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1. The lymphocytosis reported is more likely due to HSV infection than cough and cold (possibly common cold) unless the pathogen was COVID-19 virus or bacterial respiratory tract infection.
2. HSV-1 is implicated in both genital and orofacial primary infections after contact with infectious secretions that contain either HSV-1 (usually oral secretions or genital secretions (usually HSV2). The clinical course worsens in extremes of age, low immune status, the anatomic site of involvement, and the antigenic virus type.
3) Transmission of Herpes- HSV-1 is usually acquired in childhood by contact with oral secretions that contain the virus.
Epidemiology of HSV-1 infection is however changing globally, a remarkable and subtle transition, with less exposure in childhood and more in adulthood, and less oral acquisition but more genital acquisition.
4) Prevention of Transmission- Because of the highly prevalent nature of herpes simplex virus (HSV), avoiding contact with individuals who (often asymptomatically) are excreting the virus in saliva or genital secretions is needed. Daily antiviral therapy can be given to reduce episodes of asymptomatic genital shedding and to further reduce the risk of transmission.
Questions by patient
Can I actively participate in sex with my wife?
- It would be preferable to avoid the same till the completion of 10-day antiviral therapy.
- Since HSV-1 could spread by sexual route, it is preferable to avoid sexual relationships till completion of primary treatment.
Can I go near my children and kiss them?
- Since HSV-1 is transmitted by oral route, it is preferable to avoid going near children and kiss the children till the completion of 10-day therapy.
There are various types of manifestations of the herpes simplex 1 infection-
1) Lip and mouth infection-
The most common manifestation in the recurrent case is called a ”cold sore" where pain, burning, and tingling sensation often occurs at the affected site, commonly the face, around the lips, followed by the development of reddish eruptions that rapidly develop into tiny, thin-walled, water-filled lesions that becomes pus-filled and may ulcerate.
2) Acute herpes gum and mouth infection is caused by the transmission of infected saliva from another adult or another child. This is a symptomatic disease with high fever, markedly swollen gums and palate, inflammation of blood vessels in the mouth, and skin lesions due to skin contact.
3) Pharyngotonsillitis -If this spreads to the palate and throat, it may cause sore throat besides pharyngitis and high fever.
4) Herpetic whitlow that is reddish, painful eruptions in fingers.
5) Herpes lesions in the face arms and trunk.
6) Herpes genital infection- Most Genital acquisitions are primarily due to oral-to-genital transmission through oral sex, as opposed to the genital-to-genital transmission through sexual intercourse.
What are your signs and symptoms at this time?
1. Can I do a blood donation?
Ans- Yes, you can donate blood even if you have herpes — but only if you are not having an outbreak of symptoms and if it has been more than 48 hours since you finished an antiviral treatment.
2. Is antivirals safe to use without affecting kidneys?
Ans- Antiviral dosages used are usually unlikely to affect kidneys, however, there are reports of acute kidney injury and raised renal function test parameters. However, in routine clinical practice, it is rarely seen, however, renal test monitoring is very important.
Treatment suggested by me:
1. Tab Valacyclovir 1000 mg orally twice daily (every 12 hr) for 10 days.
This can be followed by prolonged suppressive therapy at a lower dose depending on symptoms.