Herpes Simplex Virus

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Herpes is a very common infection caused by a virus, called the herpes simplex virus, or HSV. There are two types of herpes, HSV-1 and HSV-2. The two virus types are very closely related, but differ in how each is spread and the location of the infection. HSV-1 is typically spread by contact with infected saliva, while HSV-2 is usually spread sexually or via the mother's genital tract to her newborn baby. HSV-1 more commonly affects the area around the mouth, while HSV-2 is more likely to affected the genital area, but both viruses can affect either region.

The course and symptoms of herpes infections vary widely from being completely asymptomatic throughout a person's life in 80% of patients, to having frequent recurrences. Once a person acquires the herpes virus, it invades and replicates in the nervous system, remaining deep within a nerve for life. The virus can remain latent (no symptoms) for years, but can also become reactivated during periods of illness, emotional stress, trauma, or other triggers, such as sunlight and menstruation. This allows the virus to replicate and not only cause recurrent disease but also to shed viral particles which can be spread to other people. For most healthy people, herpes infections are a painful nuisance of recurrent blisters in a localized area. However, in people with poor immune systems, such as organ transplant recipients or people with HIV, the virus can spread throughout the body and cause severe disease, even of the brain. Although there are antiviral medications to help reduce the viral burden, it does not cure the infection.

Type 1 Herpes (Oral Herpes)

HSV-1 is typically spread via infected saliva and initially causes acute herpetic gingivostomatitis in children and acute herpetic pharyngotonsillitis in adults.

Acute herpetic gingivostomatitis starts abruptly with high fevers; swollen red gums; vesicles (tiny blisters) on the mouth, tongue and lips, that rupture and combine into larger ulcerated plaques; and tender swollen lymph nodes. This first presentation of the disease lasts about 5-7 days, with symptoms subsiding in 2 weeks. However, the virus may still be shed from the saliva for 3 or more weeks.

Acute herpetic pharyngotonsillitis is the most common first presentation of the disease in adults, and more commonly affects the pharynx and tonsils than the mouth and lips. Along with ruptured vesicles in the tonsils and pharynx, an adult with newly acquired herpes type 1 can have fever, headache, fatigue, and sore throat.

When herpes recurs, which typically occurs on lips in HSV-1, it is called herpes labialis. Outbreaks usually occur fewer than twice a year in most people, but some can get monthly recurrences. Each outbreak starts with a tingling, burning or painful sensation at the site, followed by a red rash that evolves into tiny blisters that eventually open. Particles of the virus shed from the lesion, making it contagious to others who have never had it before, with maximal shedding occurring in the first 24 hours but lasting up to 5 days.

Type 2 Herpes (Genital Herpes)

Although genital herpes is usually caused by HSV-2, it can also be caused by HSV-1 (for instance by contact of a mouth lesion on genital skin of a non-infected person). An initial infection starts after an incubation period of 3-7 days, after which fever, headaches, fatigue and muscle pains can occur. In the area of the genital infection there may be pain, itching, painful urination, discharge from the vagina or urethra, and tender lymph nodes. As in oral herpes, genital herpes also causes vesicles to form, which can appear on vagina, labia, buttocks, or even the cervix in women, and on the penis, scrotum, buttocks, thighs, and even urethra in men. The perianal area can be involved in people who engage in anal sex.

The major problem of genital herpes is that it reactivates frequently. Recurrences vary from person to person, but most patients will have reactivation within the first year of initial infection. As in oral herpes, each outbreak starts with a feeling of pain or burning at the site, followed by a localized patch of vesicles that can be very painful. Symptoms are typically worse in women than in men. Each recurrence occurs in approximately the same area, lasts about 8-10 days, and often gets milder and less frequent each time.

The good news is that a person who already has antibodies to HSV-1 because of a prior infection with oral herpes causes a milder effect of genital HSV-2 and protects against acquiring HSV-1 in the genital area.

How do I get tested?

It's a good idea to go in to see your doctor if you are worried that you may have contracted herpes. Your doctor can perform a viral culture, which takes a few days to a week for results. A more rapid test may also be performed in the office (Tzank smear) or sent to a lab (direct immunofluorescence) with results ready in about a day. Other tests include skin biopsy or antibody testing of the blood.

How do I get treated?

Again, it's best to discuss with your doctor your treatment options. There are many over-the-counter medications and home remedies that claim to help or cure herpes, but most of these are false claims and do very little, if anything at all, to help. Your doctor may prescribe you with an antiviral medication that you can take with each episode. For people with very serious or very frequent recurrences, a different dosage may be taken on a regular basis to prevent recurrent episodes.

How can I prevent myself from getting herpes?

HSV is a very common virus, and transmission occurs quickly in new sexual relationships. Prevention can be difficult, but possible. Avoid contact with anyone infected with the virus, especially with active lesions. Barrier protection such as with a condom can help prevent spread of genital herpes, but some HSV ulcers can occur outside o the area protected by the condom and still be transmitted.