How to identify genital herpes lesions. What are the common symptoms of herpes outbreaks. How does herpes differ from other genital skin conditions. What treatment options are available for genital herpes. How to prevent herpes transmission.

Understanding Genital Herpes: A Common Yet Misunderstood STD

Genital herpes is a widespread sexually transmitted disease (STD) that affects millions of people worldwide. Despite its prevalence, there is still considerable confusion and misinformation surrounding this condition. Many individuals mistakenly assume that any genital skin lesion is herpes, which can lead to unnecessary anxiety and stress.

While genital herpes is indeed the leading cause of genital ulcers globally, it’s crucial to understand that not all genital sores are caused by the herpes virus. Various other conditions can produce similar symptoms, some of which are curable, unlike herpes. This article aims to provide a comprehensive overview of genital herpes, its symptoms, and how to differentiate it from other skin conditions affecting the genital area.

The Herpes Virus: A Master of Latency and Reactivation

One of the most distinctive features of the herpes virus is its ability to remain dormant in the body for extended periods. This characteristic, known as latency, allows the virus to hide within the body after the initial infection, only to reactivate periodically throughout a person’s life.

What triggers herpes reactivation? The virus often becomes active during times of:

• Sustained stress
• Accumulated fatigue
• Heavy physical activity
• Fever
• Weakened immune system

However, reactivation can also occur without any apparent cause.

It’s important to note that most viral reactivations do not produce noticeable symptoms. As a result, many people infected with herpes are unaware of their status, and most transmissions occur in the absence of visible skin lesions.

Recognizing Genital Herpes Lesions: Key Characteristics and Progression

The hallmark symptom of genital herpes is the appearance of skin lesions. These typically emerge during periods of viral activity, which coincide with high infectivity. For individuals experiencing their first herpes outbreak, lesions usually appear 2-4 days after exposure to the virus.

What do herpes lesions look like? Genital herpes sores typically present as:

• Multiple small vesicles (fluid-filled blisters) clustered together
• Lesions on an inflamed, reddened base
• Slightly whiter or browner than surrounding skin
• Often encircled by a reddish ring due to inflammation

As the outbreak progresses, these vesicles may develop into painful ulcers. The healing process for initial herpes lesions usually takes about 19 days from the time of sexual contact.

Common Locations of Genital Herpes Lesions

Where do herpes sores typically appear? The most frequently affected areas include:

• For women: vagina, vulva, buttocks, anus, and thighs
• For men: penis, scrotum, anus, buttocks, and thighs

Beyond the Sores: General Symptoms of Herpes Outbreaks

While skin lesions are the most recognizable sign of genital herpes, they are not the only symptoms. Particularly during the initial infection, individuals may experience a range of general symptoms, including:

• Fever
• Headache
• Malaise (general feeling of discomfort or illness)
• Muscular aches
• Tender local lymphadenopathy (swollen, painful lymph nodes in the groin area)

During subsequent outbreaks, these general symptoms are typically milder or absent. However, many people experience prodromal symptoms – early warning signs that precede the appearance of lesions. These may include:

• Pain
• Tingling sensation
• Burning feeling in the affected area

Differentiating Herpes from Other Genital Skin Conditions

While genital herpes is a common cause of genital ulcers, it’s crucial to understand that not all genital sores are caused by the herpes virus. Several other conditions can produce similar symptoms, and accurate diagnosis is essential for proper treatment and management.

Other Sexually Transmitted Diseases

Which other STDs can cause genital ulcers? The main sexually transmitted infections that can present with genital sores include:

• Primary syphilis
• Chancroid
• Lymphogranuloma venereum

Non-STD Conditions Mimicking Herpes

Several non-sexually transmitted conditions can also produce lesions that may be mistaken for herpes:

1. Human papillomavirus (HPV) infections
2. Molluscum contagiosum
3. Ingrown hairs and pseudofolliculitis
4. Folliculitis
5. Jock itch
6. Genital eczema
7. Epstein-Barr virus infections

Given the variety of conditions that can cause genital lesions, it’s crucial to consult a healthcare professional for accurate diagnosis and appropriate treatment.

Diagnosis and Treatment of Genital Herpes

How is genital herpes diagnosed? While experienced healthcare providers can often recognize herpes lesions visually, definitive diagnosis typically involves laboratory testing. This may include:

• Viral culture: Sampling fluid from an active lesion to grow and identify the virus
• Polymerase chain reaction (PCR) test: Detecting viral DNA in a sample from the lesion
• Blood tests: Identifying antibodies to the herpes virus, indicating past or current infection

What treatment options are available for genital herpes? While there is no cure for herpes, antiviral medications can help manage the condition by:

• Reducing the severity and duration of outbreaks
• Suppressing viral replication to decrease the frequency of outbreaks
• Lowering the risk of transmission to sexual partners

Commonly prescribed antiviral medications for genital herpes include:

1. Acyclovir
2. Valacyclovir
3. Famciclovir

These medications can be used for episodic treatment of outbreaks or as daily suppressive therapy to reduce outbreak frequency.

Living with Genital Herpes: Managing Symptoms and Preventing Transmission

While genital herpes is a lifelong condition, it doesn’t have to significantly impact quality of life. With proper management and precautions, individuals with herpes can lead normal, healthy lives and maintain fulfilling relationships.

Symptom Management

How can individuals manage herpes symptoms at home? In addition to antiviral medications, the following strategies can help alleviate discomfort during outbreaks:

• Keeping the affected area clean and dry
• Wearing loose-fitting, breathable clothing
• Applying ice packs to soothe inflammation
• Taking over-the-counter pain relievers
• Using topical anesthetic creams or ointments

Preventing Transmission

What steps can be taken to reduce the risk of transmitting herpes to sexual partners?

1. Abstaining from sexual activity during outbreaks
2. Using condoms and dental dams consistently
3. Taking daily suppressive antiviral therapy
4. Being open and honest with sexual partners about herpes status
5. Avoiding sexual contact if prodromal symptoms are present

It’s important to note that while these measures can significantly reduce transmission risk, they cannot eliminate it entirely due to the possibility of asymptomatic viral shedding.

The Psychological Impact of Genital Herpes: Overcoming Stigma and Misconceptions

One of the most challenging aspects of genital herpes is often not the physical symptoms, but the psychological and emotional impact of the diagnosis. The stigma associated with herpes can lead to feelings of shame, anxiety, and depression, potentially affecting an individual’s self-esteem and relationships.

How can individuals cope with the emotional aspects of a herpes diagnosis?

• Educating themselves about the condition to dispel myths and misconceptions
• Seeking support from counselors, therapists, or support groups
• Practicing self-care and stress-reduction techniques
• Focusing on overall health and well-being
• Developing effective communication strategies for discussing herpes with partners

It’s crucial to remember that having herpes does not define a person’s worth or character. With time, education, and support, most individuals learn to accept their diagnosis and lead fulfilling lives.

Advances in Herpes Research: Hope for Better Management and Prevention

While a cure for herpes remains elusive, ongoing research offers hope for improved management and prevention strategies. What are some promising areas of herpes research?

Vaccine Development

Scientists are working on developing vaccines that could either prevent herpes infection or reduce the frequency and severity of outbreaks in those already infected. While no vaccine is currently available, several candidates are in various stages of clinical trials.

Novel Antiviral Therapies

Researchers are exploring new antiviral compounds that could more effectively suppress viral replication or even eliminate the virus from nerve cells where it lies dormant. These efforts aim to develop treatments that could potentially cure herpes or provide longer-lasting suppression with fewer side effects.

Improved Diagnostic Tools

Work is underway to develop more accurate and accessible diagnostic tests for herpes, including rapid point-of-care tests that could provide results in minutes rather than days.

Gene Editing Approaches

Cutting-edge research is investigating the potential of gene editing technologies like CRISPR to target and eliminate the herpes virus from infected cells. While still in early stages, this approach offers a potential pathway to a cure.

As research progresses, individuals with genital herpes can look forward to potentially more effective treatments and management strategies in the future. In the meantime, current antiviral therapies and management techniques can help most people with herpes lead normal, healthy lives.

How To Tell Genital Herpes Apart From Other Skin Conditions

What to expect on this page?

