Terms commonly used in the discussion of herpes.

Acy : Short name for Acyclovir.

ACYCLOVIR: The first antiviral drug used to combat recurrent herpes infection. Used episodically or suppressively. Market name: ZOVIRAX

AVS Asymptomatic viral shedding. Referring to the fact that herpes virus can be shed without any obvious clinical symptoms.

ANTIBODY A type of serum protein (globulin) synthesized by white blood cells of the lymphoid type in response to an antigenic stimulus, the role of antibody being to inactivate or render harmless the invading antigen.

ANTIGEN A substance, usually protein or protein-sugar complex in nature, which, being foreign to the bloodstream or tissues of an animal, stimulates the formation of specific blood serum antibodies and white blood cell activity. Re-exposure to similar antigen will reactivate the white blood cells and antibody programmed against this specific antigen.

ANTIVIRAL Any of a number of herbs, drugs or agents capable of   inhibiting their growth or multiplication until the body is capable of controlling the virus itself. Most antiviral agents are members of the antimetabolite family.

BLISTER A localized collection of clear fluid causing elevation of the skin, separating it into an upper and lower layer. Breakdown of a blister produces an ulcer.

CANKER SORES Often confused with Herpes type 1/cold sores. Canker sores are actually not a type of herpes. They occur inside the mouth, whereas Herpes type 1 typically occurs on the lips, face or nose.

CHICKEN POX An acute, highly infectious illness, principally of young children, caused by the chicken pox-herpes zoster virus and marked by fever and successive eruptions of clear blisters over the body. Chicken pox may enter latency in the deep nerve ganglia and reactivate years later in the form of herpes zoster.

COLD SORES A euphemism used to describe Herpes type 1 which appears usually, but not imited to, on the face, nose, lips, and inside the mouth as blisters or small ulcerations.

CROSS-REACTIVITY A phenomenon seen in testing for specific blood antibodies against such organisms as herpes simplex type-1 and -2. The separate viruses have stimulated production of common or similar antibodies which cannot be distinguished from each other by reaction against the individual virus types.

CYTOMEGALOVIRUS A member of the herpes virus family which may induce the immune-deficient state or cause active illness, such as pneumonia, in a patient already immune-deficient due to chronic illness, such as cancer or organ transplantation therapy. (Abbreviated: CMV.)

CYTOPLASM The contents of a cell, exclusive of the nucleus.

This is a small plastic prophylactic device akin to saran wrap that prevents infection for dentists working on potentially infected patients (in vougue after HIV scare) Can be purchased via Condom Sense. Used to protect people who want to enjoy oral sex with a woman that has herpes or unknown health status.

DNA Deoxyribonucleic acid, the protein-sugar substance which contains the genetic information of any living cell.

DORMANT Not manifesting characteristic clinical symptoms. Pertaining to a disease or condition.

EPISODICALLY Referring to antiviral use only when an OB (outbreak) occurs.

EXTRAGENITAL Located outside of the genital region.

FAMCYCLOVIR: The latest antiviral available. Often touted as "the one" to take for initial infection since it is purported to reduce the incidence/severity of future outbreaks. (Jury still out.) Market name: Famvir.

FAMVIR: Market name for Famcyclovir.

FEVER BLISTER: Another euphemism for Herpes type 1.

GANGLION A group of nerve cell bodies clustered together in a uniform mass outside of but often close to the brain or spinal chord. Nerves run to or from the ganglia in passage to or from the brain to specific sites on the body.

HERPES VIRUSES The viral family which includes the infectious agents of herpes simplex types 1 and 2, cytomegalovirus (CMV), and Epstein Barr (mononucleosis) viruses. Herpes Zoster is sometimes consider a member of this family because of the similar appearance, ability to infect the body chronically in latent state and ability to cause one or more recurrent herpetic illnesses. It is usually characterized by blister and ulcer formation of the skin.

