic infection.
The so-called latent infection means that the virus exists in a hidden form or dormant state in the human body, and it hardly replicates and does not cause infection symptoms.
Latent infection is the reason why herpes virus cannot be cured. Herpes virus, a habit of "I’ll go in, I won’t move around", makes it difficult for the immune system to detect it, does not trigger an immune response, and cannot be eliminated by the immune system. In this way, the herpes virus can stay in the human body for a long time. So far, there is no antiviral drug or vaccine that can completely eliminate herpes virus in infected people.
Of course, herpes virus is not always in a latent state. When other pathogens are infected, or suffer from strong sunlight stimulation (such as sunburn), and the immunity is low, herpes virus can remove the latent infection state and enter the active replication period, causing diseases such as herpes. Moreover, this activation process can occur repeatedly in infected people, leading to repeated illness of virus carriers. Some opportunistic herpes viruses themselves can further weaken human immunity and lead to more serious diseases.
"Life lies in stillness". Herpes virus successfully infects and exists in billions of people with a "low-key" survival philosophy, waiting for an opportunity. When the beautiful holiday is coming, let’s pay attention to those little bubbles in sexual life first.
Herpes simplex virus type Ⅱ
Herpes Simplex Virus 2（HSV-2）
Herpes grows on the genitals and is called genital herpes. It is a common sexually transmitted infection (), and the main pathogen is herpes simplex virus II (HSV-2/HHV-2). It is estimated that about 846 million people (12% of the world’s population) suffer from genital herpes (The Lancet data in 2016).
After HSV-2 infection, most people have no symptoms or mild symptoms, so they don’t know that they have been infected at all. Generally, it occurs 4 days after contact with the source of infection, and the symptoms can last for 4 weeks. Small, single or patches of blisters will appear in the external genitalia and around the genitals, anus and perianal region, and painful ulcers and herpes sores will be formed after the blisters burst.
During the onset, it may be accompanied by symptoms such as fever, pain or swollen inguinal lymph nodes. In rare cases, there will be symptoms such as painful urination, dysuria, cervicitis and proctitis.
After the first attack, about 80% people will relapse, with an average recurrence of 4 to 6 times a year. The first attack is often the most serious, and it usually takes 2~3 weeks to fully recover. Recurrence is usually mild and can be recovered within a few days.
Genital herpes mainly goes through the following stages:
There is a tingling or itching sensation in the affected area, which usually occurs within 12 to 24 hours after the onset of the disease.
A single or sheet-like liquid-filled blister is generated.
Blisters burst and become herpes sores or ulcers.
The sore surface or ulcer indicates that the scab is dry and finally healed.
Figure 3: HSV-2 and genital herpes, herpes genital tips
HSV-2 is transmitted through kissing and skin contact, and can also be transmitted from person to person through vaginal, oral or anal sexual intercourse. In a word, if your skin or genitals come into contact with the secretions of infected people, you may be infected. Therefore, the risk of sexual transmission of HSV-2 is one in a thousand, and the risk of transmission between husband and wife is about 7.5% every year. Using condoms can reduce the risk of HSV-2 infection by half.
There is no vaccine for HSV-2 at present. It can be prevented according to the preventive measures of sexually transmitted diseases, but as mentioned above, condoms can only partially reduce the risk. If herpes is found in vulva, anus and surrounding areas, you should go out for an excuse and evacuate the scene to avoid sexual contact. Because visible skin or mucosal blisters and ulcers can produce a large number of viruses.
However, even if the infected person has no symptoms and no skin sores, his mucosa can release the virus (reproductive tract secretions are poisonous), and there is still a risk of transmission.
TIP！
Herpes cannot spread through the surface of toilet seats and other objects, because the survival ability of herpes virus after leaving the human body is very poor.
Mothers infected with HSV-2 can transmit it to their newborns through vertical transmission. During childbirth, the virus can infect the skin, mouth, lungs or eyes of newborns. If the virus spreads in the uterus, it may even lead to serious infection of the brain and other important organs of the fetus. However, if the mother has no symptoms or blisters during childbirth, the risk of infection transmission is extremely small.
If the mother is infected with HSV-2 in the late pregnancy, the risk of vertical transmission is greater. Therefore, it is suggested that women with genital herpes should take antiviral drugs in the last few weeks of pregnancy before delivery, and pregnant women with obvious ulcers during delivery should be encouraged to have caesarean section to prevent HSV-2 from being transmitted to newborns. If the newborn is infected with herpes, it needs to be treated by intravenous antiviral drugs.