We summarize in this article how to recognize genital herpes and why it’s important to talk to your doctor if you’re worried you may have it.

The most common symptom of herpes is skin lesions. These lesions can be confused with similar-looking lesions caused by a number of other conditions.

Using photographs to help you see what we’re saying, we describe herpes lesions and compare and contrast them with the lesions caused by these diseases:

• Syphilis
• Chancroid
• Lymphogranuloma venereum
• Human papilloma virus (HPV)
• Molluscum contagiosum
• Ingrown hair and pseudofolliculitis
• Folliculitis
• Jock itch
• Genital eczema
• Epstein–Barr virus
• Other rarer conditions

Oops … Is that Herpes?

How to recognize genital herpes

Overview

Genital herpes is a very common sexually transmitted disease (STD). It is so common that many people, when they find any skin lesion around the genital areas, are likely to think that it is herpes. They are not entirely wrong to think that way. Genital herpes is the main cause of genital ulcers worldwide.¹ And the condition is usually associated with a stigma that can itself cause anxiety and even depression² and might influence the affected person’s decision to disclose the infection to others or seek care.³

A genital sore is not great news regardless of what is causing it. However, many other conditions causing genital sores have a prognosis different from that of herpes. Some can be worse, but others, unlike herpes,⁴ can be completely cured. That’s why we’re beginning this article with an explanation of how to recognize genital herpes and differentiate it from other genital skin lesions.

A sleeping virus

The herpes virus is known for staying “asleep” in the body for a long time without showing symptoms. This feature is called latency: once the virus infects a person, after an initial phase that does not necessarily manifest with symptoms, it remains hidden in the body for many years, reactivating every now and then.⁴ Its reactivation is usually triggered by weakness of the immune system, such as in times of sustained stress, accumulated fatigue, heavy physical activity, or fever, but may not have any apparent cause.^{5, 6}

“….genital herpes skin lesion suddenly appears as multiple vesicles”

The reactivation of the virus rarely manifests with symptoms, so most people who have herpes don’t know it and most genital herpes transmission occurs in the absence of a visible skin lesion.

Herpes skin lesions

The most characteristic and most common symptom of genital herpes is skin lesions. They typically appear during periods when the virus is active, which corresponds to when the virus becomes highly infective through sex. When a person acquires herpes for the first time through sexual contact, after about two to four days of incubation, a genital herpes skin lesion suddenly appears as multiple vesicles (small sacs with a thin membrane and liquid inside) piled together and sitting on an inflamed base. These vesicles are commonly called herpes sores. They are a bit whiter or browner than the rest of the skin and are often delimited by a reddish ring from the inflammation. They resemble blisters and can progress into an ulcer, which is usually more painful. An ulcer is a break in the skin that usually takes time to heal. Lesions start to heal around 12 days after the sexual contact.⁸ The sites most frequently involved are, for women, the vagina, vulva, buttocks, anus, and thighs, and for men, the penis, scrotum, anus, buttocks, and thighs. Herpes skin lesions are expected to be fully healed after about 19 days.⁹

Image 1. Genital herpes in the vesicles phase on the upper image,10 and in the ulcer phase on the bottom image.¹¹

General symptoms

The initial herpes infection is sometimes associated with general symptoms of fever, headache, malaise, and muscular aches. In addition, there is often a tender local lymphadenopathy (enlargement of lymph nodes) that manifests as a painful lump in the groin area. When the virus reactivates in an already infected person, these symptoms are milder or absent and the skin lesion, if it manifests, heals more quickly. However, the reactivation is often accompanied by prodromal symptoms (feelings that are experienced before the main symptoms), such as pain, tingling, and burning preceding the appearance of the skin lesion.⁵

It is not always Herpes

It is a sore but not a herpes

While genital ulceration is often associated with herpes, it can be the result of several other conditions, including but not limited to, other sexually transmitted diseases, inflammatory conditions, skin irritation, and allergic skin lesions. In addition to herpes, the main sexually transmitted diseases that present with a genital ulcer are primary syphilis and chancroid. In the United States, syphilis infection is more common than chancroid.

Syphilis

The skin lesion of primary syphilis usually develops about three weeks (up to 90 days) after contracting the disease through sexual contact. Initially, it appears as a dark red mark or spot, and it rapidly becomes ulcerated.

Unlike the genital herpes skin lesion, which presents with multiple vesicles, primary syphilis’s skin lesion is usually solitary. However, when grouped herpes vesicles progress, they might take look like a solitary ulcer and can resemble an ulcerated primary syphilis. However, a herpes ulcer is usually painful, while a primary syphilis skin lesion is typically painless. The lymphadenopathy of syphilis is also painless, unlike the lymphadenopathy associated with genital herpes, which is often painful.¹²

Image 2. Primary syphilis skin lesions that could be mistaken for genital herpes Joseph Engelman, MD; San Francisco Department of Health.¹³

Chancroid

Chancroid is less common in the United States. It is prevalent in Africa and Asia. Its skin lesion appears about five days after sexual contact as a painful and inflamed spot that turns into an ulceration in several days.

Sometimes the skin lesion is solitary, but often more ulcers are present. A chancroid ulcer is usually deeper and bleeds easily when touched. It sometimes releases a purulent (infected) liquid. After some days, a painful local lymphadenopathy presents.¹⁴

Chancroid particularly resembles genital herpes when the latter is in its ulcerated form.

Image 3. Chancroid of the penis accompanied with its lymphadenopathy. Source: CDC/Dr. Pirozzi.¹⁵

Lymphogranuloma Venereum

Another sexually transmitted disease that presents with a genital ulcer resembling herpes is lymphogranuloma venereum, which is caused by the bacterium Chlamydia trachomatis. This disease is more common in tropical countries, but in the United States it tends to be particularly prevalent in men who have sex with men.

A genital skin lesion usually develops three days to three weeks after the sexual contact as a small vesicle that can ulcerate on its top and that heals after a few weeks. It is usually soft and painless.

The most characteristic sign of this disease is perhaps the painful lymphadenopathy that can progress to fistulas (a fistula is an abnormal canal that usually gets created by pus making its way out of where it formed).

Image 4. Lymphogranuloma Venereum’s lymphadenopathy¹⁶

Non-sexually transmissible diseases

Some other medical conditions that are not necessarily sexually transmitted can present with a skin lesion that patients sometimes confuse with a genital herpes. Epstein–Barr virus (EBV) in rare cases manifests with a painful genital ulceration that resembles common herpes. However, other manifestations would be more prominent in EBV infection, resembling the symptomatology of infectious mononucleosis with high fever and a swollen liver or spleen.¹⁷ Other rare conditions that can present with a herpes-like genital ulceration include Behcet disease, genital tuberculosis, amebiasis, and chancriform pyoderma.¹⁸

These conditions and the previously mentioned ones are challenging to diagnose even for doctors. Inspection of the skin lesions and history alone are usually not sufficient to accurately identify a genital ulcer. Laboratory testing is often necessary to confirm a diagnosis.⁷

When it is clearly not genital Herpes

The following are some conditions that cause skin imperfections around the genital area. They do not necessarily look like genital herpes or pose a diagnostic problem. However, they are common conditions and many patients ask if their skin lesions are related to herpes.

Human Papillomavirus (HPV)

HPV is a common sexually transmitted infection that can manifest with warts in different parts of the genital area. HPV warts typically are cauliflower shaped. However, there are about 100 types of HPV, and flat, spiky, and dome-shaped forms are also commonly seen. HPV warts are usually firm and, unlike herpes, very unlikely to ulcerate.¹⁹

Image 5. Genital HPV warts. Source

Molluscum contagiosum

Molluscum contagiosum is a highly infectious condition caused by a virus and commonly seen in HIV patients. It usually presents with a growth sort of skin lesion. The skin lesions, known as mollusca, can appear anywhere on the body. They are small and raised and usually have a characteristic pit in the center. They may become itchy or painful, but they are smooth and firm and do not look like an ulcer.²⁰

Image 6. Molluscum contagiosum²¹

Ingrown hair and pseudofolliculitis

When the hair is not properly shaved on fragile skin, it can curl inside it, forming a bump, and can progress to pseudofolliculitis or even folliculitis.

