Curing Contagious Confusion: It Is Time to Re-Name Herpesviridae
Countering Creeping Confusion: A Proposal to Re-Name Herpes Virus TAXONOMY
Vail Reese, MD1, Julie A. Croley, MD2, Richard F. Wagner, Jr., MD2
1 Union Square Dermatology, San Francisco, CA
Assistant Clinical Professor, UC San Francisco
2 University of Texas Medical Branch, Department of Dermatology, Galveston, TX
Tags: Viral Taxonomy, Herpes Simplex, Herpes Zoster, Epstein-Barr Virus, Cytomegalovirus, Kaposi’s Sarcoma, HHV, HSV, EBV, Varicella, Habitavirus
Corresponding Author Information:
Julie Croley, MD
University of Texas Medical Branch, Department of Dermatology
301 University Blvd, Galveston, TX 77555
Note: See Dr. Richard Ratzan’s letter about this article: Countering Herpes- A Commentary
The names of the viral family Herpesviridae and constituent species including the “herpes” root do not accurately describe the clinical presentation of infections by the large majority of viruses in the group. There is a stigma associated with herpes simplex virus (HSV) infections that does not need to be extrapolated to the remainder of the family, especially for other Human Herpes Virus (HHV) infections. The terminology is confusing to the public, who understandably assume that other herpesvirus family infections represent HSV infection. Herpesviridae may also be confused with the similar sounding Hepeviridae. We therefore propose alternative names for the Herpesvirales order and comprising members, including the Herpesviridae family and constituent species.
Herpes simplex infection has long been described. The term “Herpes” dates back to Greek scholars, including Hippocrates. The name is derived from the Greek “herpein,” which means “to creep or crawl.” This is consistent with the clinical presentation of herpes outbreaks, grouped blisters that creep, usually near the skin of the mouth or groin, in clusters.[i] Shingles, herpes zoster, also shows creeping vesicles in a unilateral linear pattern following a dermatome. “Zoster” means girdle, named for the band-like eruption on the torso. The British playwright Shakespeare is thought to refer to herpetic cold sores in Romeo and Juliet. He writes, “O’er ladies lips, who straight on kisses dream, which oft the angry Mab with blisters plagues, because their breaths with sweetmeats tainted are.”[ii]
Unlike claims made by some Internet sources, the term “herpes” does not refer to the latency of the virus. That tendency to persistent infection was only scientifically described in the early 20th century. It was later elucidated that two viruses result in human herpes outbreaks, Herpes Simplex Virus 1 and 2 (HSV-1 and HSV-2).
In 1971, as part of the first meeting of the International Committee of Taxonomy of Viruses (ICTV), it was recognized that the two viruses responsible for herpetic outbreaks were part of a larger group of structurally similar nuclear-replicating DNA viruses. Presumably, because HSV-1 and HSV-2 were the first described and best known of the group, the family was named Herpesviridae. Later, the family was assigned to the order Herpesvirales and split into three families, Alloherpesviridae, Malacoherpesviridae, and Herpesviridae, the latter of which retains the mammal, bird, and reptile viruses.
Since the 1970’s, as further DNA viruses were identified, they were added to the group. Among the nine described forms of Human Herpes Viruses (HHV), only two, HSV-1 and HSV-2 actually cause oral and genital herpes (Table 1).
We propose changing the names of the order Herpesvirales and comprising members containing the “herpes” nomenclature, including the family Herpesviridae and constituent species (Figure 1).
This for several reasons:
- Inaccurate nomenclature
Of the more recently described Human Herpes Viruses, from HHV-4 to HHV-8, none show a creeping, blistering pattern (Table 1). The clinical presentations of Roseola, Kaposi’s Sarcoma, Oral Hairy Leukoplakia and Infectious Mononucleosis are not characterized by creeping vesicles. Even the initial infection with HHV-3, Varicella or chicken pox, presents with widespread individual vesicles, not a discrete grouped morphology. Therefore, using the root “Herpein” as the basis for Herpesviridae does not accurately reflect the clinical presentation of any of these infections other than HSV-1, HSV-2 and reactivation phase of Varicella-Zoster.