HERPES ZOSTER An acute, blistering, ulcerative, inflammatory illness of the skin, caused by latent chicken pox virus migrating from the deep nerve ganglion to the zone of skin innervated by that nerve. Called also shingles, zoster, or zona.

HYPERESTHESIA / HYPERSENSITIVITY An abnormal or pathological increase in sensitivity to sensory stimuli, as of the skin to touch or cold, or the ear to sound. Often a prodromal symptom occurring in the area of an impending outbreak.

IMMUNE COMPETENT A person capable of mounting a full and normal white blood cell and antibody defense against invading foreign antigens such as viruses or bacteria.

IMMUNE-DEFICIENT A patient who is incapable of full and normal white blood cell and antibody defense against invading germs or other antigens.

LATENCY/LATENT: The state of apparent inactivity during which time the herpes virus genetic material lies sleeping in a cell without producing virus-specific biochemical changes or evidence of reproduction or illness; latent virus is not detectable by the usual biochemical tests.

MEDS (abbreviation)  Usually referring to prescribed antivirals to control Herpes. See: Acyclovir, Famcyclovir, Valcyclovir, Famvir, Valtrex, Zovirax.

NEURALGIC Pain Sharp, severe pain extending along a nerve or group of nerves.

NONPRIMARY INFECTION A first infection in a particular location of the body, such as the genitalia, in a person who has had a previous infection with herpes virus elsewhere in the body and therefore has antiherpes antibody and white blood cells. This provides partial protection against the new herpes virus. (See also PRIMARY HERPES).

OB: Outbreak - referring to obvious blisters/vesicles.

ORAL-GENITAL Pertaining to contact between the mouth and genitalia during sexual activity.

PARESTHESIA A skin sensation, such as burning, prickling, itching, or tingling, with no apparent physical cause. Tingling in the most common of prodromal symptoms for Herpes I and II.

PRIMARY HERPES/PRIMARY OB: A first infection with either herpes simplex type-1 or type-2 virus in a person who has never previously been infected with either form of simplex. Antiherpes, antibodies, and white cells are absent and overt disease may or may not develop.

PRODROME Any variety of physical sensations that signal an oncoming outbreak. Common prodromes include: skin hypersensitivity, tingling/itching at the usual outbreak site, muscle ache or other flu-like symptoms, headache, neuralgia (sharp stabbing or shooting pains on a nerve path), depression.

REACTIVATION The change from a dormant or latent state to one of active growth and replication; with reference to herpes virus, the passage from latency to active infectious organisms resulting in recurrent illness.

RECURRENT HERPES (Recurrent Infections) Repeated episodes of herpetic infectious blistering of the skin and mucous membrane due to reactivation of latent virus sleeping in the deep nerve ganglia which innervates that particular area of the body. Antiherpes antibodies and white cells are present but cannot totally prevent recurrent illness.

REINFECTION Reintroduction of an infectious agent from an outside source, as opposed to reactivation of an organism already residing in the body.

SELF INNOCULATION Infecting oneself in a new area of the body by touching an infected area, then touching a previously non-infected area.

SHEDDING Referring to the shedding of infectious herpes virus cells. Can occur during active and latent periods.

SUBCLINICAL Not manifesting characteristic clinical symptoms.

SUPPRESSIVE: Referring to use of antivirals on a daily basis to prevent/lessen outbreaks and asymptomatic shedding.

TESTS: There is testing for the virus directly and there is testing for the virus indirectly ( by testing for antibodies in the blood )
First..testing for the virus directly. This is the best way to diagnose, because it is direct. The lesion itself is swabbed (sampled) and a culture is made with this sample. The culture can be examined various (like microscopically) ways to see if hsv is present. If positive, then it is definetely positive. If it is negative, it may be a false negative because the virus did not grow in the culture. (not enough virus from swab, poor handling...) Different staining procedures can be used to "type" the hsv.

PCR (Polymerase Chain Reaction) also directly detects the virus by "sensing" its DNA. Remember the OJ trial? Same thing.