The skin in the genital area is particularly fragile, and ingrown hair can easily occur there as a result of a nonoptimal shaving technique. The bump of ingrown hair is usually small and firm, but it can look like a blister, which makes it look like a herpes lesion. It can also be painful, but its pain does not resemble the distinctive burning pain of herpes. It also does not ulcerate, and if it pops open it usually heals very quickly, unlike herpes.

When there is recurrence of ingrown hair, inflammation can occur in that area and present as redness of the surface of the skin and a chronic recurrence of itchy buttons. The condition is commonly seen in the beard area, especially on the neck and under the chin where the skin is more fragile, but it can also be seen in the pubis and other areas.

Estimated probabilities of HPV transmission from the penis to the anus were significantly higher than were those from the anus to the penis.

The skin lesions of pseudofolliculitis are, like ingrown hair and contrary to herpes, unlikely to ulcerate. They follow the pattern of hair growth, and they have particularly more pruritis or pain a day or two after shaving.²²

Image 7. Ingrown hair (left) and pseudofolliculitis (right). Source : NHS

Folliculitis

A hair follicle can become infected and form an inflamed button, most commonly because of a superficial bacterial or fungal infection or the progression of ingrown hair toward the infection.

“ Herpes has vesicles that ulcerate”

Folliculitis appears as a pimple, usually with a hair topping it and reddish surroundings. A white coloration—a sign of pus—can sometimes be seen under the skin of the button. If the folliculitis is due to ingrown hair, the ingrown hair can also sometimes be seen under the button.²³

The pimple of folliculitis does not ulcerate and heals quickly when it opens. The condition is benign and usually self-limiting.

Image 8. Folliculitis. Source: HC-UFPR Dermatology Service

Jock itch

Jock itch, or tinea cruris, is a common dermatologic condition, especially in men. It is caused by a fungus and classically results in a well-delimited red patch of skin formed by a pattern of rings. The patch usually forms in the groin and skin folds in the genital area but can spread to other parts of the body. The infection might cause itching and even a burning sensation but does not cause the distinctive ulceration of genital herpes.²⁴

Image 9. Jock itch on the inner thigh of a man²⁵

Genital eczema

Eczema, or dermatitis, refers to a group of skin diseases that cause skin inflammation. They have an allergic and environmental causal mechanism and are not contagious.

The genital area can be particularly prone to eczema since its skin and fragile and easily irritated and because of moisture and friction from clothing. Various types of eczema could affect the genital area, and each has its own characteristics. However, all types of eczema cause skin redness and itching. The skin lesion is poorly defined, and itching is usually the predominant symptom. Swelling is also a common feature of eczema. Bumps that can scar are frequent, blisters are rarer, and ulceration similar to that of herpes is almost exceptional unless the lesions have been extensively scratched.^{26, 27}

One type of eczema looks especially like herpes but has nothing to do with the herpes virus. It is called dermatitis herpetiformis. It is characterized by blisters filled with a clear fluid and is intensely itchy. It is related to celiac disease and gluten intolerance and its skin lesions can appear in multiple places on the body.²⁸

Image 10. Allergic Eczema. Source

Should I talk to a doctor about it?

Now that you have a broad idea of how to differentiate a genital herpes ulcer from other commonly encountered conditions, you should consult your doctor when you suspect genital herpes for the first time. The first episode of herpes can have more noticeable symptoms than recurrences later will and it will be less difficult to ensure that the prognosis is benign and rule out more harmful conditions.

Herpes is still a condition often associated with anxiety, fear, and shame. Your healthcare provider can talk to you about your feelings in that regard and give you support and guidance.

With any genital condition, it is important to have the correct diagnosis made by your doctor, who will use laboratory tests for confirmation to establish a proper management plan.

References

1. Gupta R, Warren T, Wald A. Genital herpes. The Lancet. 2007;370(9605):2127-2137. doi:10.1016/S0140-6736(07)61908-4

2. Mindel A, Marks C. Psychological symptoms associated with genital herpes virus infections: epidemiology and approaches to management. CNS Drugs. 2005;19(4):303-312. doi:10.2165/00023210-200519040-00003

3. Fortenberry JD. The effects of stigma on genital herpes care-seeking behaviours. Herpes J IHMF. 2004;11(1):8-11.

4. Centers for Disease Control and Prevention. STD Facts – Genital Herpes.Published October 22, 2019. Accessed November 1, 2019.

5. Whitley RJ, Kimberlin DW, Roizman B. Herpes simplex viruses. Clin Infect Dis Off Publ Infect Dis Soc Am. 1998;26(3):541-553; quiz 554-555. doi:10.1086/514600

6. Freeman ML, Sheridan BS, Bonneau RH, Hendricks RL. Psychological Stress Compromises CD8+ T Cell Control of Latent Herpes Simplex Virus Type 1 Infections. Immunol Baltim Md 1950. 2007;179(1):322-328.

7. Mertz GJ, Coombs RW, Ashley R, et al. Transmission of genital herpes in couples with one symptomatic and one asymptomatic partner: a prospective study. J Infect Dis. 1988;157(6):1169-1177. doi:10.1093/infdis/157.6.1169

8. Kimberlin DW, Rouse DJ. Clinical practice. Genital herpes. N Engl J Med. 2004;350(19):1970-1977. doi:10.1056/NEJMcp023065

9. Corey L, Adams HG, Brown ZA, Holmes KK. Genital herpes simplex virus infections: clinical manifestations, course, and complications. Ann Intern Med. 1983;98(6):958-972. doi:10.7326/0003-4819-98-6-958

10. Merck Manuals. Image: Genital Herpes on the Penis. Merck Manuals Consumer Version. Published 2019. Accessed November 8, 2019.

11. Draeger E. Management of genital herpes: a guide for GPs. Prescriber. February 2014. Accessed November 8, 2019.

12. Lautenschlager S. Cutaneous manifestations of syphilis : recognition and management. Am J Clin Dermatol. 2006;7(5):291-304. doi:10.2165/00128071-200607050-00003

13. Klausner JD. The Great Imitator Revealed: Syphilis. Top Antivir Med. 2019;27(2):71-74.

14. Wolff K, Goldsmith L, Katz S, Gilchrest B, Paller AS, Leffell D. Fitzpatrick’s Dermatology in General Medicine. 7th Edition. 2008. Accessed November 4, 2019.

15. Buensalido JAL. Chancroid: Background, Pathophysiology, Epidemiology. October 2019. Accessed November 8, 2019

16. Latini A, Zaccarelli M, Paglia MG, et al. Inguinal and anorectal Lymphogranuloma Venereum: a case series from a sexually transmitted disease center in Rome, Italy. BMC Infect Dis. 2017;17. doi:10.1186/s12879-017-2484-8

17. Halvorsen JA, Brevig T, Aas T, Skar AG, Slevolden EM, Moi H. Genital ulcers as initial manifestation of Epstein-Barr virus infection: two new cases and a review of the literature. Acta Derm Venereol. 2006;86(5):439-442. doi:10.2340/00015555-0140

18. Laetsch Semadeni B, Lautenschlager S. Le diagnostic différentiel des ulcères génitaux. 1re partie. Forum Méd Suisse ‒ Swiss Med Forum. 2009;9(03). doi:10.4414/fms.2009.06724

19. Anic GM, Giuliano AR. Genital HPV infection and related lesions in men. Prev Med. 2011;53(Suppl 1):S36-S41. doi:10.1016/j.ypmed.2011.08.002

20. Centers for Disease Control and Prevention. Molluscum Contagiosum | Poxvirus | CDC. Published January 3, 2019

21. File:Molluscaklein.jpg. In: Wikipedia.

22. Ogunbiyi A. Pseudofolliculitis barbae; current treatment options. Clin Cosmet Investig Dermatol. 2019;12:241-247. doi:10.2147/CCID.S149250

23. Winters RD, Mitchell M. Folliculitis. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2019.Accessed November 5, 2019

24. Degreef H. Clinical forms of dermatophytosis (ringworm infection). Mycopathologia. 2008;166(5-6):257-265. doi:10.1007/s11046-008-9101-8

25. Tinea cruris. In: Wikipedia. ; 2019.Accessed November 8, 2019

26. Williams HC. Atopic Dermatitis. N Engl J Med. 2005;352(22):2314-2324. doi:10.1056/NEJMcp042803

27. Nedorost ST. Generalized Dermatitis in Clinical Practice. 2012 edition. Dordrecht: Springer; 2012.

28. Katz SI, Hall III RP, Lawley TJ. Dermatitis Herpetiformis: The Skin and the Gut. Ann Intern Med. 1980;93(6):857. doi:10.7326/0003-4819-93-6-857

Genital herpes: The painful facts about a tricky virus

A young woman* came into my office complaining of horrible pain and itching in her genital area. She had recently started dating, and her current boyfriend was her first sexual contact. He, however, had had other partners before her. She had telltale sores and tests confirmed that the cause was genital herpes.