When people with genital herpes are naturally exposed to HIV, the risk of HIV infection is estimated to increase by two to four times. This is because the ulcer caused by herpes infection or the damage of skin and mucosa (oral cavity, vagina and rectal intima) may damage the protective effect of skin and mucosa. HSV infection can also increase the number of CD4 cells in genital mucosa, and HIV can invade these cells.
Similarly, if HIV-infected people suffer from genital herpes at the same time, they are more likely to spread HIV to others. In people who are co-infected with HIV and HSV, the replication, activation and release of HIV in genital herpes infection sites will increase the risk of HIV transmission to sexual partners.
HSV-2 cannot be cleared. When genital herpes occurs, oral antiviral drugs can be used for treatment, including valaciclovir, famciclovir and acyclovir. Severe patients should be given acyclovir intravenously. Although these antiviral drugs can not eliminate herpes virus infection, they can reduce the severity of symptoms and shorten the duration of symptoms. The first attack or recurrence should be treated as soon as possible. Taking antiviral drugs every day can reduce the frequency and severity of recurrence and reduce the risk of transmitting the virus to sexual partners.
TIP！
Pre-pregnancy examination can choose to detect herpes simplex virus.
Herpes simplex virus type I
Herpes Simplex Virus 1（HSV-1）
Now, let’s take our eyes back from our crotch and look at our lips in the mirror. Is there a "fire knot"? When winter comes, many people will grow some small blisters or sores around their lips, which is a typical symptom caused by herpes simplex virus type I (HSV-1/HHV-1): Herpes labialis (Figure 4), commonly known as getting angry.
Figure 4: Cold sores, eye herpes, herpetic keratitis, facial herpes, gingival herpes and finger herpes caused by HSV-1 infection | Source: wikipedia.
According to the latest research, it is estimated that there are billions of people suffering from cold sores in the world, among whom 67% are infected with HSV-1, which is equivalent to 3.7 billion people.
I don’t need to tell you the symptoms of cold sores infected by HSV-1, as you know: burning pain, small blisters, and sore surface damage. Cold sores usually heal in about two weeks, but they will recur. Let’s see what the virus did during the onset:
Figure 5: Onset stage of cold sores (click to enlarge) Alex Semprini1 et al., BMJ, 2019.
From the prodromal stage to the blister stage (day 0~3), the virus did not cause an open sore surface. At this stage, antiviral ointment can be used to suppress the deterioration of the disease. You can consider using ointment containing antiviral components such as valaciclovir and acyclovir and hydrocortisone.
From the blistering stage to the healing stage (day 2-14), an open sore surface has been caused, and the liquid on the sore surface contains a lot of viruses. At this stage, you should avoid picking by hand to prevent the disease from getting worse or secondary bacterial infection, and don’t scratch other parts of the body after picking herpes.
During the onset of cold sores, you should avoid eating spicy, greasy or heavy-tasting food, and don’t eat citrus fruits to avoid irritating the wound.
In fact, "cold sore" is a symptom name, and HSV-1 can also occur in other parts-in the eyes, it is called peripheral herpes (even herpetic keratitis), in the face, it is called facial herpes, in the hands, it is called herpes gingivitis in the gums (the first infection is easy to occur), and it can be herpetic angina in the throat …
HSV-1 can also cause genital herpes, but that is not a typical symptom of HSV-1.
In most cases, HSV-1 is asymptomatic after infection, but lurks in the trigeminal ganglion-just above the auricle (Figure 6). Psychological stress, menstruation, sunburn, fever, dehydration or local skin trauma may reactivate HSV-1. Dental or neurosurgical operations, lip tattoos or dermabrasion are also common causes.
The activated virus can spread again, then actively migrate to the primary infection site (usually lips or eyes) and replicate, causing cold sores or herpetic keratitis. Virus particles produced after activation can also reach the brain, causing a rare but serious diffuse acute brain infection, namely herpes simplex encephalitis (Figure 6).
Fig. 6: Latency and activation of HSV-1. Note that the trigeminal ganglion is just above the auricle. (Click to enlarge) | Source: Trends in Microbiology
HSV-1 is mainly transmitted through oral mucosa or damaged skin contact with body fluids containing virus. Therefore, we should not share things that come into contact with the oral cavity, such as toothbrushes and water cups, and avoid close contact with others (avoid kissing, oral sex or excessive physical collision).
