VZV, HSV, HPV — Oh My!

VZV, HSV, HPV — Oh My Indeed!

A point of confusion for many patients (because it is legitimately confusing) is the difference between VZV, HSV, and HPV viruses.  First, let’s clarify these acronyms.

VZV = Varicella Zoster Virus

HSV = Herpes Simplex Virus

HPV = Human Papillomavirus

So the reason it is confusing is because A) the acronyms sound somewhat similar, B) VZV and HSV are both part of the Herpes family of viruses (Herpesviridae), and C) VZV can cause a diagnosis called herpes zoster which has the word herpes in it. Herpes zoster is not caused by the Herpes Simplex Virus.

So let’s do a quick synopsis of each one.

VZV = Varicella Zoster Virus

Conditions it causes: Chickenpox, Herpes zoster – aka Shingles

Chickenpox is something most of us are familiar with (at least those of us old enough to remember having had it). These days, most kids are immunized to it in the US when they are young.  It is characterized by little blisters with some surrounding redness, along with fever and feeling tired.  For those who want a descriptive analogy of what the rash looks like, check out “dew drops on a rose petal.”

Herpes zoster, aka Shingles, is something that occurs most frequently in adulthood. Classically, it occurs on one side of the body, with the same little blisters which can be grouped together. It can be burning, stinging, painful or itchy.  There is a vaccine that is recommended for most people over 60 years of age since the risk of getting this rash is more frequent with increased age.  Shingles occurs because the varicella zoster virus reactivates.  After initial exposure, the virus lays dormant in the nerves and with some trigger or waning immunity, it can reactivate and cause shingles.

HSV = Herpes Simplex Virus

Conditions it causes: Cold sores/oral herpes/herpes labials/fever blisters, Genital herpes/Anogenital herpes, herpes simplex

There are two types of the herpes simplex virus – HSV1 and HSV2.  Generally, HSV1 favors the oral area and HSV2 favors the genital area.  That being said, either could be found in either place.  Herpes can also infect skin besides the oral area or the genital area.

Like the Varicella Zoster Virus, the herpes virus can reside in the nerves  after initial infection. Then, it can reactivate (e.g. during times of trauma, stress, decreased immunity or otherwise), and show up.  Like shingles, it also shows up with little blisters. These tend to be small clustered blisters.  More on herpes in a future post to follow.

HPV = Human Papillomavirus

Conditions it causes: Warts including warts on the skin and genitalia, can also cause cancer like cervical cancer, penile cancer, and other cancers

Most commonly, the HPV virus causes common warts. These could be on the hands, fingers, soles of feet, or other areas.  However, HPV viruses can also cause cancers in various areas including the anal canal, cervix, vulva and vagina in women and the anal canal or penis in men (thus the need for Pap smears, and the development and recommendation of the HPV vaccine).  There are many different strains of HPV, with some considered relatively benign strains (e.g. those commonly causing warts) and some considered higher risk strains (e.g. those responsible for HPV induced cancers).  Check out this link from the CDC for more info and more on HPV in a future post to follow.



Herpes from wrestling?

Courtesy of Wikipedia user David MonniauxYes, it is possible. And we dermatologists have a fancy term for it: “herpes gladiatorum.”  It is also referred to as “wrestler’s herpes,” “mat pox,” or “scrumpox.”  In previous posts, we learned that the herpes virus (HSV) is transmissible through various means of contact with other infected individuals and can occur in various places (lips, hands, eyes, genital area, etc…).  Well, wrestlers are frequently in close physical contact with each other and with the mat during matches or practice.  As such, the herpes virus can spread.  Usually, the herpes rash breaks out over the face, neck or arms.  The rash can be tingling, painful, and can show the same little blisters which pop and crust over as in other herpes infections.

If you suspect that you have a herpes infection (or your opponent has herpes), get it checked out before your wrestling match (or any other close contact sport for that matter).  Prevention is key!

Herpes in the eye?!

Yes, herpes can infect your eye. When it affects the front part of your eyeball (the cornea), it is called herpes keratitis. The cause of this herpes eye infection is none other than the herpes simplex virus (HSV). It is the same virus that can cause cold sores/fever blisters/orolabial herpes. In the same way that it affects the skin of and around your lips, it can affect your eye.