Herpesviridae includes numerous strains that infect other mammals, fish, birds and reptiles. Rarely, these strains manifest like HSV, with oral and genital blisters. Herpes B virus in monkeys,[iii] Equine Herpes Virus 3 in horses,[iv] and loggerhead genital-respiratory HV in tortoises may cause skin, oral and/or genital vesicles[v]. The large majority of Herpesviridae infections in the animal, fish, bird and reptile kingdoms do not show a creeping vesicular dermatitis. Since a creeping blistering eruption is so rarely seen in this family, the term “Herpesviridae” and root “herpes” are predominantly inaccurate.
Human herpes simplex infection is a chronic, incurable, painful sexually transmitted disease. While it is manageable with topical and oral antivirals, it is associated with not just physical discomfort, but also embarrassment and shame.[vi], [vii], [viii] Movies that feature HSV typically depict flawed characters with low morality.9 Like condyloma and syphilis, HSV-1 and HSV-2 infections represent contagious conditions that can be spread through sexual contact. The remaining forms of HHV have no clinical connection to herpes simplex infections.
There are several precedents in medicine for changing diagnostic terminology based on stigma. Benign, age-related, non-viral skin neoplasms were called “senile warts” and age-related vascular growths were called “senile angiomas.” Though “senile” means age-related, the term has developed a stigma because of the widespread use of the phrase “senile dementia” to describe age-related memory loss. These lesions are instead called seborrheic keratoses and cherry angiomas, respectively. Today, even senile dementia is more commonly called early onset dementia or Alzheimer’s disease. The preferred phrase for mental retardation is intellectual disability. In October 2010, American President Barack Obama passed Rosa’s Law, stripping the phrases “mental retardation” and “mentally retarded” from many areas of the US government, replacing the phrases with “intellectual disability” or “individual with an intellectual disability.”10 In the 1940’s the name “Hansen’s disease” was developed to replace “Leprosy.”11 “Neurotic excoriation” has largely been replaced by “dermatotillomania” or “skin picking.”
Apropos to this discussion, a rare vesicular disorder that affects pregnant women was originally called “Herpes gestationis.” With the elucidation that this disease is not caused by a virus but is instead an autoimmune blistering condition similar to bullous pemphigoid, it is now called “Pemphigoid gestationis.”12 When stigma taints historical diagnostic terms, they have been considered dated and replaced.
- Public awareness and education
When diagnosed with conditions caused by human herpesviruses other that HSV-1 and HSV-2, the general public will potentially turn to the Internet for self-education. Patients may be dismayed to learn that their child’s chicken pox or roseola is, in fact, a result of a herpesvirus. That mononucleosis or Kaposi’s Sarcoma might be confused with herpes may cause an increased psychological burden. Without further direction from clinicians, there is the potential for misinterpretation. By changing the name of the herpesvirus family, this tendency can be minimized.
The name Herpesviridae is very similar to the family Hepeviridae, an entirely unrelated set of liver-associated viruses.
We therefore propose alternative names for the Herpesviridae family and constituent species, as well as for the other members of the Herpesvirales order containing the “herpes” root.
“Habitare” is a Latin root which means “to live,” “to dwell,” “to inhabit.”13 We propose the following name change: the root “habita” to replace all “herpes” nomenclature within the Herpesvirales order (Figure 1). Use of this root accurately reflects the unifying nature of all viruses in the Herpesviridae family. Relatively few of the viruses in Herpesviridae cause creeping vesicular eruptions. But all the members of the family, both in humans and other species, after an initial infection, remain in a latent state in tissues.14 Later on, the viruses reactivate, causing diverse presentations such as in Kaposi’s Sarcoma and Zoster.
Changing the root to “habita” would accurately reflect the shared characteristic of all of the members of this family of DNA viruses: Latency. The herpes viruses coexist, “dwell” within and “inhabit” their host tissues for months and years.
Changing the root to “habita” would separate the stigma associated with the term “herpes” from the remaining viruses of the family.
Changing the root to “habita” would limit confusion as the public seeks knowledge about various non-HSV members of the family.
Changing the root to “habita” would limit confusion with the Hepeviridae family.
Since “Habitavirus” begins with an “H”, the acronym “HHV” would not change, but would instead represent “Human Habitavirus.”