Serum testing. Serum is just blood with some of the protien components removed. All testing that uses blood test for antibodies. So they are all indirect tests. They can't determine the location of the infection.

The most common blood test is the ELISA. This test uses antigens for hsv to look for antibodies to hsv. An antigen is just a part of a foriegn object like a virus, that caused the immune system to form an antibody. Antibodies and antigens fit together. So if there are hsv antibodies in the blood, they will hook up with the antigen presented by the ELISA test. These antibodies are then detected. The problem with typing hsv here is that type 1 and 2 are very similar. They are so similar in structure that an antibody for one type will "hook-up" with an antigen from the second type. In other words, there is cross-reactivity between them. So for example, hsv-1 antibodies can be detected by hsv-2 test antigens.

The Western Blot is another type of test that uses antigens and antibodies. In the case of U of Wash. and Viridae, the antigen for hsv-2 that they use is very specific. There is a glycoprotien, gG-2, that happens to be very different on two differnt types. The WB uses this specific antigen to detect hsv-2 antibodies. Hsv-1 antibodies do not cross-react with this specific antigen because it doesn't "fit". The area on hsv-1 that corresponds to this glycoprotien of hsv-2, has a much differnt structure and therfore causes a differently structured antibody to be formed.

Several companies are now testing a quick, cheap ELISA test based on this same gycoprotein. When these tests become available, there will be no need for the WB.

Antibodies do need time to develop. The two classes of antibodies we talk about most are IgG and IgM. (Immunoglobulin G or M). IgM is the first to form, and indicates a recent infection. Its level will fall off to zero after a few weeks or so. IgG takes longer to develop, but sticks around once it does. Thus, IgG is an indicator of an existing infection, and is most commonly used to test for hsv. If you test for it to soon, it may give a false negative because it hasnt had enough time to develop.

ULCER A loss of the superficial layer of the skin or mucous membranes in a localized area, usually associated with redness, serious moisture, and irritation until scabbing occurs.

VALCYCLOVIR An antiviral medication, developed after Acyclovir and prior to Famcyclovir. Considered "better" than Zovirax and the jury is still out on whether it is better than Famvir.

VALTREX Market name for Valcyclovir.

VARICELLA VIRUS Or Varicella-zoster virus A herpesvirus that causes chickenpox and shingles.

VESICULAR A small sac or cyst, especially one containing fluid. Pathology: A serum-filled blister formed in or beneath the skin.

VIRUS A minute infectious agent to small to be seen under the ordinary laboratory light microscope but visible under the magnification of the electron microscope. The individual particle consists of a central genetic (heredity) core made of DNA or RNA but not both. This is surrounded by a protein coat which may be multilayered. Some viruses, such as herpes, have a third coating which is membranous in nature and may be taken from the animal cell just infected. Viruses may infect animals, plants, or bacteria. They are not susceptible to the usual antibiotics, such as penicillin, but may be inhibited by special antimetabolites or other antiviral agents which have little to no effect on bacteria. Viruses are incapable of growing anywhere but within living cells.

WESTERN BLOT A test that can detect antibodies for HSV1 and HSV2. The Western Blot does not detect recent infections. your body needs about 4 months to develop the antibodies for this test. Two places in North America perform the western blot commercially for hsv-2. They are University of Washington and Viridae in Vancouver. Both have sites linked to the HHP. The WB is about $80. Your doc will send some of your blood out to one of those two places. (You may have to explain the test to your doc, and twist his arm a bit to get it.)

The WB detects antibodies for hsv-2. The antibodies it detects are IgG which are the long term antibodies. Your body needs up to 4 months to develop these antibodies. The WB does not measure recent infections.

WHITE BLOOD CELLS Those blood corpuscles responsible for maintaining the body's immune surveillance system against invasion by foreign substances such as viruses or bacteria. White cells become specifically programmed against foreign invaders and work to inactivate and rid the body of a foreign substance.

ZOVIRAX: Market name for Acyclovir.

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