(*This is not one specific person but actually a composite of many patients. When I say we see a lot of genital herpes in our practice, I really mean it.)

Genital herpes is far and away the most common sexually transmitted infection (STI) that we see in primary care. I find myself explaining the diagnosis to distressed patients far more often than I would like.

There are two types of herpes, HSV-1 and HSV-2. Generally speaking, HSV-1 is responsible for those annoying cold sores (skin ulcers) that can pop up during times of stress or lack of sleep. HSV-2 usually causes genital sores. Many people don’t realize that HSV-1 can cause genital ulcers as well, though these tend to be less severe and less likely to recur.

It can take as little as a few days and up to a week after a person has been exposed before any symptoms appear. First, there will be redness and tingling, followed by painful bumps that progress to fluid-filled “blisters.” Eventually, these burst to form ulcers which then crust over, healing over several weeks. HSV-2 infections can be more severe, causing terrible pain, as well as flu-like symptoms, and even inflammation of the membrane that covers the brain (meningitis).

You can only get genital herpes if your partner has an active infection with sores, right? Wrong

A person can be exposed to the virus and pass it to someone else without ever having symptoms. It happens more often than you’d think. That’s because the virus can exist in genital fluids even without any ulcers. This is called “asymptomatic shedding of virus.” Although there is a lot more active virus when there are sores, asymptomatic shedding is probably how most people get herpes. What’s more, only one out of four people who tests positive for genital herpes actually knows that they have the virus. That’s a lot of people. Combine the two and you have many people unknowingly infecting others.

As with the couple above, many people who learn they have genital herpes are shocked. They tell me that they didn’t see any sores on their partner (“And I really looked!”) or that their partner had never ever had any ulcers, ever (“And I believe them!”). This is common and true, because people can have genital herpes and not know it.

Got Ulcers? Get Tested

A person with genital ulcers should see his or her doctor. It’s important to confirm whether or not it is herpes and if so, what type. Genital herpes outbreaks are treated with antiviral medications. These medications can help to reduce the number of days of discomfort and have few side effects. They are most effective when taken early in an outbreak. Some people take these drugs daily to prevent outbreaks.

Once someone has had a test that confirms either type of genital herpes, future partners can have a blood test which tells them if they already have been exposed to the same strain of virus. If the person tests negative, the partner with the infection would be advised to take antiviral therapy daily, in order to help prevent infecting his or her partner. Although daily antiviral therapy decreases the chances of spreading the virus, there is no guarantee, so it’s best to have a frank conversation with a new sexual partner.

No ulcers doesn’t equal no herpes, so then what?

If you’ve never had genital ulcers and as far as you know, have never been exposed, is it worth getting tested? That’s a controversial point and in fact, the widely followed official guidelines discourage screening.

Why? Many reasons: Let’s say the test comes back positive for HSV-2. This means that the patient may have been exposed to HSV-2 at some point in their lives, somehow, somewhere. Research tells us that these folks may be periodically shedding virus particles in their genital fluids. These patients would then be diagnosed with genital herpes, encouraged to share their status with future partners, and offered daily antiviral medication to prevent possibly spreading the virus.

All of this can be a tough pill to swallow, so to speak. There is significant social stigma and shame associated with herpes. In addition, there are occasionally false-positive tests. Labeling someone with the diagnosis can be devastating to their future relationships, and asking someone to take a pill for a condition they may or may not have and may or may not spread seems unreasonable.

However, many experts disagree with the official guidelines. I wrote to Dr. John Gnann, professor of infectious disease at the Medical University of South Carolina and co-author of a review in the New England Journal of Medicine . He has suggested the below guidelines, and outlines the rationale:

“For herpes viruses, there is no ‘past exposure only’ scenario. If a person is HSV-2 seropositive, then that person is HSV-2 infected and will carry the virus forever. That means one of three things:

1. The person has had herpes with symptoms.
2. The person has had herpes with symptoms but didn’t realize the cause.
3. The person has the herpes virus that from time to time can appear in genital fluids. The only way to know if a person is shedding the virus is with daily tests. That’s just not practical.

A lot of people fall into the second and third categories — again, that’s why so many people still get the virus. Dr. Gnann suggests herpes testing for

• people with any other sexually transmitted infection including chlamydia, human papilloma virus (HPV), etc.
• people in a relationship with a herpes-positive partner
• any person who asks to be tested.

He adds: “Anyone who has a positive blood test for HSV-2 (whether or not they have episodes with symptoms) should be told that she or he can potentially give HSV-2 infection to a partner. They should also be told about daily preventive antiviral therapy.”

As a primary care doctor, I found Dr. Gnann’s testing guidelines and rationale to be quite sound, and, I might add, different from my usual practice. I am having a more in-depth discussion about the option for HSV blood testing with my patients who have been diagnosed with any sexually transmitted infection, as well as anyone who requests testing for such infections, in addition to those with partners with HSV.

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Herpes – Symptoms, Diagnosis, Treatment

Symptoms of herpes

Many people who get herpes never have symptoms. Sometimes the symptoms are mild and are mistaken for another skin condition. If you experience symptoms, they may include:

• Painful sores in the genital area, anus, buttocks, or thighs.
• Itching.
• Painful urination.
• Vaginal discharge.
• Tender lumps in the groin.

During the first outbreak (called primary herpes), you may experience flu-like symptoms. These include body aches, fever, and headache. Many people who have a herpes infection will have outbreaks of sores and symptoms from time to time. Symptoms are usually less severe than the primary outbreak. The frequency of outbreaks also tends to decrease over time.

Stages of infection

Once you have been infected with the virus, you’ll go through different stages of infection.

Primary stage

This stage starts 2 to 8 days after you’re infected. Usually, the infection causes groups of small, painful blisters. The fluid in the blisters may be clear or cloudy. The area under the blisters will be red. The blisters break open and become open sores. You may not notice the blisters, or they may be painful. It may hurt to urinate during this stage.

While most people have a painful primary stage of infection, some don’t have any symptoms. They may not even know they’re infected.

Latent stage

During this stage, there are no blisters, sores, or other symptoms. The virus is traveling from your skin into the nerves near your spine.

Shedding stage

In the shedding stage, the virus starts multiplying in the nerve endings. If these nerve endings are in areas of the body that make or are in contact with body fluids, the virus can get into those body fluids. This could include saliva, semen, or vaginal fluids. There are no symptoms during this stage, but the virus can be spread during this time. This means that herpes is very contagious during this stage.

Recurrences

Many people have blisters and sores that come back after the first herpes attack goes away. This is called a recurrence. Usually, the symptoms aren’t as bad as they were during the first attack.

Stress, being sick, or being tired may start a recurrence. Being in the sun or having your menstrual period may also cause a recurrence. You may know a recurrence is about to happen if you feel itching, tingling, or pain in the places where you were first infected.

Cold Sores (HSV-1) (for Teens)

What Are Cold Sores?

Cold sores are small painful blisters that can appear around the mouth, face, or nose. Cold sores (or fever blisters) are very common. They usually go away on their own within 1 to 2 weeks.

What Are the Signs & Symptoms of Cold Sores?

Cold sores first form blisters on the lips, around the mouth, and sometimes inside the mouth. The blisters then become sores, which can make eating painful. They’re filled with fluid, but crust over and form a scab before they go away.

Sometimes the virus causes redness and swelling of the gums, fever, muscle aches, a generally ill feeling, and swollen neck glands.

