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Herpes Simplex Virus InfectionsAlso known as Herpes, Herpes simplex, Oral herpes (Cold sores, fever blisters, Herpes labialis, Herpes gingivostomatitis) & Genital herpes (Herpes genitalis)
Herpes simplex virus infections, commonly known as herpes, is a viral infection caused by the herpes simplex virus (HSV). The term herpes is derived from the Greek word “to creep or crawl” in reference to the spreading nature of herpetic skin lesions in the form of small, painful blisters which usually turn into open sores. It affects a majority of the population one or more times during their lifetime but most people have asymptomatic herpes infection and only some develop symptoms.
There are two main types of HSV – HSV type 1 (HSV-1) and HSV type 2 (HSV-2). HSV-1 usually causes oral herpes which mainly affects the mouth and the surrounding areas whereas HSV-2 mostly causes genital herpes which mainly affects the genitals.
The virus can spread by close contact, sexual intercouse as well as from mother to baby during birth is the mother is infected. It is seen that women are known to be at a higher risk of suffering from HSV infections as compared to men.
Diagnosis of HSV infection is usually made by examination of skin blisters. Detection of Herpes simplex virus antibodies can also aid in diagnosis. Most herpetic infections resolve themselves without any treatment. Treatment, if required, typically consists of antivirals that can help in the management of herpes flare ups and prevent recurrence of the infection.
- All age groups
- Both men and women but more common in women
- Lymphogranuloma venereum
- Granuloma inguinale
- Crohn disease
- Behcet syndrome
- Fixed drug eruptions
- Sexual trauma
- General physician
- Infectious disease specialist
Causes Of Herpes Simplex Virus Infections
Herpes simplex virus (HSV) infections are common viral infections caused by the Herpes simplex virus. While most people have asymptomatic HSV, which means you do not show any signs or symptoms, when infected, some may experience sporadic episodes of small, fluid-filled blisters or sores.
HSV can spread through close contact with the infected person. Ideally, the herpes simplex virus is transmitted when a person touches the sore. However, even a person who doesn’t have any sores can spread the virus. This is seen in most cases and the condition is known as asymptomatic viral shedding.
Once infected, the virus enters the cells and begins its replication. The virus also travels to the nerve cells where it stays in an inactive (dormant) state. This means that although the virus is present in the body, it neither replicates nor shows any symptoms. However, the virus can be suddenly activated at a later stage causing recurrence of the infection. These recurrences are often triggered by :
Stress or anxiety
Any infection, injury or febrile illness
Hormonal changes such as during menstruation
Exposure to extreme cold or hot conditions
Types Of Herpes Simplex Virus Infections
Herpes simplex is caused by either of the two types of herpes simplex virus (HSV), members of the herpesvirales family of double-stranded DNA viruses, such as:
HSV-1 majorly causes oral herpes also known as cold sores or fever blisters. It is a highly contagious infection occurring in and around the mouth. It is a very common infection and is usually acquired during childhood. Transmission is by oral-to-oral contact through saliva, which means it can spread through kissing or sharing objects such as toothbrushes, lipsticks or utensils.
However, it is also possible for HSV-1 to be transmitted through oral-genital contact causing infection in or around the genital area (genital herpes).
This type of HSV is mostly sexually transmitted through contact with genital surfaces, skin, sores or fluids of someone infected with the virus. It causes genital herpes or herpes genitalis which involves the genital or anal area.
Risk Factors Of Herpes Simplex Virus Infections
The following risk factors increase the susceptibility to herpes virus simplex infections:
Gender: It is seen that women are more prone to HSV infection as compared to men.
Close contact with an infected person: The virus can spread through prolonged skin-to-skin contact, kissing as well as sharing items such as brushes, cups, or towels.
Multiple sexual partners: Having multiple sexual partners can increase the risk of herpes infection as there are increased chances of coming in contact with a person who already has herpes or is an asymptomatic carrier.
Unprotected sexual contact: HSV-2 is mostly sexually transmitted through vaginal, anal or oral sex. People who don’t use safety measures like condoms or dental dams are at a higher risk of contracting herpes.
Low immunity: People who have low immunity or suffer from immunocompromised conditions such as human immunodeficiency virus (HIV) infection, autoimmune diseases, cancer, or immunoglobulin A (Ig A) deficiency are at a high risk. Also, if you are on immunosuppressive drugs such as chemotherapy or steroids or underwent organ transplant the risk is higher.
Symptoms Of Herpes Simplex Virus Infections
Herpes simplex virus infection is asymptomatic most of the time, however, in some cases the following signs and symptoms may be noticed.
1. Burning, itching, or tingling: If you have herpes, your skin may itch or burn for a few days before the appearance of blisters.
2. Sores: Painful fluid-filled blisters or sores may appear. These sores usually appear 2-20 days after a person has come in close contact with an infected person. They may form a crust prior to healing. The location of sores differ according to the type of HSV infection:
In the case of oral herpes (HSV-1) blisters usually appear on and around the lips (herpes labialis). Oral infection involves the inside of cheeks, tongue, gums and roof of the mouth (herpetic gingivostomatitis).
