To wake a sleeping herpes virus
Certain prescription drugs may activate the most common strains of herpes
Joshua A. Krisch • October 19, 2013
Prednisone, prescribed for ailments ranging from severe allergies to cancer, is one of the drugs implicated in the study. [Image credit: Flickr user Jsrcyclist]
Everyone’s got herpes.
Between HHV-8, a lethal, cancer-causing strain of the virus and HHV-6, a relatively benign incarnation that rarely causes more than a fever, essentially all human beings are infected with some form of herpes. While the occasional cold sore may not perturb most patients, however, new research suggests that some medications activate herpes viruses, with potentially grave consequences.
Herpes, like many viruses, has a characteristic latency period during which the pathogen is barely detectable and causes no symptoms. When activated, however, herpes can rampage about the body, leaving painful sores in its wake. Researchers have long suspected that certain chemotherapy treatments, especially those that suppress the immune system, may activate latent herpes viruses even as the drugs carry out lifesaving tasks within the body.
“Viral reactivation during immunosuppressive therapy, especially chemotherapy, is a very real event,” said Dr. Jack Goldberg, oncologist at Penn Presbyterian Medical Center in Philadelphia.
In a new study published in Journal of Virology, a team of researchers at George Washington University (GWU) in Washington, D.C., found that prednisone, doxorubicin and vincristine, three immunosuppressive chemotherapy drugs also used in managing bone marrow transplants and severe allergies, are capable of activating some of the most common herpes viruses.
The offending drugs work by inducing programmed cell death, a normal cellular function called apoptosis, to destroy cancerous cells. Herpes viruses lying dormant within these doomed cells “sense” the impending death of their hosts and reactivate to infect new, healthy cells, said Dr. Steven Zeichner, a professor of medicine at GWU and coauthor of the study. “We now have considerably more support for the idea that herpes viruses can sense when their host cells are undergoing apoptosis,” he said. As a result, the viruses begin to replicate and produce symptoms that may be fatal, especially in cases of severe immunosuppression.
Despite these viral side effects, clinicians like Goldberg balk at the thought of discarding effective cancer treatments. “If you’ve got a drug that works, you’re going to find a way to use it,” he said. In that spirit, physicians have already begun prescribing antiviral treatments along with some cancer drugs in an effort to stave off viral reactivation.
Zeichner is enthusiastic about using precautionary anti-herpes drugs in a similar way, but cautions that plenty of clinical trials lie ahead. “Scientists hate to make absolutist statements until they have proved something about twenty different ways,” he said.
But Zeichner estimates that some strains of herpes infect the entire human population—potentially exposing millions of weakened patients to severe viral infections.
And with herpes hiding in us all, learning to tiptoe around the sleeping virus is an immediate priority.
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About the Author
Joshua A. Krisch
Josh is the frenzied product of ambulance nightshifts, aviation emergencies, long hours in the laboratory, and a burning desire to write about them. While earning his B.A. in biology at Yeshiva University and completing graduate work in health sciences at Cornell, Josh was routinely exposed to the excitement of science and medicine. When not deciphering medical jargon, Josh enjoys bad science fiction, decent coffee and excellent company.
5 Comments
Who invented the Herpes virus? Why do we have it? Where did it come from??? How many varieties of it are there?
Would like to know… Thanks, Carol
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What is herpes?
Herpes Simplex Virus, HSV-1 or HSV-2
Herpes is one of the most common viral infections in the United States. One of every four Americans over 18 has been exposed to genital herpes. Most people don’t know they’re infected.
What causes herpes?
Herpes is a viral infection of the skin caused by the Herpes Simplex Virus (HSV). There are two types of herpes: HSV-1 and HSV-2.
HSV-1 usually causes infections of the mouth such as “cold sores” or “fever blisters” on the lips. Most of the time HSV-2 causes genital herpes. But, either type of herpes can cause an infection of the mouth or genitals.
How is it spread?
Herpes is spread by direct skin-to-skin contact with someone who is infected. You can get herpes from someone who has sores on his or her lips, skin or genitals. But, most of the time, herpes is spread when someone does not have any signs or symptoms. The herpes virus can still rub off a person’s skin even when he or she has no sores that you can see.
Remember: you can get herpes from someone who has no sores or symptoms and if you have herpes you can spread it even if you have no sores or symptoms.