The names Herpes simplex 1, Herpes simplex 2 and Herpes Zoster would remain as clinical diagnoses. These viruses would be considered Human Habitaviruses, along with the remaining members of the HHV group.
To accurately reflect the shared characteristic of latency of this viral family, reduce confusion and limit stigma, we propose re-naming this family, instituting “Habitavirales,” “Habitaviridae” and “habita” to replace the order name “Herpesvirales,” family name “Herpesviridae,” and species root “herpes,” respectively.
Table 1: Characteristics of Human Herpes Viruses
|Human herpesvirus||Viral name||Abbreviation||Disease name||Clinical manifestation||Creeping grouped vesicles?||Latency?|
|HHV-1||Herpes simplex 1||HSV-1||Herpes, cold sores, fever blisters||Painful groups of vesicles||Yes||Yes|
|HHV-2||Herpes simplex 2||HSV-2||Herpes, cold sores, fever blisters||Painful groups of vesicles||Yes||Yes|
|HHV-3||Varicella-Zoster||VZV||Varicella, Chicken pox||Scattered extensive pruritic vesicles||No||Yes|
|Herpes Zoster, Shingles||Dermatomal painful groups of vesicles||Yes||Yes|
|HHV-4||Epstein-Barr virus||EBV||Infectious mononucleosis, oral hairy leukoplakia, Burkitt’s lymphoma||Corrugated white tongue plaque||No||Yes|
|HHV-5||Human Cytomegalovirus||HCMV||Mononucleosis, birth defects||None||No||Yes|
|HHV-6A||Human herpesvirus 6 A||HHV-6A||Possible assoc with multiple sclerosis, cancers||None||No||Yes|
|HHV-6B||Human herpesvirus 6 B||HHV-6B||Roseola, exanthem subitum||Morbilliform eruption, “exanthema subitum”||No||Yes|
|HHV-7||Human herpesvirus 7||HHV-7||Roseola, exanthem subitum||Morbilliform eruption, “exanthema subitum”||No||Yes|
|HHV-8||Kaposi’s sarcoma- associated herpesvirus||KSHV||Kaposi’s Sarcoma||Violaceous skin and internal tumors||No||Yes|
Figure 1. Proposed Taxonomy Name Change
1 Whitley RJ, Kimberlin DW, Roizman B. Herpes simplex viruses, Clin Infect Dis 1998;26:541–5.
2 Herpes virus infections: historical background. Stanford.edu (Accessed July 16, 2016, at http://virus.stanford.edu/herpes/History.html.)
3 Weigler BJ. Biology of B virus in macaque and human hosts: a review. Clin Infect Dis 1992:555–67.
4 Allen GP, Umphenour NW. Equine coital exanthema. In: Coetzer JAW, Tustin RC, eds. Infectious diseases of livestock. 2nd ed. Cape Town: Oxford Press, 1992:860-7.
5 Marschang RE. Viruses infecting reptiles. Viruses 2011;3:2087-126.
6 Merin A, Pachankis JE. The psychological impact of genital herpes. J Health Psychol 2010;16:80–90.
7 Alexander L, Naisbett B. Patient and physician partnerships in managing genital herpes. J Infect Dis 2002;186:S57–65.
8 Barnack-Tavlaris J, Reddy D, Ports K. Psychological adjustment among women living with genital herpes. J Health Psychol 2011;16:12–21.
9 Holliday AC, Salh A, Wagner RF Jr. Cold sore, cold soul? An examination of orolabial herpes in film. J Med Mov 2014;10:19-25.
10 Ford M, Acosta A, Sutcliffe TJ. Beyond terminology: the policy impact of a grassroots movement. Intellect Dev Disab 2013;51:108–12.
11 Dobson M. Leprosy. In: Dobson M. Murderous Contagion: A Human History of Disease. London: Quercus Editions Ltd, 2015:26.
12 Holmes RC, Black MM, Dann J, James DCO, Bhogal B. A comparative study of toxic erythema of pregnancy and herpes gestationis. Brit J of Dermatol 1982;106:499–510.
13 Habitare. The Latin Dictionary (Accessed July 16, 2016 at http://latindictionary.wikidot.com/verb:habitare.)
14 Reese T. Coinfections: another variable in the herpesvirus latency-reactivation dynamic. J Virol 2016;90:5534–7.