If you have cold sores, we should avoid touching the sore surface and wash our hands frequently during the onset. Because cold sores can spread to other parts of the body through fingers, such as eyes, skin or fingers, this process is called "self-inoculation". Finger infection may occur when children with cold sores or primary HSV-1 infection suck their fingers. Therefore, even if you have been infected with herpes virus, you should avoid spreading herpes to other parts of your body.
HSV-1 causes this kind of "small blister", and there are many infected people, but the symptoms are not serious. At present, there is no treatment or vaccine for this virus.
Attention! !
"caring for each other" can describe the deep affection between husband and wife, and "caring for grandchildren" is the joy of grandparents and grandchildren. I don’t care about the affairs of adults, and I can’t manage them. When it comes to infants, I still have to emphasize two words: I must avoid contact with strangers, let alone kiss (Figure 7). Resolutely put an end to the bad habit of chewing food and feeding babies! Ouch! Not even parents, not at all!
Figure 7: Poor baby reminds you: Don’t kiss blindly | Source: theAsianparent.com
Chickenpox-herpes zoster virus
Varicella-Zoster Virus（VZV）
Next, let’s look back on the past and learn about varicella-zoster virus (VZV/HHV-3) from the long river of time. VZV is also our old friend, and it can even be said that it has not been seen for many years. When I was a child, I met it, and it was called chickenpox. When I saw it when I grew up, it drifted away. It was called "waist-bound dragon", "snake’s disk sore", "spider’s sore" and "snake Dan" … In fact, its original name was herpes zoster.
Children, teenagers and young people are infected with VZV, which causes chickenpox, while adults infected with VZV often cause herpes zoster. VZV has a wide range of influences. In 2013, there were 140 million cases of varicella and herpes zoster worldwide (reported by The Lancet in 2015), which caused thousands of deaths every year.
The first time we fell in love with this virus was in the respiratory tract.
Primary VZV infection begins with epithelial cells of upper respiratory mucosa, and then spreads to tonsils and other local lymphoid tissues. Infected T cells can spread the virus to the skin through blood transportation from these lymphoid tissues, causing herpes zoster distributed all over the body.
During the primary infection, the virus is transported reversely from the infected skin along the nerve axon, or the virus is brought into the sensory neuron cells of the ganglion through T cells, and a latent infection is established in the dorsal root ganglion. After virus replication is reactivated, VZV can re-enter skin cells via anterograde axon transport, causing herpes zoster (Figure 8).
The skin lesions and leachate of chickenpox and herpes zoster contain high concentrations of infectious viruses, so they are easily transmitted to susceptible people.
Figure 8. VZV infection process and symptoms (click to enlarge) | Source: Cleveland Clinic
Chickenpox in children usually begins to appear 10 to 21 days after being infected with the virus. Early symptoms include nausea, loss of appetite, muscle aches and headaches, and then chicken pox on the chest, back and face until it spreads all over the body (Figure 8). Other symptoms include fever and fatigue, and may also cause symptoms such as pneumonia, encephalitis and bacterial dermatosis, which last for about a week.
The symptoms of chickenpox infection in teenagers are more serious than those in children. The consequences of infection in pregnant women are more serious. The virus may spread through the placenta and infect the fetus, resulting in fetal malformation, congenital varicella syndrome or premature delivery.
If the child has chickenpox, the following methods can be used for care:
Use a cool and clean wet towel or bathe in warm water to relieve skin itching and discomfort.
Dry your body by patting it with a dry towel, and don’t rub it to prevent the chickenpox from bursting.
Use calamine lotion (avoid face) and analgesic cream when necessary.
Trim nails and keep them clean, and put gloves on your child before going to bed to avoid scratches.
If you have chicken pox in your mouth, you need to eat cool, soft and light food, and avoid eating sour, salty, hot and spicy food.
If the condition is serious, you need to seek medical advice in time.
When you are old, immunosuppressed or immunocompromised, VZV lurking in the body is easy to activate and then come out as a demon-this is Shingles.
When herpes zoster comes on, it will produce a wide herpes band on the face or one side of the body, which is full of blisters and rashes, stinging or painful, and some people will have fever, pain and feel tired. The rash usually heals within 2-4 weeks.
