Herpes simplex virus (HSV) is a common pathogen that causes recurrent infections in humans.

Herpes simplex virus (HSV) is a common, lifelong viral infection affecting millions worldwide.^1,2 Pharmacists play a crucial role in counselling patients, understanding the different strains, triggers, and treatment options.

HSV TYPES AND TRANSMISSION

There are two main types of HSV:

• HSV-1: Primarily associated with oral herpes, causing cold sores or fever blisters. It can also cause genital herpes.^1,2,3
• HSV-2: Primarily associated with genital herpes but can also cause oral herpes through oral-genital contact.^1,2,3

Both types spread through direct contact with infected skin or mucous membranes. Transmission can occur:

• During sexual contact, even without visible lesions^1,2
• Through oral-to-oral contact, particularly during kissing^1,2
• Sharing personal items like razors, lip balm, or food utensils (more common with HSV-1)⁴
• From mother to child during childbirth.^1,4

TRIGGERS AND OUTBREAKS

While individuals with HSV can be asymptomatic, outbreaks can be triggered by various factors:

• Stress, emotional upheaval
• Illness, fever
• Sun exposure (especially for HSV-1)
• Hormonal changes (in some women with genital herpes)
• Injury or surgery to the affected area (including friction during sexual intercourse).^1,4

SIGNS AND SYMPTOMS

The clinical manifestations of an outbreak can vary, but may include:

• Tingling, burning, or itching at the infection site
• Blister formation that may weep or crust over
• Pain, burning, or discomfort during urination (genital herpes)
• In severe cases, flu-like symptoms like swollen lymph nodes and body aches.^1,2

DIAGNOSIS AND TREATMENT

Diagnosis is typically based on clinical presentation and medical history. In some cases, viral swabs or blood tests may be used.

Unfortunately, there is no cure for HSV. Treatment focuses on managing outbreaks and reducing viral shedding:

• Antiviral medications (acyclovir, valacyclovir, famciclovir): These can shorten outbreaks, reduce severity, and decrease transmission risk.³
• Pain relievers: Over-the-counter pain relievers can help manage discomfort.⁴
• Topical treatments: Creams or ointments can be applied to lesions to reduce pain and promote healing.⁴
• Suppressive therapy: For frequent outbreaks, daily antiviral medication can be prescribed to reduce their frequency and severity.³
• Lifestyle modifications: Encouraging patients to manage stress, use sun protection, and avoid known triggers can help reduce the frequency of outbreaks.

PHARMACIST ROLE

Pharmacists are well-positioned to provide education, support, and medication management for patients with HSV. Key areas include:

• Counselling: Providing accurate information about transmission, triggers, and management strategies.³
• Dispensing medication: Ensuring patients understand proper use of antivirals and potential side effects.
• Addressing concerns: Offering support and addressing anxieties associated with the diagnosis.
• Referral: Recommending patients to healthcare providers for further evaluation or management of complications.

Through proper education and counselling, pharmacists can help patients lead healthier lives and reduce the impact of HSV on their daily activities.

REFERENCES 

1. The Ultimate Guide To Genital Herpes. Epicentre Health Research. Epicentre Aids Risk Management. Available from: https://epicentre.org.za/herpes/#:~:text=While%20an%20estimated%20491%20million,Abbai%20et.%2C%202019). 
2. Herpes simplex virus. World Health Organization. 5 April 2023. Available from: https://www.who.int/news-room/fact-sheets/detail/herpes-simplex-virus 
3. Genital Herpes. Sexually Transmitted Infections Treatment Guidelines, 2021. Centers for Disease Control. 2021. Available from: https://www.cdc.gov/std/treatment-guidelines/herpes.htm 
4. Herpes Simplex. Cleveland Clinic. 17 May 2022. Available from: https://my.clevelandclinic.org/health/diseases/22855-herpes-simplex 
5. Stone J, Looker KJ, Silhol R, Turner KME, Hayes R, Coetzee J, Baral S, Schwartz S, Mayaud P, Gottlieb S, Boily MC, Vickerman P. The population impact of herpes simplex virus type 2 (HSV-2) vaccination on the incidence of HSV-2, HIV and genital ulcer disease in South Africa: a mathematical modelling study. EBioMedicine. 2023 Apr;90:104530. doi: 10.1016/j.ebiom.2023.104530. Epub 2023 Mar 16. PMID: 36933410; PMCID: PMC10034427. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10034427/ 
6. Abbai NS, Nyirenda M, Naidoo S, Ramjee G. Prevalent Herpes Simplex Virus-2 Increases the Risk of Incident Bacterial Vaginosis in Women from South Africa. AIDS Behav. 2018 Jul;22(7):2172-2180. doi: 10.1007/s10461-017-1924-1. PMID: 28956191; PMCID: PMC5871553. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5871553/