The most difficult virus in history has attacked 90% of the world's population. If you find it during sex, you must stop immediately

The herpes virus is one of the most widespread viruses in humans and cannot be eliminated by the human body. It will harass you for life and even give you a fatal blow. What's more, the herpes virus is hard to prevent. We have to be prepared to deal with the onset of the disease, and some preparations are particularly important.

Do you have a sexual partner? Do you have a pet? Do you have a baby? Are you trying to get pregnant? Are you old? Do you have other immune diseases? (You can still get the disease yourself even if you don’t have any…) Please read and recite the full text with emotion to understand it.

Written by Li Qingchao (Shandong Normal University)

Original title: "Once infected, lifelong recurrence, the most difficult virus in history has conquered 90% of the world's population. If you find it during sex, you must stop it immediately丨Virus Super Topic"

People generally refer to small things, small problems, and small troubles as "small kiss cases". Ordinary people here also call them "small blisters". Small blisters refer to blisters or pustules on the skin or mucous membranes, which can be caused by burns or infections. In this issue, we introduce a type of virus that "loves to cause blisters": herpes viruses.

The word "herpes" comes from the Greek word herpein, which describes the feeling of a bug crawling slowly on the skin, and is extended to mean "spread". Common lip blisters are often caused by herpes outbreaks, and chickenpox, which is itchy and painful but cannot be scratched, is also caused by the herpes virus. Of course, you may have heard of these. But the herpes virus is much more widely distributed and has many more types than you think, and the consequences of ordinary "small blisters" are also much more serious than you think. Dr. House once diagnosed a case of encephalitis caused by the herpes simplex virus.

Figure 1. Although this line was not spoken by House o(╯□╰)o丨Source: House, S02E19

As the wonderful holiday approaches, we mainly focus on the little bubbles that occur during sex, as well as the little bubbles that occur even without sex, and then get to know its brothers and sisters.

Herpes virus: The virus in your body Herpes virus is a large class of large viruses with double-stranded linear DNA genome and envelope (Figure 1). It can be divided into three subfamilies: α, β or γ, and 107 species have been confirmed (ICTV 2019 data). There are 8 types of human herpesvirus (HHV) that can infect humans (HHV1~8), of which HHV1~5 are extremely common herpes viruses in the population, and more than 90% of adults are infected with at least one. They mainly cause disseminated blister-like lesions on the skin or mucous membranes (HHV1~3), and can also cause symptoms such as mononucleosis, nasopharyngeal carcinoma, and retinopathy (HHV4~5).

Figure 2: Typical structure of herpes virus | Ekaterina E. Heldwein, Science, 2018

In addition to the characteristics of ① high infection rate, herpes virus infection also has the characteristics of ② latent infection, ③ lifelong infection and incurable disease, ④ repeated activation, ⑤ unclear infection symptoms and ⑥ opportunistic infection.

The so-called latent infection means that the virus exists in the human body in a hidden form or dormant state, hardly replicating or causing symptoms of infection.

Latent infection is the reason why herpes virus cannot be cured. The habit of herpes virus "I go in and I don't move around" makes it difficult for the immune system to detect, 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 the herpes virus in the infected person's body.

Of course, the herpes virus is not always in a latent state. When infected by other pathogens, or exposed to strong sunlight (such as sunburn), or when the immune system is weakened, the herpes virus can be released from the latent infection state and enter the active replication phase, causing diseases such as herpes. Moreover, this activation process can occur repeatedly in the infected person, causing the virus carrier to repeatedly become ill. Certain opportunistic herpes viruses themselves can further weaken the human immune system and lead to more serious diseases.

"Life lies in stillness", the herpes virus has successfully infected and existed in billions of people with a "low-key" survival philosophy, waiting for an opportunity to attack. As the wonderful holiday is approaching, let's first pay attention to those little things in sex life.