Some people will have nerve pain symptoms similar to electric shock or burn for months or years after the recovery of herpes zoster. This situation is called "postherpetic neuralgia", which is nerve damage caused by VZV, and it is easy to occur in people with low immunity such as the elderly. It is estimated that there is a 1/3 chance of suffering from herpes zoster in a person’s life, which is more common in the old age (the annual incidence rate of people over 65 is about 1%) and generally does not recur.
The onset of herpes zoster will produce a red band-shaped herpes on one side of the body, and it is often accompanied by severe pain. It is rumored in Jianghu that "if this dragon/snake wraps around its waist, people will die", but fortunately, my waist is thick.
. Obviously, this is nonsense. I assure you that herpes zoster rarely grows in a full circle, because VZV lurks in the dorsal root ganglion, and the herpes after activation is limited to the corresponding skin segment. The so-called skin section refers to the skin area dominated by various spinal nerves, which is distributed up and down in the human trunk and separated from the left and right (Figure 9). However, VZV does have a certain lethality, causing about 6,000 deaths every year (The Lancet reported in 2016).
Fig. 9: Distribution of skin segments of human upper body. Herpes zoster only occurs in the corresponding skin segments in the latent area | Source: wikipedia.
Different from herpes simplex virus HSV, VZV is an air-borne disease with strong transmission ability. An infected person can spread to another person with a sneeze/cough. Chickenpox or herpes zoster can also spread through contact with the skin surface with herpes from 1-2 days before it appears until herpes scabs.
At present, there are vaccines against VZV, and some areas in China have been included in the immunization program. . Injection of VZV vaccine will reduce the incidence of chickenpox and herpes zoster, and more importantly, even if you have chickenpox or herpes zoster, the vaccine can greatly reduce the proportion of moderate and severe patients.
VZV vaccine is not suitable for pregnant women, tuberculosis patients, people with low immunity and immunosuppression, and allergens should be tested before vaccination. It should be noted that once a family member has been vaccinated with VZV, personally, it is suggested that all close family members should be vaccinated together. The low VZV vaccination rate may increase the risk of herpes zoster among unvaccinated people. Because the VZV vaccine currently used is an attenuated live vaccine.
After getting chickenpox or herpes zoster, you need to take care of your skin carefully to prevent secondary infection. In severe cases, you can use analgesics, antiviral drugs and steroids. Be careful not to take aspirin (acetylsalicylic acid) when you are suffering from chickenpox or herpes zoster, and when you are vaccinated with VZV, because aspirin will increase the risk of Reye’s syndrome caused by VZV-Reye’s syndrome is a rapidly deteriorating brain disease with brain dysfunction such as persistent vomiting, extreme sleepiness or aggressive behavior.
Other herpes viruses
Finally, let’s take a look at several other common people infected with herpes virus. Their common feature is still: if you are infected, you will never want to get rid of it. When your immunity is weak, you must make waves.
Epstein-Barr Virus (EBV/HHV-4) is one of the most commonly infected viruses. Its spread is somewhat similar to HSV-1. It is generally spread through saliva, and it has the nickname of "the kissing disease". It can also be spread by sharing food, drinks and dental utensils. Of course, EBV also exists in other body fluids. Infection often occurs in infants and young children. Half of the children under the age of six have been infected with EBV, and more than 90% of the people in adulthood have been infected with EBV.
EBV generally infects B cells and epithelial cells, and can lurk in B cells for life. Under the conditions of overwork, nutritional deficiency, excessive sadness, hormone fluctuation (puberty, pregnancy, menopause) and childbirth, EBV can be activated, thus causing diseases.
Children infected with EBV often have no symptoms. When adolescents or adults are infected with EBV, there is a 35% to 50% chance of causing infectious mononucleosis, resulting in fatigue, fever, pharyngitis, lymphadenopathy, hepatosplenomegaly, rash and other symptoms. EBV infection is related to malignant tumors such as lymphoma, gastric cancer and nasopharyngeal carcinoma, and autoimmune diseases such as multiple sclerosis. At present, there is no good means of prevention and treatment. The central idea is to keep yourself healthy, in good health and strong immunity, so these viruses will not be evil.