After someone first gets HSV-1, the virus can lie quietly in the body without causing any symptoms. But it can wake up again later from things like:

When the virus reactivates, it can cause tingling and numbness around the mouth before blisters appear.

What Causes Cold Sores?

The herpes simplex virus type 1 (HSV-1) causes cold sores. This is a different

virusfrom herpes simplex virus type 2 (HSV-2). HSV-2 causes lesions in the genital area called genital herpes. Even though HSV-1 typically causes sores around the mouth and HSV-2 causes genital sores, these viruses can cause sores in either place.

How Do People Get Cold Sores?

People can get HSV-1 by kissing or touching someone with cold sores, or by sharing eating utensils, towels, or other items with an infected person. Many people with HSV-1 got it as kids during their preschool years.

How Are Cold Sores Treated?

Cold sores usually go away in about 1 to 2 weeks. No medicines can make the virus go away. But some treatments can help make cold sores less painful and not last as long:

• Cold compresses can help with discomfort.
• Prescription or over-the-counter treatments are sometimes recommended by the doctor.
• Cool foods and drinks can help make eating more comfortable.
• Taking acetaminophen or ibuprofen may ease pain. Don’t take aspirin, as it’s linked to a rare but serious illness called Reye syndrome.

When Should I Call the Doctor?

If you have a cold sore, it’s important to see your doctor if:

• you have another health condition that has weakened your immune system
• the sores don’t heal by themselves within 2 weeks
• you get cold sores often
• you have signs of a bacterial infection, such as fever, pus, or spreading redness

Can Cold Sores Be Prevented?

The virus that causes cold sores is very contagious. To help prevent it from spreading to others:

• Keep your drinking glasses and eating utensils, as well as washcloths and towels, separate from those used by other family members and wash these items well after use.
• Don’t kiss others until the sores heal.
• Wash your hands well and often, especially after touching a cold sore.

Be especially careful not to touch your eyes. If HSV-1 gets into the eyes, it can cause a lot of damage.

Herpes Signs and Symptoms

While some people realize that they have genital herpes, many do not. It is estimated that one in eight persons in the United States has genital herpes; however, as many as 90 percent are unaware that they have the virus. This is because many people have very mild symptoms that go unrecognized or are mistaken for another condition or no symptoms at all.

Because signs can vary a great deal, we recommend that an individual see a healthcare provider to be tested if they have a lesion of any kind. This can be swabbed for testing.

A person may show symptoms within days after contracting genital herpes, or it may take weeks, months, or even years. Some people may have a severe outbreak within days after contracting the virus while others may have a first outbreak so mild that they do not notice it. Because of these possibilities, it can be difficult for people to know when and from whom they may have contracted the virus.

The First Episode

If you were diagnosed with genital herpes in the last few days, you may be experiencing a number of uncomfortable or painful symptoms. Or, perhaps the symptoms are rather mild, barely noticeable, and resemble an insect bite or a rash. First episodes usually occur within the first two weeks after the virus is transmitted.

The “classic” symptoms that most people associate with genital herpes are sores, vesicles, or ulcers – all of which can also be called “lesions.” (The scientific literature on herpes uses the term “lesion” to describe any break or irregularity in the skin.) These classic lesions of genital herpes often resemble small pimples or blisters that eventually crust over and finally scab like a small cut. These lesions may take anywhere from two to four weeks to heal fully.

During this time, some people will experience a second crop of lesions, and some will experience flu-like symptoms, including fever and swollen glands, particularly in the lymph nodes near the groin. Headache and painful urination also sometimes accompany full-blown symptoms of first episodes.

Again, while first episodes can amount to a major bout with illness, the signs of herpes come in a wide variety – and in some people an initial infection produces mild symptoms or even symptoms that are ignored.

For many people, herpes lesions can so mild that they may be mistaken for:

• insect bites
• abrasions
• yeast infection
• “jock itch”

. . .and other conditions. In other words, the signs go unrecognized as being caused by genital herpes. Signs and symptoms can be found on the penis and vulva, near the anus, on the thigh, on the buttocks, and virtually anywhere in the genital area.

Treatment with antiviral drugs is standard during first episodes and can speed healing significantly. If you haven’t already, you may want to discuss treatment with your healthcare provider at this time.

Recurrent Genital Herpes

If you have recently made it through a first episode that consisted of full-blown symptoms, you know something about signs and symptoms already. The good news is that the first episode is almost always the worst that HSV throws your way. Signs and symptoms of recurrent episodes (when they occur) tend to be milder and heal much more quickly, typically within two to twelve days.

If the first episode produced fairly mild symptoms, then later recurrences usually won’t be more severe. But, as noted earlier, when genital herpes recurs after a first episode, it doesn’t always cause recognizable signs and symptoms.

Some people have recurrent outbreaks with the so-called “classic” blister-like herpes lesions that crust over, or with painful sores. In recurrent herpes, however, this process usually takes about half the time it does in first episodes. In addition, many people have very subtle forms of recurrent herpes that heal up in a matter of days. And lastly, herpes is capable of reactivating without producing any visible lesions This is called asymptomatic reactivation.

Much of the broad description of herpes “lesions” included above applies to recurrent herpes as well. Lesions may take the form of something resembling:

• a red spot
• a pimple
• an ingrown hair
• razor burn
• hemorrhoids
• insect bite

There’s quite a variety. And while genital herpes certainly can and does cause these signs of infection literally on the genitals (the penis or the vulva) it also can produce signs of infection nearby. Herpes sores on or between the buttocks are common (and sometimes slow to heal), as are lesions on the thigh. Herpes can bring about what feels like a tiny fissure around the anus, something easily confused with hemorrhoids. So remember: recurring signs and symptoms in the genital or anal area could be herpes lesions.

But what if you don’t see any lesions nor have other symptoms? In some studies, people with herpes were completely unaware of lesions about one-third of the time that the virus was found to be active in the genital area. While recognizing lesions and other symptoms is important, this cannot always tell you when the virus is active.

Recognizing the Signs: The Prodrome

Early in the phase of reactivation (also called an outbreak), many people experience an itching, tingling, or painful feeling in the area where their recurrent lesions will develop. This sort of warning symptom—called a “prodrome”—often comes a day or two before lesions appear. To be on the safe side, it’s best to assume virus is active (and, therefore, can be spread through direct skin-to-skin contact) during these times.

Where do symptoms appear?

When a person has genital herpes, the virus lies dormant (sleeps) in the bundle of nerves at the base of the spine. When the virus reactivates (wakes up), it travels nerve paths to the surface of the skin, sometimes causing an outbreak.

The nerves in the genitals, upper thighs and buttocks are connected, so a person can experience outbreaks in any of these areas. Such areas include the vagina or vulva, penis, scrotum or testicles, buttocks or anus, or thighs.

Genital herpes, regardless of whether it is HSV-1 or HSV-2, does not cause symptoms on the mouth or face. For more on oral-facial herpes, see the oral herpes page.

How often do outbreaks occur?

The number of outbreaks someone has varies from person to person. The average number of outbreaks for a person with genital HSV-2 is four to five per year. The average for genital HSV-1 is less than one outbreak per year.

Usually, there are more outbreaks during the first year, and many people find that outbreaks become less severe and less frequent with time.

Herpes “triggers” (determining exactly what leads to an outbreak) are highly individual, but with time, many people learn to recognize, and sometimes avoid, factors that seem to reactivate HSV in their own bodies. Illness, poor diet, emotional or physical stress, friction in the genital area, prolonged exposure to ultraviolet light (commonly for oral herpes, such as a beach trip or skiing weekend), surgical trauma, and steroidal medication (such as asthma treatment) may trigger a herpes outbreak.

The frequency of outbreaks can often be managed through effective stress management, and getting adequate rest, nutrition, and exercise. For people with frequent outbreaks, suppressive (daily) therapy with any one of the antiviral treatments can reduce outbreaks by as much as 80%.

Genital herpes symptoms & treatments – Illnesses & conditions

About genital herpes

Genital herpes is a sexually transmitted infection caused by a virus called herpes simplex virus (HSV).