Herpes Simplex Virus 2 (HSV-2)

Herpes grows on the genitals and is called genital herpes. It is a common sexually transmitted infection (remember the STI we talked about last time), and the main pathogen is herpes simplex virus type 2 (HSV-2/HHV-2). It is estimated that about 846 million people (12% of the world's population) have genital herpes (2016 Lancet data).

After HSV-2 infection, most people have no symptoms or mild symptoms, so they don't know they have been infected. Generally, the disease will occur 4 days after contact with the source of infection, and the symptoms can last for 4 weeks. Small, single or clustered blisters will appear on the external genitalia and around the genitals, anus and perianal area. When the blisters rupture, painful ulcers and herpes sores will form.

During the illness, there may also be symptoms such as fever, pain or swollen inguinal lymph nodes. In less common cases, there may be symptoms such as stinging urination, dysuria, cervicitis, and proctitis.

After the first attack, about 80% of people will have a relapse, with an average of 4 to 6 relapses per year. The first attack is often the most severe and generally takes 2 to 3 weeks to fully recover. Relapses are usually milder and can be recovered within a few days.

Genital herpes develops in the following stages:

There is a stinging or itching sensation in the affected area, which usually occurs within 12 to 24 hours of the onset of the disease.

Single or clustered fluid-filled blisters may occur.

The blisters burst and become herpes sores or ulcers.

The sores or ulcers show scabs that dry and eventually heal.

Figure 3: HSV-2 and genital herpes | herpes genital tips

HSV-2 is spread through kissing and skin-to-skin contact, and can also be spread from person to person through vaginal, oral, or anal sex. In short, if your skin or genitals come into contact with secretions from an infected person, you can get infected. Therefore, the risk of HSV-2 transmission during sexual intercourse is one in a thousand, and the risk of transmission between couples is about 7.5% per year. Using condoms can reduce the risk of HSV-2 transmission by half.

There is currently no vaccine for HSV-2. It can be prevented by following the precautions for sexually transmitted diseases, but as mentioned above, condoms can only partially reduce the risk. If herpes is found on the vulva, anus, and surrounding areas, you should find an excuse to go out and evacuate the scene immediately to avoid sexual contact. Because visible blisters or ulcers on the skin or mucous membranes can produce a large number of viruses.

However, even if the infected person has no symptoms and no skin sores, his mucous membranes can release the virus (genital secretions carry the virus), and there is still a risk of transmission.

TIP!

Herpes cannot be spread through surfaces such as toilet seats because the herpes virus survives poorly outside the human body.

A mother infected with HSV-2 can transmit the virus to her newborn through vertical transmission. During delivery, the virus can infect the newborn's skin, mouth, lungs, or eyes. If the virus is transmitted in the womb, it can even cause serious infection of the fetus's brain and other vital organs. However, if the mother has no symptoms or blisters during delivery, the risk of infection transmission is extremely small.

If the mother is infected with HSV-2 in late pregnancy, the risk of vertical transmission is greater. Therefore, women with genital herpes before delivery are advised to take antiviral drugs in the last few weeks of pregnancy, and pregnant women with obvious ulcers during delivery are encouraged to have a cesarean section to prevent HSV-2 transmission to the newborn. If the newborn is infected with herpes, it needs to be treated with intravenous antiviral drugs.

The risk of contracting AIDS when a person with genital herpes is naturally exposed to HIV is estimated to be 2- to 4-fold higher. This is because sores or breaks in the skin and mucous membranes (the lining of the mouth, vagina, and rectum) caused by herpes infection may compromise the protective effects of the skin and mucous membranes. HSV infection also increases the number of CD4 cells in the genital mucosa, which HIV can invade.

Similarly, HIV-infected people who also have genital herpes are more likely to transmit HIV to others. In people with dual HIV and HSV infection, HIV replication, activation and release at the site of genital herpes infection increases the risk of HIV transmission to sexual partners.