Genital herpes (HSV-2) sores mostly appear on genital organs like the vagina, vulva, labia and cervix in women and penis and testicles in man. In some cases, buttocks, anal region and inner thighs are also involved.
3. Flu-like symptoms: You may observe typical flu-like symptoms such as fever, sore throat, swollen lymph nodes in the neck (oral herpes) or groin (genital herpes), and muscle aches.
4. Urinary problems: People, mostly women, suffering from genital herpes may feel a burning sensation while urinating or trouble urinating.
5. Herpes keratitis: Sometimes the herpes simplex virus may spread to one or both eyes, where you may feel sensitivity to light, discharge from the eyes, pain, and a gritty feeling in the eye.
Note: Herpes can occur in other areas such as fingers (known as herpetic whitlow) and brain (known as herpes encephalitis).
Diagnosis Of Herpes Simplex Virus Infections
During an outbreak, a doctor or clinician can diagnose HSV infections by examining the sores or blisters. They might also ask about other symptoms, including flu-like symptoms and early signs, like tingling or burning.
To confirm the diagnosis, a swab or fluid sample may be taken from the sores or blisters and sent to a laboratory for culture or PCR testing.
When sores have healed or are not present, blood tests to check for HSV-1 and HSV-2 antibodies, a marker to show if one has been exposed to the virus, are recommended. These include:
While the blood test doesn’t show an active infection especially in the absence of open sores or lesions, it informs about exposure to herpes virus in the past. In case of first infection, the test will most likely be negative as there wouldn't have been enough time for the body to develop antibodies. In such cases, the HSV-1and HSV-2 antibody test may be repeated in eight to 12 weeks.
Prevention Of Herpes Simplex Virus Infections
To prevent contracting or spreading of HSV-1 infection or oral herpes:
Do not share your personal items such as towels & brushes with anyone.
Avoid sharing your drinks.
Do not let anyone come in close contact with you or touch your sore in case of an active infection.
Avoid triggers such as stress, sunlight, extreme cold weather, which can lead to recurrence of the infection.
To prevent contracting and spreading HSV-2 infection or genital herpes:
Practice safe sex. The consistent and correct use of barrier contraceptives like condoms can reduce the risk of an infection even if your partner is asymptomatic. Condoms can also protect from other sexually transmitted diseases. Use of condoms or dental dam while giving or receving oral sex is also equally important.
Avoid intercourse as soon as either partner suspects or is diagnosed with HSV infection.
Get an antibody test to know if you have herpes or any other sexually transmitted disease, which you may transmit to your partner.
Take antiviral medication as advised by your doctor. This reduces the chances of other people contracting the disease.
Specialist To Visit
You should visit your doctor if you have:
Small blisters that turn into red sores upon bursting around your mouth, genital, anal or thigh region.
Itching, tingling, or burning around your genitals
Burning sensation while urinating
Unusual discharge from the vagina or penis
You can consult specialists such as:
Infectious disease specialist
Treatment Of Herpes Simplex Virus Infections
Once you have the herpes virus, it stays in your body for the rest of your life. Herpes sores usually improve on their own in a week or two without medical treatment. But in case of severe or frequent outbreaks, a doctor can prescribe antiviral medications for the suppression of infection, manage the symptoms and prevent its recurrence. Your doctor might recommend an antiviral cream or ointment to relieve the symptoms such as burning, itching, or tingling. In some cases, antiviral oral medicines or injections are also given.
Some of the antiviral medicine used to treat both HSV-1 and HSV-2 infection are:
Click here to know more about the medicines for herpes simplex virus infections.
Home-care For Herpes Simplex Virus Infections
There are few things you can do at home to help manage herpes sores.
1. To relieve pain and discomfort
For painful blisters and sores, you can apply medicine such as benzocaine and L-lysine.
You can also put ice on the blisters to reduce pain and itching.
Keep away from triggers such as stress and getting a sunburn to prevent future outbreaks.
2. To prevent the spread of HSV infection
Prevent the spread of this virus to other parts of your body by:
Washing your hands after touching a blister or open sores
Not applying ointment with your fingertips to the open sores but making use of a cotton tip applicator.
3. To prevent the spread to an uninfected person
If you have sores or symptoms of herpes simplex virus avoid having sex with your partner
People with active symptoms of oral herpes should avoid oral contact with others and sharing objects that have contact with saliva such as utensils.
Even if you do not have any symptoms, you must use a latex condom to lower the risk of spreading the virus.
If you are pregnant and your partner has herpes, you must inform your doctor. You may need to take medicine towards the end of your pregnancy in order to prevent passing the virus to your newborn.
Complications Of Herpes Simplex Virus Infections
1. Finger or thumb infection
Also known as herpetic whitlow, in this infection your finger or thumb may become red or swollen before the appearance of blisters. This is usually accompanied by burning pain.