What are the signs and symptoms?
Only about half the people who get herpes have symptoms. Those who do have symptoms usually have an outbreak two to 10 days, or within three weeks, after they get the virus. The first symptoms are usually the worst. They are called primary herpes.
Signs and symptoms may include:
A fever, headache, and muscle aches. Three days later, painful blisters and skin ulcers appear where you were infected. This may be your mouth, genital area, anus and/or rectum.
Blisters may be “hidden” in your vagina.
About a week after the skin rash, tender and swollen glands, or lymph nodes, may develop in your groin.
If you do not get treatment, your rash and pain will usually go away within 3 to 4 weeks.
Your sores will heal, but the virus will never go away. It will always stay in your body in a latent form. This means it will be quiet, hidden, and you will not have symptoms. But, herpes can become active again and cause new sores. This is called “recurrent” herpes.
The second time you have symptoms, they will usually hurt less and not be as bad as the first time. Recurrent herpes often starts with a burning or itchy feeling one to two days before a skin rash begins.
Can herpes cause any more problems?
The most severe problem (complication) happens when a woman passes the virus to her baby during delivery. If the infant is infected, it is very serious. This infection often causes the baby to die or suffer mental retardation and blindness. This problem is rare and usually happens when a woman gets herpes for the first time near delivery. If a woman has a genital herpes outbreak when she goes into labor, she may need a C-section (Cesarean delivery).
Urinating may be very painful if you have sores on your vulva (the external parts of the female genitals). You may be more comfortable if you sit in a tub of warm water and urinate into the bath water.
It is rare, but the first time you have herpes, it can cause the nerves to your bladder to become inflamed. If this happens, you will not be able to urinate. This is a temporary problem. You should see a health care provider for treatment.
How will I know if I have herpes?
If you have any sores, blisters, or red areas on your genitals your health care provider should examine you. He or she will swab the area to test for the virus. If you don’t have any sores, a blood test can be done to see if you have ever been exposed to herpes.
Is there a cure?
No. Herpes is a chronic, lifelong infection. It will never go away. Even though there is no cure, antiviral medicines can help to:
Treat the symptoms,
Lower your chances of having an outbreak,
Lower the number of times you shed the virus without knowing it, and
Prevent you from having the symptoms again.
Medicines include:
Acyclovir (ay sye’ kloe veer) which is also called Zovirax;
Famcyclovir (fam sye’ kloe veer) also called Famvir, and
Valacyclovir (val ay sye’ kloe veer) or Valtrex.
These work best if you take them at the first sign of burning or itching, before the sores appear. Another way to take them is to take a small amount each day. Acyclovir is given to newborns who are infected during birth.
What about my partner(s)?
Because herpes is a sexually transmitted disease (STD), your sex partners should be checked for symptoms. Many partners do not have symptoms that can be seen or felt. But, your partners still need to be checked for infection and other STDs.
Since herpes is a lifelong infection, it is important to talk openly and honestly with your partners. If you’d like advice about how to talk to your partners, call one of the numbers at the end of this fact sheet.
When can I have sex again?
You should not have oral, vaginal or anal sex when you have sores. Also do not have any kind of sex if you think you might be getting an outbreak. Remember: you can pass the virus to your partners even when you do not have symptoms.
You should tell your current and future partners that you have herpes.
How can I prevent herpes?
Not having sex (abstinence) is the only sure way to avoid infection.
To lower your chances of giving or getting herpes, use latex or polyurethane condoms every time you have oral, vaginal or anal sex. Using these condoms the right way each time you have sex can reduce your risk of genital herpes. Using condoms will not totally stop the risk of giving or getting herpes because this disease is spread through “skin-to-skin contact” from sores/ ulcers OR infected skin that may look normal. Condoms also help prevent the spread of other STDs including HIV, the virus that causes AIDS.
If you are sexually active, you and your partners should get a full physical checkup. This includes a complete sexual history and testing for common STDs. You should be checked for gonorrhea, chlamydia, syphilis, herpes, genital warts, trichomoniasis, and HIV.
Will anyone know the results of the exams?
Your test results and any treatment will be kept absolutely confidential. No one can find out your results, except you. If you are under 18 you can be checked and treated for STDs without getting permission from your parents.
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