HSV-2 cannot be eliminated. Genital herpes outbreaks can be treated with oral antiviral drugs, including valacyclovir, famciclovir, and acyclovir. Severe cases should be treated with intravenous acyclovir. Although these antiviral drugs cannot eliminate the herpes virus infection, they can reduce the severity of symptoms and shorten the duration of symptoms. Drugs should be started as soon as possible after the first outbreak or recurrence. Taking antiviral drugs daily can reduce the frequency and severity of recurrences and reduce the risk of spreading the virus to sexual partners.

TIP!

Herpes simplex virus testing may be an option during prenatal checkups.

Herpes Simplex Virus 1 (HSV-1)

Now, let's take our eyes off our crotches and look at our lips in the mirror. Is there a "hot pimple"? When winter comes, many people will have some small blisters or sores around their lips. This is a typical symptom caused by herpes simplex virus type 1 (HSV-1/HHV-1): cold herpes (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, billions of people worldwide suffer from cold sores, and 67% of those under the age of 50 are infected with HSV-1, which is approximately 3.7 billion people.

You know the symptoms of cold sores caused by HSV-1 infection: burning pain, small blisters, and sore-like lesions. Cold sores usually heal in about two weeks, but they can recur. Let's take a look at what the virus does during the outbreak:

Figure 5: Stages of herpes labialis (click to see larger image) | Alex Semprini1 et al., BMJ, 2019

From the prodromal stage to the blister stage (days 0 to 3), the virus does not cause open sores. Antiviral ointments can be used to suppress the deterioration of the disease. You can consider using ointments containing antiviral ingredients such as valacyclovir and acyclovir and hydrocortisone.

From the blistering period to the healing period (2nd to 14th day), open sores have already formed. The fluid on the sore surface contains a large amount of viruses. During this stage, you should avoid scratching with your hands to prevent the condition from worsening or causing secondary bacterial infection. Don't scratch other parts of the body after scratching the herpes.

During the period of cold sore outbreak, you should avoid eating spicy, greasy or strong-tasting foods, and do not eat citrus fruits to avoid irritating the wound.

In fact, "cold sores" is a symptom name. HSV-1 can also cause disease in other parts of the body - in the eyes it is called periocular herpes (even herpetic keratitis), on the face it is called facial herpes, on the hands it is called finger herpes, on the gums it is called vesicular herpetic gingivitis (more likely to occur in the first infection), in the throat it can be herpetic pharyngitis...

HSV-1 can also cause genital herpes, but that is not a typical symptom of HSV-1.

In most cases, HSV-1 infection is asymptomatic and remains dormant in the trigeminal ganglion, just above the front of the auricle (Figure 6). Psychological stress, menstruation, sunburn, fever, dehydration, or local skin trauma can all reactivate HSV-1. Dental or neurosurgery, lip tattooing, or microdermabrasion are also common triggers.

The reactivated virus can then actively migrate to the site of primary infection (usually the lips or eyes) and replicate, causing herpes labialis or herpetic keratitis. Viral particles produced after reactivation can also reach the brain, causing a rare but severe diffuse acute brain infection, herpes simplex encephalitis (Figure 6).

Figure 6: Latent and reactivated HSV-1. Note that the trigeminal ganglion is located just above and in front of the auricle. (Click to see the larger image) | Source: Trends in Microbiology

HSV-1 is mainly transmitted through oral mucosa or broken skin contact with body fluids containing the virus. Therefore, in life, we should not share objects that come into contact with the mouth, such as toothbrushes, water cups, etc., and avoid close contact with others (avoid kissing, oral sex, or sports with excessive physical contact).

If you have cold sores, you should avoid touching the sores and wash your hands frequently during an outbreak. Cold sores can be spread to other parts of the body, such as the eyes, skin, or fingers, through the fingers. This process is called "self-inoculation." Finger infection can occur when a child with cold sores or primary HSV-1 infection sucks their fingers. Therefore, even if you are infected with the herpes virus, you should avoid spreading herpes to other parts of the body.

This "small blisters" caused by HSV-1 infects a large number of people, but the symptoms are not serious. There is currently no treatment or vaccine for this virus.

