The Herpes family – it’s good to be familiar with it

What is so special about the herpes family that it has its own chapter on this website?

The answer to this question can be divided into two:
On a personal level:
1. Ever since I remember myself, I have experienced recurrent episodes of herpes labialis. I was there when acyclovir was discovered and granted its discoverers the noble prize.
2. My main field of research is congenital CMV. This is also a virus that belongs to the herpes family.On a general level:
1. The herpes family, and the different viruses it contains, represent a large burden in the field of pediatrics and pediatric (as well as adult!) morbidity. If a parent and physician are familiar with the different ways herpes presents, both on a community and hospital level, they will be better consultants and will not mix up the different viruses and infections like most parents too.
2. This is a fascinating family of viruses, and it does not leave the patient after the primary infection but remains latent (hidden) in our body with possibility of recurrence. This makes this virus one of the most important viruses in medicine.

Latent? Hidden? What does that mean?

Following the primary infection with the virus, which can either be clinically symptomatic or asymptomatic, the viruses in this family remain in our body for life. Depending on the virus and our immune system, recurrent infection in our life can occur as a result of the virus that is already present in our body (reactivation) or that the introduction of a new virus that we hadn’t come across yet (re-infection).
I will give some examples below.

Herpes simplex virus type 1 – HHV1

Easy.
This virus is responsible for some of the main pediatric infections:
Primary infection – this is referred to as primary herpetic gingivostomatitis.
Following primary infection, the virus remains latent in our nervous system and leads to recurrent episodes that are referred to as herpes labialis (cold sore).
Since this virus is often secreted in saliva, whether or not there exists an active lesion, we sometimes see episodes of herpes 1 infection in babies following circumcision with direct sucking.
Of course this virus has many additional presentations that include skin infections (herpes gladiatorum), vaginal infections (see more below about HHV2) and more.

Herpes simplex virus type 2 – HHV2

In the past this virus mainly caused vaginal herpes. An unpleasant infection the in the region of the vulva. With the evolution of sexual intercourse, nowadays herpes 1 can also cause these infections.

Herpes number 3 – Varicella zoster virus – VZV

You know this virus very well. This is the virus that causes chicken pox (varicella) and shingles (zoster). It is called varicella zoster.
VZV is a good example for the herpes family viruses.
Primary infection – chicken pox. Most of the time, following a primary infection, the virus remains latent in the nervous system and decades later, depending on the immune system, it can reactivate in a more localized way and is referred to as shingles.
We have an excellent chapter on our website about chicken pox, a chapter about shingles and an important chapter about the shingles vaccination.

Herpes number 4 – cytomegalovirus – CMV

This virus is known for the two main syndromes it can cause:
1. A non-specific febrile disease in children and adolescents including a milder version of infectious mononucleosis
2. A congenital infection – children that catch the infection intrauterine. This is also why we have a very important chapter on our website about how to avoid getting this virus during pregnancy.

Herpes number 5 – Epstein Barr Virus – EBV

This is one of the important viruses in this family. It is also the cause of many different infections in human, the one most known is infectious mononucleosis or the kissing disease. Recurrent infections are not common and occur in immune suppressed patients.

Herpes number 6 – human herpes virus 6 – HHV6

This is a very important virus because it causes the common infection in pediatrics called roseola. All children will catch this virus by the time they are 2 years old, and it remains latent in our nervous system throughout life.
Recurrent infections are more common in immune suppressed patients.

Herpes number 7 – human herpes virus 7 – HHV7

This is the “younger cousin” of herpes 6 and it causes a similar infection to roseola even though it is less common than 6, which is the culprit for most of these infections.

Herpes number 8 – human herpes virus 8 – HHV8

This is less significant in the field of pediatrics. It is mostly responsible for causing Kaposi sarcoma in immune suppressed patients, mainly those with HIV.

In summary, this is the herpes family. Do not get mixed up between these and make sure you look for the right chapter relevant to each type of virus in this important family of viruses.