There are two different types of the virus (type 1 and type 2), both of which can affect the genitals. One of the types is the same virus that causes cold sores around the mouth (type 1).

Genital herpes causes painful blisters and sores on and around the genitals. It can also sometimes cause problems if it’s caught for the first time either very early or very late in pregnancy.

How do I get genital herpes?

The herpes virus (HSV) is easily passed from person to person by close, direct contact including:

• kissing
• unprotected vaginal, anal or oral sex (without a condom)
• sharing sex toys that aren’t washed or covered with a new condom each time they’re used
• your genitals coming into contact with your partner’s genitals – this means you can get genital herpes from someone even if there is no penetration, orgasm or ejaculation

Sometimes you can catch herpes when your sexual partner has no visible sores or symptoms. This is because the virus can become active on the skin without causing any visible blisters or sores. This is sometimes called ‘asymptomatic shedding’.

Herpes can also be passed to a newborn baby during childbirth. This is less common if the first episode of herpes is diagnosed before or at the beginning of pregnancy, and if there are no visible ulcers at time of delivery. Sometimes medications are started towards the end of pregnancy to reduce this risk.

Symptoms of genital herpes

Many people with the herpes virus do not experience any symptoms when first infected.

If symptoms do occur they usually take between two and twelve days after contact to appear.

Sometimes symptoms may not be noticed until months, or sometimes years, after being in contact with the virus.

Once you have the herpes infection, the virus stays in your body. It can lie dormant for long periods, but can reactivate in the area that was originally infected. If the virus reactivates, the sores and blisters can reappear. This is known as a ‘recurrent episode’ of genital herpes.

This first episode of genital herpes may last from two to four weeks. Repeated episodes are not usually as severe, or long, as the first and you may never have a repeat episode.

Symptoms of the first infection can include spots or red bumps around the genital area. These can be very painful. In time, these swellings can break open and form sores or ulcers which gradually crust over, forming new skin as they heal. 

Other symptoms include:

• pain inside the vagina, head of penis or back passage (rectum)
• vaginal discharge
• pain peeing or being unable to pee
• fever
• flu-like symptoms, backache, headache and a temperature
• mild swelling of the lymph glands in the groin, armpits and neck

If you have a recurrent infection, your symptoms may include:

• a tingling or burning sensation before blisters appear (this can signal the start of a recurrent infection)
• painful red blisters, which soon burst to leave ulcers
• pain inside the vagina, head of penis or back passage 

Testing for genital herpes

If you think you may have genital herpes you should make an appointment with your GP or local sexual health services.

If there are symptoms present such as blisters, sores and ulcers, your doctor or nurse may be able to make a diagnosis straight away.

If you have visible blisters, your doctor or nurse may take a swab for testing, to check if this is herpes and what type. This swab can also test for another STI which causes blisters called syphilis.

The genital herpes swab tests is very reliable, though if the ulcer is too dry then the result may be less likely to find a positive result.

Treating genital herpes

Although there is no known cure for herpes, the symptoms of genital herpes can be treated.

The symptoms of recurrent genital herpes will usually clear up without any treatment. There’s also medication to help speed up the healing process and reduce the severity of an episode, if needed.

If you start taking the medication as soon as an outbreak begins, you may shorten or even stop the episode.

Some people experience many recurrences of genital herpes. In these cases, a longer course of tablets should prevent any recurrent episodes.

Talk to your doctor or nurse at the sexual health service, or to your GP about possible treatment options that may suit you.

If you’re pregnant and find out you have a genital herpes infection, tell your midwife as soon as possible.

As there’s no screening test for herpes, partners are only advised to have a test if they also have symptoms.

Avoiding passing genital herpes to a partner

If you have herpes, you can follow some simple measures to avoid passing the virus on to your partner(s), and to continue to have a healthy and happy sex life. These include:

• telling your partner if you have herpes
• learning to recognise the warning signs (tingling, itching or inflammation) that an episode is starting
• not have sex during an episode of herpes
• avoiding direct contact with your sores or blisters and another person
• avoiding kissing and oral sex when you or your partner has cold sores around the mouth

If you have frequent episodes of herpes then it is worth talking to your GP or sexual health clinic about longer term treatment which may also reduce the chance of you passing on the virus to your partner.

Preventing recurring episodes

Keep a record of when you have an episode of genital herpes. You may see a pattern developing, and be able to identify your trigger factors.

Many people find that episodes occur when they’re run-down, under stress, around the time of menstruation or when the skin gets irritated due to friction or tight clothing.

If you do see a pattern of trigger factors, try to adjust your lifestyle to avoid or reduce your exposure to them or speak to your healthcare professional for advice.

Reducing the risk of genital herpes

The best way to prevent all sexually transmitted infections is to practice safer sex. This means using a condom for vaginal, anal or oral sex.

The herpes virus can’t pass through a condom. However, if the virus is present and active on the skin in areas around the genitals not covered by the condom (as is often the case), infection may still occur. Therefore condoms are not 100% protective against the herpes virus.

If your partner has herpes, avoiding sex when they have visible sores reduces your risk of getting herpes.

Other STI’s

If you’ve been diagnosed with herpes it’s recommended that you are tested for all STI’s including:

This is even more important if you have recurrent episodes.

Find your local sexual health clinic

Search for your nearest sexual health clinic through Scotland’s Service Directory.

Sexual health clinics

Other languages

The information on this page has been translated into: 

Herpes in Hiding | NIH News in Health

November 2010

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Genital Herpes Often Unrecognized

It’s an uncomfortable topic, but it’s a health issue you should know about. Nationwide, about 1 out of 6 people between ages 14 and 49 is infected with the herpes simplex virus type 2—the main cause of genital herpes. Surprisingly, most people don’t know they’re infected. Even if you have no symptoms, or only mild ones, you can still transmit the virus to others.

Herpes simplex virus (HSV) comes in 2 forms. The most common, HSV-1, is best known for causing cold sores or fever blisters on the face, especially on the lips and mouth. But HSV-1 can also cause genital herpes. HSV-2 usually affects the genitals, but can also infect the mouth. Both types of HSV can pass from one person to another through sexual or other skin-to-skin contact.

“Once people are infected with herpes simplex, the virus stays in the body for the rest of their lives,” says Dr. Carolyn Deal, who heads the sexually transmitted diseases branch at NIH. Symptoms may first appear about 2 weeks after infection. After that, the herpes virus goes into hiding in your nerve cells. It may re-emerge several times a year. Over time, reappearances occur less often.

The first outbreak is usually the most severe and lasts the longest, sometimes 2 to 4 weeks. During an outbreak, you might notice tingling or sores (lesions) near the area where HSV first entered your body. Small red bumps are the first to appear. They change into small blisters, and then become itchy, painful sores that might develop a crust. The sores eventually heal without leaving a scar.

Often, though, people don’t recognize their first genital herpes outbreak or later recurrences. A study by the U.S. Centers for Disease Control and Prevention found that more than 80% of people with HSV-2 infections have not been diagnosed with the disease.

Your health care provider can sometimes diagnose genital herpes by looking at the sores or testing a sample from infected skin. Between outbreaks, a blood test can detect evidence of HSV-1 or HSV-2.

Although there’s no cure for herpes, prescription medicines can help calm symptoms and prevent future outbreaks. Taken regularly, these medications can also reduce the risk of passing herpes to sexual partners.

“For prevention, the recommendations for genital herpes are similar to many other sexually transmitted diseases,” says Deal. The most reliable way to prevent infection is to abstain from sex or to be in a long-term monogamous relationship with an uninfected partner. Condoms can also reduce the risk of transmission, but are not a reliable solution, as they may not cover all infected areas. Infected people should avoid having sex with uninfected partners during an outbreak.

Although herpes infections generally don’t cause serious medical problems alone, they can cause complications. Genital herpes can increase your chances of becoming infected with HIV, the virus that causes AIDS. In rare cases, herpes outbreaks during pregnancy can put the newborn child at risk for serious or even deadly infections.

Although genital herpes is a lifelong disease, there are many options for managing the condition and preventing its spread. Talk to your health care provider about any concerns.

90,000 Herpes Simplex Virus Infection – Symptoms, Diagnosis and Treatment

Symptoms of genital herpes range from none to tingling and burning without lesions, and recurrent genital expression.