Notice!!

"Xiangruyishao" can describe the deep affection between husband and wife, and "Hanyisun" is the joy of family life between grandparents and grandchildren. We don't care about adults' affairs, and we can't care about them. When it comes to infants and young children, we still have to emphasize two things: avoid contact with strangers, let alone kissing (Figure 7). Resolutely put an end to the bad habit of chewing food to feed babies! Ugh! It's not allowed for parents, nothing!

Figure 7: The poor baby reminds you: Don’t kiss blindly | Source: theAsianparent.com

Varicella-Zoster Virus (VZV)

Next, let us look back to the past and learn about the varicella-zoster virus (VZV/HHV-3) from the long river of time. VZV is also an old friend of ours, and we can even say that it is a "childhood friend" that we haven't seen for many years. When we encountered it as a child, it was called chickenpox. When we grew up and saw it again, it was called "herpes zoster", "herpes discus", "spider herpes", "snake scalp"... In fact, its original name is herpes zoster.

VZV infects children, adolescents and young adults, causing chickenpox, while infection in adults often causes shingles. VZV also has a wide range of impacts, with 140 million cases of chickenpox and shingles worldwide in 2013 (Lancet 2015), causing thousands of deaths each year.

Our first encounter with this virus was in the respiratory tract.

Primary VZV infection begins in the epithelial cells of the upper respiratory tract mucosa, and then spreads to the tonsils and other local lymphoid tissues. Infected T cells can start from these lymphoid tissues, transport the virus through the blood, and spread the virus to the skin, causing a vesicular rash distributed throughout the body.

During primary infection, the virus is transported retrogradely from the infected skin along the nerve axons, or carried into the sensory neuron cell bodies of the ganglia by T cells, and establishes a latent infection in the dorsal root ganglia. After viral replication is reactivated, VZV can reenter skin cells via anterograde axonal transport, causing herpes zoster (Figure 8).

The skin lesions and exudates of both chickenpox and shingles contain high concentrations of infectious viruses and are therefore highly contagious to susceptible persons.

Figure 8. VZV infection process and symptoms (click to see larger image) | Source: Cleveland Clinic

Children usually begin to develop symptoms of chickenpox 10 to 21 days after infection with the virus. Early symptoms include nausea, loss of appetite, muscle aches and headaches, followed by chickenpox on the chest, back and face and then throughout the body (Figure 8). Other symptoms include fever and fatigue, and may also cause pneumonia, encephalitis, bacterial skin diseases, etc., and symptoms last for about a week.

The symptoms of chickenpox in adolescents are more severe than those in children. The consequences of infection in pregnant women are more serious, as the virus may spread through the placenta and infect the fetus, causing fetal malformations, congenital varicella syndrome or premature birth.

If your child has chickenpox, you can use the following methods to care for him or her:

Use a cool, clean, damp washcloth or bathe in warm water to soothe itchy and uncomfortable skin.

Pat your body dry with a dry towel, do not rub it, to prevent the acne from breaking.

Use calamine lotion (avoid the face) and pain-relieving ointment if necessary.

Trim nails and keep them clean, and have your child wear gloves before bed to avoid scratching.

If you have chickenpox in your mouth, you need to eat cool, soft and light foods, and avoid sour, salty, hot and spicy foods.

If the symptoms are serious, seek medical attention immediately.

When people age, are immunosuppressed or have low immunity, the VZV lurking in the body can easily be activated and cause trouble again - this is shingles.

When shingles occurs, a wide band of blisters and rashes will appear on the face or one side of the body, with tingling or pain. Some people may have a fever, pain, and fatigue. The rash usually heals within 2-4 weeks.

Some people experience nerve pain symptoms similar to electric shock or burning for months or years after recovering from shingles. This condition is called "postherpetic neuralgia", which is nerve damage caused by VZV and is more common in people with low immunity, such as the elderly. It is estimated that there is a 1/3 chance of contracting shingles in a person's lifetime, and it is more common in the elderly (the annual incidence rate for people over 65 years old is about 1%), and it generally does not recur.

