Herpes Gladiatorum Treatment Guidelines

What is herpes gladiatorum?

Herpes gladiatorum is an inflammatory skin condition characterized by the appearance of a rash of pustules or blisters, accompanied by redness, itchiness, pain, swelling, or a tingling sensation. Like most contagious skin infections, it is typically spread via skin-to-skin contact, but can also be caught through contact with contaminated surfaces (e.g. sharing towels, water bottles, sports gear, etc.)

This viral skin infection is caused by the herpes simplex virus type 1 (HSV-1). It is most common among athletes who play contact sports such as wrestling due to close physical contact, and is colloquially known as mat herpes. Once the HSV-1 virus has been transmitted to a person, they carry the infection for life.

Herpes gladiatorum is distinct from genital herpes in that outbreaks most commonly occur on the upper body (including the head and neck, shoulders, arms and trunk), rather than in areas associated with sexual contact such as the genitals and mouth. Genital herpes are also more likely to be caused by the herpes simplex virus type 2.

There are many treatments available to manage recurrent infections or symptom flare ups, including antiviral medications and suppressive therapy. These can also reduce the risk of transmitting the disease to others, although it may spread even while there are no active symptoms. Timely diagnosis and treatment of herpes gladiatorum is crucial for minimizing its spread.

Treatment for herpes gladiatorum

The herpes simplex virus type 1 has an incubation period of 3-14 days, meaning people are typically infectious before they develop symptoms and realize they have herpes gladiatorum. Once it is active, mat herpes often requires medical intervention to manage. Here are some common treatments:

Initial care

When outbreaks of herpes gladiatorum occur, it is best to avoid doing anything to exacerbate the symptoms such as picking or itching the rash. Applying cool compresses daily can help relieve itchiness or pain, as can wearing loose clothing that does not rub against the affected area. Mild recurrent cases of herpes gladiatorum may resolve on their own within days or weeks.

Topical treatments

Topical ointments and creams are typically used to help reduce the pain and discomfort associated with herpes infection outbreaks (such as rashes and cold sores.) Typically they are applied daily until the infection clears. Antiviral creams are usually sufficient to heal a milder case of herpes gladiatorum.

They may include antiviral ointments containing acyclovir, penciclover or docosanol. Topical steroids such as hydrocortisone can also help reduce pain and discomfort.

Antiviral treatment

A more severe herpes gladiatorum infection is typically treated with antiviral medication, which works by preventing the herpes simplex virus from replicating itself, thus reducing associated symptoms. Antiviral treatments are especially recommended for the primary outbreak of herpes viruses. Commonly prescribed oral antivirals include acyclovir, valacyclovir, and famciclovir.

Suppressive therapy refers to treatment in which antiviral drugs are taken every day to reduce the frequency of outbreaks over time. Episodic therapy involves taking them for a few days at the first symptoms to clear an individual breakout. Early exposure to oral antiviral medication helps decrease the severity of the outbreak and minimize the frequency of future reactivations.

Ongoing management

There are several factors that may exacerbate or trigger a flare up of HSV 1, including stress, hormone imbalance, UV exposure, emotional distress, and immunosuppression. Making lifestyle changes to avoid these can help reduce the discomfort associated with herpes gladiatorum. Oral supplements such as zinc, vitamin E, vitamin C, and lysine can also help prevent flare ups.

Antiviral-resistant herpes treatment

Generally, recurrent infection of mat herpes will be less severe and shorter in duration than the initial outbreak. Very frequent outbreaks or severe herpes flare-ups are cause for concern, especially if symptoms have not responded to antiviral treatment within a week.

This may indicate antiviral resistance, which occurs when the virus changes and no longer responds to normal antiviral treatment (typically in immunocompromised individuals). Acyclovir-resistant herpes gladiatorum outbreaks may require a higher dose or stronger, more toxic antiviral substances such as foscarnet or cidofovir. These may be administered orally, topically, or intravenously.

Prevention

There are several ways to prevent contracting herpes gladiatorum and to minimize risk factors. Showering immediately after physical activity involving skin to skin contact is recommended, as is using your own, clean towel, sports gear and equipment, clothing, and personal hygiene products. Frequent hand washing and avoiding touching the face can also help. Equipment such as mats should be wiped down after every use.

To prevent outbreaks of herpes gladiatorum, coaches of contact sports should enforce these guidelines. If a case is identified within a group (e.g. a wrestling club), all should be notified so they can take steps to prevent it spreading.

How to use our treatment guidelines handout template

Follow these steps to make the most of these useful guidelines:

Step 1: Access the handout

Download these free Herpes Gladiatorum Treatment Guidelines by following the link on this page or by searching for it in Carepatron's free template library.

Step 2: Make recommendations

Consult the treatment options listed on the handout to make treatment and lifestyle recommendations to the patient. Consider the severity of the outbreak, as well as whether it is the patient's first time experiencing mat herpes symptoms. For example, if a patient is presenting with systemic symptoms such as fever, chills, and swollen glands, this is indicative of a severe case and may warrant more drastic and immediate medical attention.

Step 3: Distribute

You may wish to give patients a copy of these treatment guidelines to help them better understand their symptoms and the appropriate treatment.

Benefits of using this handout

General practitioners, sports healthcare workers, dermatologists, coaches, and school nurses may all benefit from using this handout. Here are some of the key benefits to this handy resource:

Efficiency

These guidelines help healthcare professionals to quickly determine the appropriate treatment for a patient's particular case of mat herpes, without having to do extensive research.

Improved accuracy

These treatment guidelines allows healthcare professionals to easily assess the severity of a skin infection during an initial medical evaluation. This helps direct them to the right treatment, ensuring accurate and appropriate interventions are conducted.

Ease of use

One of the key advantages of our free treatment handout is its straightforward, easy-to-follow layout. This makes it a perfect resource to distribute to patients with herpes skin infections, empowering them to understand and be active in their treatment and promoting patient-centered care.