Symptoms of lip herpes include tingling and burning, followed by vesicular and ulcerative lesions occurring in the oropharynx and perioral mucous membranes.

Acyclovir, famciclovir and valacyclovir are effective in reducing the duration and severity of an outbreak.

Daily suppressive therapy reduces the frequency of recurrent episodes by 80% and the risk of transmission by approximately 50%.

Type-specific serological study based on glycoprotein G is used to diagnose infection with or without lesions and to differentiate types 1 and 2.

The main clinical manifestations of infection caused by herpes simplex virus (HSV) type 1 (HSV-1) or HSV type 2 (HSV-2) are ulcers of the mouth, genitals and eyes.Rarely, primary or recurrent HSV infections can also occur elsewhere with neurologic, ocular, hepatic, or pulmonary complications. The primary episode occurs during an initial HSV infection in which the host patient does not provide an immune response.

Herpes of the lips (oral herpes) is an infection of the mouth and lips, usually caused by HSV-1. If symptoms occur, they include fever, sore throat, and swelling of the pharynx.After a few days, painful ulcers may develop on the lining of the throat and mouth, and fever and pain in the mouth may last for several days. Relapses sometimes occur, and usually it happens in the same place. Relapses last 6–48 hours; they begin with pain, burning, or tingling, and then vesicles form. Systemic manifestations usually do not occur, and the lesions crust over and heal in about 10 days.

Genital herpes is caused by an infection with HSV-1 or HSV-2.The first clinical episode of genital ulceration may reflect either a new viral infection or a new detection of the disease with an earlier viral infection. The infection is transmitted to patients through sexual contact. Women may experience genital pain, discharge, and dysuria with ulcerative lesions on the vulva, perineum, buttocks, cervix, and vagina. During primary infection, women tend to have systemic symptoms, including fever, neuralgia, and constipation, while men have a milder primary course.Men may develop vesicles on the shaft or glans of the penis, as well as urethritis. Proctitis may be accompanied by discharge, rectal pain, tenesmus, constipation, impotence, and urinary retention after anorectal intercourse. About 90% of patients experience recurrent episodes during the first year, which become less frequent and severe over time. [1] Lafferty WE, Coombs RW, Benedetti J, et al. Recurrences after oral and genital herpes simplex virus infection. Influence of site of infection and viral type.N Engl J Med. 1987 Jun 4; 316 (23): 1444-9.
http://www.ncbi.nlm.nih.gov/pubmed/3033506?tool=bestpractice.com
[2] Benedetti J, Corey L, Ashley R. Recurrence rates in genital herpes after symptomatic first-episode infection. Ann Intern Med. 1994 Dec 1; 121 (11): 847-54.
http://www.ncbi.nlm.nih.gov/pubmed/7978697?tool=bestpractice.com

Asymptomatic shedding of HSV-1 and HSV-2 may occur in the absence of lesions; transmission of the virus can occur during asymptomatic shedding of the virus.HSV in the neuronal ganglia develops with a delay and can be periodically reactivated. Most reactivation of the virus is asymptomatic but can lead to transmission of the virus to another person. The classic clinical picture of vesicles progressing to painful ulcers is rare; often atypical and mild symptoms occur, and in most people the disease is not identified.

For more information on the treatment of HSV eye infection, refer to the topics “Uveitis” and “Keratitis”.For more information on the treatment of suspected HSV encephalitis, refer to the topic Encephalitis.

Herpes – what is it?

Herpes is an infection that manifests itself in the form of sores that form on the lips or on the skin next to the lips. In common parlance, herpes is often called “fever”, and physicians use the term “recurrent herpes labialis”.

What causes herpes?

The cause of herpes is the gerpes simplex virus.You have probably heard the name “herpes” before, but take your time: the gerpes simplex virus exists in two varieties – type 1 and type 2.

Type 1

The gerpes simplex virus of the first type affects only those parts of the human body that are “above belt “. It is he who, in most cases, causes the appearance of ulcers in the mouth.

Type 2

Gerpes simplex virus of the second type affects those parts of the human body that are “below the belt”; this virus is also known as genital herpes.This type of virus usually does not cause mouth sores – although there are exceptions.

How does gerpes simplex get infected?

If you feel – or have been told – that you have “caught something infectious,” you usually assume that a virus has entered your body and caused the disease. In most cases, this is exactly what happens, but gerpes simplex differs from many other viruses in that it does not penetrate into your body, but initially lives, “slumbers” in it – and at some point is activated.

Where does this virus come from in the body?

From a previous infection. Primary infection of the body with the gerpes simplex virus, after which it, once in the body, “falls asleep”, does not always have the form of ulcers, or “fever”. Doctors call this infection “primary herpetic stomatitis”, and since it can take many forms, you may simply not recognize it.

What are the signs and symptoms of primary infection with gerpes simplex type 1 virus?

“Classic”, vivid symptoms of primary herpetic stomatitis – ie.That is, the primary infection of the body with the gerpes simplex virus – usually the following:

The primary signs of infection usually do not contain anything specific – they appear in the form of fever, irritability, headache, pain when swallowing may occur.

About a day after the first signs of infection appear, pain in the mouth and gums become severely inflamed.

Usually on the third day, small bubbles appear all over the mouth.

Bubbles soon burst and gray erosion forms.

These erosions can be very painful and usually prevent you from eating.

Soon the erosion heals. Typically, the entire infection cycle is completed in 10-14 days.

Are you sure you have never experienced these symptoms?

If you do not remember that you have ever had the “classic” symptoms of primary herpetic stomatitis, it may be, firstly, because you had it in childhood. Most often, primary infection with this virus occurs before the age of 7 years.

In addition, you can not remember all these symptoms also because your case was, as doctors say, “subclinical”.

99 percent of cases of primary herpetic stomatitis are subclinical, that is, the infection goes away so that the symptoms remain subtle. It is possible that during the initial infection, you developed only one or two not very painful ulcers.

How common is gerpes simplex type 1 infection?

It is believed that 80 percent of the world’s population has antibodies to this virus in their blood.Antibodies are proof of the presence of a virus because our immune system only creates these antibodies when the virus enters the body.

Herpes is eternal …

After the initial infection with the gerpes simplex virus (it does not matter – subclinical or expressed), this virus remains in the body for life. However, do not rush to grieve over this: out of 80 percent of the population with this virus in the body, only one third is susceptible to periodic outbreaks of this infection.The rest are only carriers of the virus, but for various reasons this virus remains “dormant” in their organisms.

In which area of ​​the body does this virus “live”?

As we have already said, it is the “revival” of the gerpes simplex virus that leads to the appearance of herpetic ulcers. Between bursts of its activity, the virus “sleeps” in the nervous tissue of the body (the first type of virus “prefers” the trigeminal ganglion). When the virus “revives”, its particles descend down this nerve to the surface of the skin, forming herpetic ulcers on it.

Usually, with repeated outbreaks of virus activity, these ulcers appear in the same place, near the lips or on the face. This happens to the descendant, that the nerve along which the virus particles descend, “serves” this particular area of ​​the skin.

What is the reason for the revival of the virus (and the reappearance of herpes sores)?

There are several factors that cause the virus to revive. Apparently, they all somehow weaken the immune system, which, under other, normal circumstances, can control outbreaks of virus activity.

Emotional disorder and stress.

Physical stress and fatigue

Illnesses like colds or flu

Lip or skin damage – physical trauma or deep cracks

Lip damage from strong sunlight or UV lamps

Menstruation or pregnancy

Immune system research

that modern antiviral drugs can significantly reduce the pain and duration of herpes if they are used in a timely manner.Knowing what factors can trigger a cold sore outbreak, you can roughly imagine under what circumstances you should expect it. If you start taking antiviral drugs early (preferably at the itching stage), they can greatly reduce the soreness and duration of herpes.

How can you distinguish herpes from other diseases of the oral cavity?

Herpetic ulcers can be distinguished from other ulcers, which are also common in the mouth, by their appearance and location.

Where do herpes sores usually form?

They usually appear:

On the lips or along their contour.

On the skin of the face near the mouth.

With each new outbreak, these ulcers usually appear in the same place.