When shingles occurs, a red, band-like herpes will appear on one side of the body, and it is often accompanied by severe pain. There is a rumor that "if this dragon/snake wraps around the waist, the person will die." Fortunately, my waist is relatively thick.

Obviously, this is nonsense. I assure you that herpes zoster rarely grows all over the body, because VZV lurks in the dorsal root ganglion, and the herpes outbreak after activation is limited to the corresponding dermatome. The so-called dermatome refers to the skin area innervated by each spinal nerve, which is distributed up and down and separated from the left and right on the human trunk (Figure 9). However, VZV does have a certain lethality, causing about 6,000 deaths each year (Lancet 2016 report).

Figure 9: Distribution of dermatomes on the human upper body. Herpes zoster only occurs in the corresponding dermatomes in the latent area. Source: Wikipedia

Unlike herpes simplex zoster virus (HSV), VZV is an airborne disease with a high transmission capacity. It can be transmitted to another person with a sneeze/cough from an infected person. It can also be transmitted by contact with the skin surface of the herpes starting 1-2 days before the appearance of chickenpox or shingles until the herpes crusts over.

Currently, there is a vaccine for VZV, which has been included in the immunization plan in some areas of my country. The shingles vaccine currently on the market in China is the recombinant shingles vaccine (RZV) produced by GlaxoSmithKline, with the trade name Shingrix. VZV vaccination will reduce the chance of contracting chickenpox and shingles. More importantly, even if you contract chickenpox or shingles, the vaccine can greatly reduce the proportion of moderate to severe patients.

VZV vaccine is not suitable for pregnant women, tuberculosis patients, people with low immunity and immunosuppression. Allergens should be tested before vaccination. It should be noted that once a family member has received the VZV vaccine, I personally recommend that family members in close contact should also be vaccinated. A low VZV vaccination rate may increase the risk of herpes zoster in unvaccinated people. This is because the VZV vaccine currently used is a live attenuated vaccine.

After getting chickenpox or shingles, you need to take good care of your skin to prevent secondary infection. In severe cases, you can use analgesics, antiviral drugs and steroids to treat it. Note that you should not take aspirin (acetylsalicylic acid) during chickenpox or shingles, or when getting the VZV vaccine, because aspirin can increase the risk of Reye's syndrome caused by VZV - Reye's syndrome is a rapidly worsening brain disease with brain dysfunction such as persistent vomiting, extreme sleepiness or aggressive behavior.

Other herpes viruses

Finally, let us learn about several other common herpes viruses that infect humans. Their common characteristics are still: once you are infected, there is no way you can get rid of it. They will take advantage of your weak immunity and cause trouble.

Epstein-Barr Virus (EBV/HHV-4) is one of the most common viruses that infect humans. Its transmission is similar to that of HSV-1. It is usually transmitted through saliva and is known as the "kissing disease". It can also be transmitted by sharing food, drinks, toothbrushes, etc. Of course, EBV is also present in other body fluids. Infection often occurs in infancy. Half of children under the age of six have been infected with EBV, and more than 90% of the population has been infected with EBV by adulthood.

EBV generally infects B cells and epithelial cells, and can remain latent in B cells and exist in the infected person's body for life. EBV can be activated by overwork, malnutrition, excessive sadness, hormone fluctuations (puberty, pregnancy, menopause) and childbirth, thus causing disease.

Children infected with EBV often have no symptoms. When adolescents or adults are infected with EBV, there is a 35% to 50% chance of developing infectious mononucleosis, which causes symptoms such as fatigue, fever, pharyngitis, lymphadenopathy, hepatosplenomegaly, and rash. EBV infection is associated with malignant tumors such as lymphoma, gastric cancer, nasopharyngeal cancer, and autoimmune diseases such as multiple sclerosis. There are currently no good means of prevention and treatment. The central idea is to keep yourself healthy. If you are healthy and have strong immunity, these viruses will not cause trouble.