2. Esophagus infection
Herpes esophagitis is a viral infection of the esophagus that may be very painful and interfere with swallowing. It is usually seen in immunocompromised patients, post chemotherapy & HIV patients.
3. Eye infection
Herpes if left untreated may cause herpes keratitis. It leads to redness in one or both eyes, swollen eyelids, conjunctivitis with opacity and superficial ulceration of the cornea, pain in the periorbital region or impaired vision.
4. Other sexually transmitted infections
Genital herpes can increase the risk of transmitting or contracting other sexually transmitted infections including HIV.
5. Bladder complications
In some cases, genital herpes can cause inflammation of the urethra which is the tube that carries urine from the bladder to outside. The swelling can close the urethra for many days requiring the insertion of a catheter to drain the bladder.
6. Rectal inflammation (proctitis)
Genital herpes can also lead to inflammation of the lining of the rectum.
7. Nervous system involvement
Cranial or facial nerves can get infected by HSV, resulting in temporary paralysis of the affected muscles. Rarely, in Maurice syndrome, neuralgic pain may precede each recurrence of herpes by 1 or 2 days. On rare occasions, if herpes is left untreated it can lead to meningitis or encephalitis which is the inflammation of the membranes and cerebrospinal fluid surrounding the brain and spinal cord.
8. Eczema herpeticum
In patients with a history of atopic dermatitis or Darier disease, herpes simplex may result in a widespread disease called eczema herpeticum. Numerous blisters can erupt on the face or body along with swollen lymph glands and fever.
9. Erythema multiforme
A single or recurrent episodes of erythema multiforme can occur rarely with HSV infection. The rash of erythema multiforme presents as symmetrical plaques on hands, arms, feet and legs. It is marked by target lesions which sometimes have central sores.
Alternative Therapies For Herpes Simplex Infections
Some home remedies might help in alleviating the symptoms associated with sores and blisters. Do consult your doctor before trying any of them.
1. Tea tree oil
Tea tree oil is a great remedy for plenty of health issues. To heal the herpes sores outbreak, the oil must be diluted with a carrier oil before using it on a cold sore or genital herpes.
2. Aloe vera
Aloe vera has wound-accelerating and soothing properties. Aloe vera gel extracted from the plant can be directly applied to the body without being diluted. It is helpful in getting rid of itching and redness caused by sores.
Echinacea is a medicinal plant having anti-viral properties. It is known for enhancing the immune system and easing the symptoms of this viral infection. All parts of the Echinacea plant, namely flowers, leaves, and roots can be used for healing herpes.
4. Lemon balm
Lemon balm is one of the most effective herbal remedies that may cure and reduce the risk of transmission of herpes. It has flavonoids, phenolic acid, and rosmarinic acid, which helps in healing the sores or blisters.
5. Baking soda
Baking soda is an effective treatment for getting rid of herpes fast. It provides relief from the itchy and painful sores.
6. Epsom salt
Bathing in epsom salt water is a great remedy for soothing the itching and pain in herpes. This remedy makes the sores dry, thereby reducing itching.
7. Oregano oil
Oregano oil has anti-viral properties that can help alleviate the symptoms of the herpes simplex virus and help in the speedy recovery of herpes blisters.
8. Ice pack
The simplest method to get some relief from herpetic lesions, specifically for genital herpes is application of ice. However, it should be kept in mind that long exposure to ice on the genital parts can damage the tissues.
Living With Herpes Simplex Infections
Herpes can be managed well with medications and other preventive measures. It usually doesn't cause any serious troubles in healthy adults. However, there are a few things that should be kept in mind if you or your partner are living with herpes infection.
If you or your partner have an active herpes infection do not indulge in any form of sexual activity.
It is advised to use condoms while having sexual intercourse. However remember, condoms only protect against genital exposure to the virus, however they fail to protect against skin-to-skin contact with open sores.
In case of genital herpes avoid touching the affected areas during an outbreak, and wash your hands frequently to avoid transferring the infection to other parts of the body.
Herpes, like other sexually transmitted diseases, comes with some social stigma and can also have an impact on sexual relationships. If you're feeling distressed about your condition, it is advised to talk with your doctor, therapist, or counselor.
Frequently Asked Questions
- Herpes stomatitis. MedGen. NCBI.
- Herpes simplex: Signs and symptoms. American Academy of Dermatology Association. (AAD).
- InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Genital herpes: Overview. 2018 Jun 27.
- Mathew Jr J, Sapra A. Herpes Simplex Type 2. [Updated 2021 Feb 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-.
- Herpes simplex: Tips for managing. American Academy of Dermatology Association. (AAD).
- Key facts. Herpes Simplex Virus. World Health Organization (WHO). Last updated on 1 May 2020.
- Herpes. Centers for Disease Prevention and Control (CDC). Last updated in Jan 2021.