Chicken Pox, Head Knots, and Underarm Spots–

Did you know you have Herpes?

By Nick Norwitz ’18

There is a herpes virus for everyone. From iguanas to harbor seals to humans, the herpes virus family has evolved to make a wide variety of organisms its home. Well over 95% of the human population is infected with herpes, which means you probably have this little pseudo-life form within you right now.

Have you ever had chicken pox or received a chicken pox vaccine? If so, then you are infected with varicella zoster virus, also known as human herpes virus III. Have you ever had mononucleosis? If you have had the “kissing disease,” then you are infected with Epstein-Barr virus, or human herpes virus IV.

Once you become infected with a herpes virus, it becomes you friend for life. After herpes infects the body, it goes latent and will exist in your body’s cells permanently. However, herpes can be woken up.

So what triggers a herpes virus to emerge from its dormant state, and what effect can a reemergent herpes virus have on the body? While some triggers are known and some clinical effects have identified, most of herpes-human interaction biology is still shrouded in mystery. Or, to take the glass half full perspective, there are many new and interesting discoveries to be uncovered (one of which that I will share was made in a Dartmouth student).

The classic example of herpes virus reactivation is the disease shingles. Herpes
Shingles is an extremely painful skin rash that occurs when human herpes virus III (the chicken pox virus) is reactivated. Shingles usually occurs in elderly individuals whose immune systems have past their prime. However, there is some evidence that mechanical forces can arouse the virus. One interesting case that demonstrates this connection involves an injured Dartmouth student who chose to “run” a full marathon on crutches. After the student crossed the finish line, he was brought immediately to the medical tent to be examined where doctor informed him that he had shingles. Interestingly, the shingles virus presented precisely on the dermatome along which his crutches had been rubbing against for the past 26.2 miles. To the doctor, the conclusion was obvious: Human herpes virus III goes dormant in nerve cells. Thus it made sense that the intense underarm friction stimulated the nerves sufficiently to wake the virus. The next day the shingles was gone.

However, the connection is not always so straightforward. Shingles is reasonably well understood, but the science of headaches is considerably less so. A study performed by W.J. Vanast et al. found that 27 out of 32 patients examined for a study on New Daily Persistent Headaches (NDPH) — a condition whose name is self-explanatory — had evidence of an active Epstein-Barr herpes virus infection. In this study, 12 of these patients were followed for the next 18 months. After 18 months, six of these patients tested negative for Epstein-Barr and the other six of these patients tested positive for Epstein-Barr. In five of the six patients in whom the Epstein-Barr reverted to dormancy, the headaches disappeared. And in five of the six patients in whom the Epstein-Barr remained active, the headaches persisted. This suggests a tight correlation between the virus and NDPH. herpes2

There are no solid studies that demonstrate how the herpes virus might cause headaches. In fact, many virologists, immunologists, and neurologists are unaware that a potential connection even exists. In the ocean of biology, herpes headaches are a flounder, buried and camouflaged in the sand. Nevertheless, we can still speculate on how Epstein-Barr herpes can cause headaches. Epstein-Barr goes dormant in the immune system’s B-cells. Given the complex integration of the immune system with other body systems, a wide variety of factors could trigger the virus, from stress to hormonal fluctuations to temperature to high platelet counts. Once activated, the virus stimulates a vigorous immune response involving the production of pro-inflammatory and anti-inflammatory cytokines. These vasodilators and vasoconstrictors cause blood vessels in the brain to constrict (leading to tension headaches) or dilate (leading to migraine headaches) respectively.* If this seems paradoxical, that’s because it is. Unfortunately, there is a striking lack of knowledge about how this most common of medical maladies works at a biological level.

Herpes viruses are important for their ubiquity and impact on human health. They are associated with chicken pox, shingles, headaches, mononucleosis, psychomotor retardation, deafness, depression, chronic fatigue, ocular problems, and even cancer. However, herpes is just a small piece in the far grander mystery of virology as a whole. Viruses are the most diverse and numerous organisms on the planet. Bacteriophages alone accounts for 1000 times more biomass than all the elephants in the world. And up to 9% of our own genome is actually retroviral DNA. Here’s the real punch line: Not only do you probably have herpes, but one-tenth of humanity is actually virus!

*Cytokines are not supposed to cross the blood brain barrier, but they occasionally do. When they do so they can cause damage to the barrier, leading to other clinical markers such as an increased platelet count.