Herpes eye infection may be accompanied by pain, redness, tearing, irritation, blurred vision or difficulty tolerating the light. You may or may not have little water blisters around the eye. These blisters can not only affect the area around your eye, but also the tip of your nose!

Herpes infection of the eye is serious and is an emergency. If you have any concerns of this, see your doctor immediately. The consequences are scarring of the eye which could lead to blindness.

Just like cold sores, herpes eye infection can reappear. That’s because the herpes virus can lay dormant inside the nerves underneath your eye and skin. During flares, the virus reawakens and travels to the skin or eye. If you have frequent herpes eye infection, you may need to take a medication to suppress the virus from reactivating.

Herpes, part III: genital herpes

An example of male genital herpes on the penis. Note the small fluid bubbles (vesicles).An example of female genital herpes.

So it was just a matter of time before this herpes thread would reach the topic of genital herpes. Genital herpes can be quite difficult to control and causes a lot of distress and anxiety.

So what is genital herpes? Genital herpes is caused by the herpes simplex virus. Most of the cases are from HSV2 (the herpes simplex virus type 2) although HSV1 (type 1) could cause it too. Genital herpes is a sexually transmitted disease.

What is primary genital herpes and recurrent genital herpes? The herpes virus can infect you after contact with an infected person, and it can take 2-20 days before you get any symptoms. The first episode of the infection is called primary genital herpes. After that, the herpes virus stays dormant and quiet in your cells but then it can be triggered to recur (thus the name, recurrent genital herpes). Keep in mind, even when you don’t have active, painful skin findings, you can still “shed” herpes virus and thus be infectious.

What does it look like? The first time you have genital herpes, you can have little blisters (vesicles) and you can also get fever, a headache, muscle aches, swollen lymph nodes, pain, itching, discharge, etc. Sometimes, the first episode of herpes infection is very severe and people have had to be hospitalized for it.

Recurrent genital herpes often starts with burning or itching and then the little blisters can appear. You can get discomfort and pain as well.

When are you infectious? Even if you don’t have active water blisters, you can still “shed” herpes virus and be infectious. Certain antiviral medications such as acyclovir can reduce the amount of shedding of the herpes virus.

Are there treatments? There’s no cure, but there are antiviral medications such as acyclovir, valacyclovir or famciclovir which can help make the infection more tolerable. Some patients opt for daily antiviral suppressive therapy to help prevent outbreaks. Since everyone’s case is different, discuss with your doctor how best to manage your herpes.

More herpes: cold sores

Cold sore - aka herpes labialis or fever blister. This is caused by the herpes virus.
Cold sores, aka fever blisters or orolabial herpes is caused by… you guessed it… the herpes virus. Usually it’s cause by the herpes simplex virus type 1 (HSV1) but type 2 (HSV2) can cause it too.

How does it present? Usually there can be tingling or a burning sensation before anything appear on the skin. You can then get some redness and little water or pus bubbles in the skin which can then burst and crust over. You may also notice a fever, sore throat or swollen glands or lymph nodes.

How can you treat it? If started early, an antiviral medication such as valacyclovir or acyclovir can shorten the duration and intensity of your cold sores. Ask you doctor about whether these medications are right for you.

Herpes is infectious. Especially when you have open sores, don’t share straws, drinks etc. You can also spread the virus via kissing, etc. Try not to shave over the area either. You could drag the virus to nearby skin.

Another reason to wear gloves: herpes

Example of herpetic whitlow - a herpes infection of the finger. This was in a young child who had in previous few days had developed infection in the mouth. Courtesy of James Heilman, MD.
Believe it or not, herpes infection of the fingers was not uncommon back when healthcare workers did not wear gloves. Touching infected skin, cold sores, mouth lesions etc. with bare hands would transmit the herpes virus. Nowadays, with universal precautions, it’s much less common. Herpetic whitlow is the name given to the herpes infection of the fingers. The finger starts out with pain and tenderness and then little blisters appear. Keep in mind that these little blisters are also infectious.

Nowadays, kids are the ones who most frequently get this herpes infection on the fingers — usually from biting their fingers while they have cold sores. Basically, any touching of any other herpes infection can lead to an infection on your fingers. So be careful where the ungloved fingers go!