Human Cytomegalovirus (HCMV/HHV-5) is a beta-herpes virus that primarily infects the salivary glands, but can also infect other parts of the body. Infectious HCMV may be present in any body fluids of an infected person, and can be transmitted through contact with infected body fluids, or vertically. A person has a 90% chance of being infected with HCMV during their lifetime. After infection, HCMV remains latent in the human body and can be reactivated at any time. HCMV infection usually has few symptoms and is almost undetectable in healthy people, but it can be life-threatening for people with weakened immune systems:

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 low weight, microcephaly, and epilepsy. Even if there are no symptoms, there may be hearing, mental and motor coordination problems in the future. Parents and childcare staff of newborns should maintain their own hygiene habits to minimize the risk of transmitting the virus to newborns.

Adults with weakened immune systems, such as those infected with HIV, severely burned, or who have received an organ transplant, may become ill due to the reactivation of HCMV, with symptoms such as retinitis, pneumonia, and colitis. Antiviral drugs can be used to prevent and treat the disease.

Immunocompetent adults are rarely affected by HCMV, but the virus can also cause mononucleosis and increase the risk of diabetes, cardiovascular disease, and cancer.

Roseolovirus includes two viruses, HHV-6 and HHV-7, which can cause infantile roseola, also known as roseola infantum (all mothers know it). It is a very common mild infection that generally does not require treatment. Symptoms include fever and rash that last for about four days. Use antipyretics if necessary. If symptoms such as drowsiness, persistent high fever and convulsions occur, seek medical attention immediately.

Kaposi's sarcoma-associated herpesvirus (KSHV/HHV-8) can be transmitted through saliva or sexual intercourse. The infection rate varies greatly between regions. In my country, about 10% of the population is infected. KSHV infection is generally asymptomatic, but it can cause Kaposi's sarcoma, a localized skin tumor, on the skin of AIDS patients.

Other animal herpes viruses that may infect humans: Humans are generally rarely infected with herpes viruses carried by animals, but for high-risk specific groups such as animal breeders, experimental animal contacts and users, veterinarians, etc., attention should be paid to preventing infection with animal herpes viruses. Monkey B virus is a herpes virus carried by monkeys. Monkeys have no symptoms, but it is fatal to humans. Don't mess with monkeys. Pseudorabies virus is a common animal herpes virus that can infect livestock such as pigs, cattle, and sheep. Recently, there have been reports that it can infect humans and cause severe encephalitis.

Conclusion Question: "Oh my God! In addition to the disgusting fat on my poor little body, there are so many hateful "tenants". I feel dirty. What should I do?

Answer: "Live well, after all, there are very few people who are not infected. Knowing so much knowledge is not to make you suspicious and overly worried. What's the point of worrying blindly? Most herpes viruses are really "small blisters." Knowing these viruses is to know how to prevent them, how to deal with symptoms, recover health as soon as possible, and avoid the worst situation. People in the world, with the company of HHV-1, HHV-2, HHV-3, HHV-4, HHV-5, HHV-6 and 7, let us still live a carefree life.

References

https://www.who.int/en/news/item/01-05-2020-billions-worldwide-living-with-herpes

https://www.who.int/en/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/az/diseases-and-conditions/38/genitalherpes

https://www.cdc.gov/std/herpes/stdfact-herpes-detailed.htm

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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

https://en.wikipedia.org/wiki/Varicella_zoster_virus

https://www.sohu.com/a/283735369_699704

https://www.connecticutchildrens.org/health-library/en/parents/chicken-pox/

https://en.wikipedia.org/wiki/Herpesviridae

https://www.verywellfamily.com/how-to-make-your-own-oatmeal-bath-289466

https://www.cdc.gov/epstein-barr/about-ebv.html

https://en.wikipedia.org/wiki/Epstein%E2%80%93Barr_virus

https://en.wikipedia.org/wiki/Kaposi%27s_sarcoma-associated_herpesvirus