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.



What are the early signs of syphilis?

Chancre of syphilis on the penis. Courtesy of wikipedia user Pygmalion.
It’s Saturday night and before your weekend gets too crazy, learn about the early signs of syphilis.

Syphilis is a contagious infection caused by the bacteria Treponema pallidum and is spread through sex (and thus a sexually transmitted disease/STD). Syphilis has been around since ancient times and continues to cause problems in humans even today.

How does syphilis first present?

The first stage of syphilis presents with the chancre (pronounced shank-er). About 3 weeks after exposure and infection, a red bump or erosion appears. This spot can grow bigger and more firm. Other bumps and lumps may appear near this site and represent enlarged lymph nodes. Unlike other STDs such as chancroid, primary syphilis is usually NOT painful.

Where do chancres appear?

Where the infection entered! That means you can develop a chancre on the genitals, by the anus, on the lips, tongue, fingers, etc.

What should you do if you suspect you might have gotten exposed to syphilis?

See a doctor. The good thing about syphilis is that we have very effective treatments so do not hesitate seeking medical attention. A few minutes of potential awkwardness can save you much larger problems down the road (and prevent the further spread of syphilis to partners and to children if you’re pregnant).

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.