Human Cytomegalo Virus (HCMV/HHV-5) is a type β herpes virus, which mainly infects salivary glands, but also infects other parts of the body. Infectious HCMV may exist in any body fluid of the infected person, and it can be transmitted vertically through contact with the infected body fluid. There is a 90% probability of being infected with HCMV in a person’s life. After infection, HCMV lurks in the human body and can be reactivated at any time. HCMV infection is usually rare and almost undetectable in healthy people, but it may be life-threatening for people with low immune function:
Newborns: Vertical transmission of HCMV is one of the common causes of neonatal abnormalities. If the mother is infected with HCMV for the first time during pregnancy, the newborn may have symptoms such as light weight, microcephaly and epilepsy. Even if there are no symptoms, there may be problems in hearing, mental and motor coordination in the future. Newborn parents and babysitters should maintain their own hygiene habits and minimize the risk of transmitting the virus to newborns.
Adults with low immunity, such as HIV-infected people, severely burned people or organ transplant recipients, may get sick because of the reactivation of HCMV, and have symptoms such as retinitis, pneumonia and colitis. Antiviral drugs can be used for prevention and treatment.
Adults with normal immunity are rarely affected by HCMV, but the virus can also cause mononucleosis and increase the risk of diabetes, cardiovascular disease and cancer.
Roseolovirus, including HHV-6 and HHV-7, can cause infant roseola, also known as infantile rash (known to old mothers), which is a very common mild infection. Generally, it doesn’t need treatment, and its symptoms are fever and rash, which lasts for about four days. If necessary, use antipyretics. If symptoms such as lethargy, persistent high fever and convulsions appear, you should seek medical attention in time.
Kaposi’s sarcoma-associated herpesvirus (KSHV/HHV-8) can be transmitted through saliva or sexual behavior, and the infection rate varies greatly from region to region, with about 10% of the population infected in China. KSHV infection is generally asymptomatic, but it causes Kaposi’s sarcoma, a local skin tumor, on the skin of AIDS patients.
Other animal herpesvirus that may infect people: Generally, human beings are rarely infected with herpesvirus carried by animals, but for high-risk specific groups such as animal breeders, laboratory animals, users and veterinarians, attention should be paid to preventing animal herpesvirus infection. Monkey B virus is a herpes virus carried by monkeys. Monkeys have no symptoms, but it is fatal to people. Don’t mess with monkeys. Pseudorabies virus is a common animal herpes virus, which can infect pigs, cattle, sheep and other domestic animals. Recently, it has also been reported that it can infect people and cause serious encephalitis.
Conclusion
Ask: "oh, my god! There are so many hateful "tenants" on my poor little body except the disgusting fat. I feel dirty. What should I do?
A: "live well, after all, there are very few people who are not infected." Knowing so much knowledge doesn’t make you suspicious and worry too much. What’s the use of worrying blindly? Most herpes viruses are really "small bubbles". Understanding these viruses is to know how to prevent them, how to deal with symptoms, restore health as soon as possible, and avoid the most serious situation. People in rivers and lakes, the world of mortals, HHV-1, HHV-2, HHV-3, HHV-4, HHV-5, HHV-6 and HHV-7 keep us alive.
reference data
https://www.who.int/zh/news/item/01-05-2020-billions-worldwide-living-with-herpes
https://www.who.int/zh/news-room/fact-sheets/detail/herpes-simplex-virus#hsv1
https://www.health.harvard.edu/a_to_z/genital-herpes-a-to-z
https://en.wikipedia.org/wiki/Herpesviridae
https://en.wikipedia.org/wiki/Herpes_simplex_virus
https://en.wikipedia.org/wiki/Genital_herpes
https://en.wikipedia.org/wiki/Herpes_labialis
https://www.healthhub.sg/a-z/diseases-and-conditions/38/genitalherpes
https://www.cdc.gov/std/herpes/stdfact-herpes-detailed.htm
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Herpes simplex virus 1 (HSV-1)- An Overview
Herpes Simplex Virus (HSV): Structure, Clinical Feature, Lab Diagnosis
https://www.std.uw.edu/
https://www.connecticutchildrens.org/health-library/en/parents/chicken-pox/
https://en.wikipedia.org/wiki/Chickenpox
https://en.wikipedia.org/wiki/Shingles
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https://www.sohu.com/a/283735369_699704
https://www.connecticutchildrens.org/health-library/en/parents/chicken-pox/
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https://en.wikipedia.org/wiki/Kaposi%27s_sarcoma-associated_herpesvirus
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Original title: "Once the infection recurs for life, the most difficult virus in history has captured 90% of the world’s population. When it is discovered during sexual life, it must be stopped in time."
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