What do herpes sores look like?

Herpes sores usually disappear after 8-12 days, and during the following stages of the cycle of the disease take the following forms:

Day 1-2: Stage of itching

Usually the first signs of herpes are sensations of itching, constriction, or swelling in the place where herpetic ulcers subsequently form.Sometimes these sensations are accompanied by a slight reddening of the area.

Day 2-3: Stage of Bubble Formation

The first visible sign of herpes sores is the appearance of fluid-filled bubbles. Usually these bubbles are very small (the area of ​​one bubble is less than the thickness of a coin), and form a tight group no larger than a penny. Sometimes several bubbles merge together to form a larger bubble.

Day 4: Stage of ulceration

Shortly after formation, vesicles burst and in their place appear shallow reddish erosions, which soon become gray in color.This stage of herpes is the most painful. Also, herpes can be contagious at this stage.

Day 5-8: Stage of crust formation

In places where erosion is not moistened with saliva, they soon begin to dry out and a brownish crust forms on them. Its formation is often accompanied by burning or itching sensations. Often, the bark cracks or falls off, causing bleeding.

Day 9-12: Healing stage

Herpetic erosions heal over time.Usually, scabs form on erosion, which gradually decrease in size and then fall off. Each new scab is smaller in size than the previous one, and this continues until the ulcer completely disappears, usually leaving no traces.

Is herpes painful?

Yes, herpes sores are usually painful, although the degree of pain may vary from person to person. At each stage of herpes development, you will experience some discomfort, but ulceration is usually the most painful stage.

Is herpes contagious?

Yes. Since herpes sores contain the gerpes simplex virus, particles of this virus can enter the body of other people, and they, too, become infected with herpes. The most common route of such infection is direct contact with the skin of a patient with herpes, for example, by kissing. The virus can be transferred from a sick person to a healthy person and through a “third” object – for example, through kitchen utensils, lipstick, toothbrush or even a face towel.

In addition, you need to know that if you are sick with herpes, you can transfer the virus not only to healthy people, but also to healthy parts of your own body.The gerpes simplex virus can cause herpes felon, a painful infection of the fingers. A herpetic infection of the eye can damage the cornea. (Always wash your hands thoroughly after applying medicated ointment to ulcers.)

The most dangerous stage in the development of herpes in terms of infection is when the blisters open (ulceration stage). The liquid that fills these bubbles contains literally millions of virus particles. As the disease progresses, the number of virus particles decreases.Usually, by the time the scab forms, the amount of virus particles in the ulcer disappears almost to nothing. From a practical point of view, however, herpes is contagious to varying degrees at all stages of its development.

How to treat herpetic ulcers?

Although no remedy has yet been invented for a complete cure for herpes, there are various drugs and methods that can be very useful in a single outbreak. On this page you will find out which medications for the treatment of herpes you can buy at pharmacies, and what methods you can use without even leaving your home.

On the next page, you will learn about herpes medicines that can only be purchased with a prescription. These are potent antiviral drugs that significantly weaken the course and increase the prevention of the occurrence of herpetic ulcers.

Remember that herpes is contagious at all stages of its development. Therefore, in order not to become not only a carrier, but also a carrier of this virus, always wash your hands thoroughly after applying drugs to ulcers.

Ready-made preparations for the treatment of herpes

Many ready-made preparations for the treatment of herpes sold in pharmacies have a mainly palliative effect – that is, they are intended to relieve the symptoms of the disease (pain, itching and burning).Other finished products help create an environment in which disease progression is slowed down and / or treatment is accelerated.

Ready-made preparations of the third category have properties that allow them to directly prevent the formation of herpetic ulcers.

Antiviral drugs for the treatment of herpes

Denavir (penciclovir)

Denavir is an antiviral cream designed specifically for the treatment of herpetic ulcers. Studies have shown that Denavir reduces the soreness of herpes sores and speeds up their healing.

Denavir should be applied several times a day (every 2 hours for 4 days), applying it to the place where herpetic ulcers develop. You need to start using it as soon as you feel the approach of herpes (i.e. at the stage of itching). Research carried out by the manufacturer has shown that when using Denavir, ulcers heal in 4-5 days, while without treatment, the disease cycle requires 8-12 days.

Penciclovir (trade name – Denavir) has the property of inhibiting the multiplication of the gerpes simplex virus, and, therefore, is a direct antiviral agent.If you apply this remedy at an early stage of herpes development, it significantly reduces the pain and duration of the disease.

Many experts consider Denavir to be the best remedy for this disease. Remember that herpes is contagious at all stages of its development. Therefore, in order not to become not only a carrier, but also a carrier of this virus, always wash your hands thoroughly after applying drugs to ulcers.

“PANAVIR” is an effective remedy for the treatment of herpes

easily and without complications (discomfort and side effects are absent as such) causes the organism to become accustomed to the effect)

Preparations containing doconazole

Doconazole is a compound that can slow down the activity of the gerpes simplex virus and thus reduce both the morbidity of the disease and the duration of its course.Clinical trials of products containing doconazole have shown that their use reduces the healing time of herpes sores to one day.

Usually, doconazole-containing creams are applied several times a day to the area of ​​the skin where the ulcers form; you should start using them from the moment you feel the approach of herpes (preferably at the stage of itching).

Other ready-made antiviral drugs for the treatment of herpes

The following ready-made drugs are included by us in one list because they all contain combinations of ingredients that give them approximately the same properties.Ointments – Acyclovir, Zovirax

Anesthetics

Anesthetics applied to ulcers can relieve burning, itching and pain. The active ingredients found in these products include tetracaine, benzocaine, lidocaine, benzyl alcohol, camphor, and phenol.

Foods that slow down the formation of ulcers and accelerate their healing

It is believed that such components as zinc, lysine, phenol and tannic acid have antiviral properties – and therefore they can cover the development of herpes and the formation of herpes sores.Antibacterial agents by themselves do not affect gerpes simplex virus particles, but preparations containing them are able to create an environment that promotes rapid healing of ulcers by preventing re-infection with bacteria.

Preparations that moisturize and soften herpetic ulcers

Lip balms can be used to moisturize and soften herpetic ulcers – ulcers will bleed and crack less. These foods usually contain petroleum jelly and allantoin.

Sunscreens

Because prolonged exposure to sunlight can cause or accelerate the formation of cold sores, many lip ointments and lip balms contain zinc oxide or other substances that provide sun protection.

“Home” remedies for the treatment of herpetic ulcers

Many people believe that the following “home” remedies have the ability to accelerate the healing of herpetic ulcers, and they are actively used. However, we consider it necessary to warn: this is not confirmed by scientific research.

Ice can be applied …

This remedy may be useful because:

If you apply ice for five to ten minutes every hour during the itching stage, ice will lower the temperature in the area where the ulcers begin to form.Lowering the temperature, in turn, will reduce the metabolism in this area, and ulceration will also be greatly slowed down.

Ice applied to already formed ulcers has an anesthetic effect, relieves pain and itching.

… and a tea bag …

Tea contains tannic acid, which is believed to have natural antiviral properties (some of the ready-made pharmaceutical preparations for the treatment of herpes ulcers also contain tannic acid).

Applying a wet tea bag to ulcers early in their formation (especially in the itching stage) can severely weaken their growth and prevent them from developing to the final stage.Apply the sachet for a few minutes every hour.

… and lubricate the ulcers with petroleum jelly

If moisturizing creams such as petroleum jelly are applied to the ulcers during the scab stage, the scabs will not crack and fall off.

Nutritional Supplements

It has been reported that L-lysine, one of the amino acids, can relieve outbreaks of cold sores, but this fact has not yet been sufficiently confirmed by medical research. Therefore, lysine supplements should only be used on the advice of a physician.

Herbal remedies

Herbal preparations – tea tree oil and sage, which have antiseptic properties and a soothing violet – are also often included in the list of preparations. used to treat herpes. Remember, however, that these drugs need to be able to use – therefore, they should be used only on the recommendation and with the advice of a doctor.

Prevention of herpes sores

There are several ways in which you can prevent the formation of herpes sores or minimize their number.

Since prolonged exposure to sunlight is believed to be one of the causes of a cold sore outbreak, when leaving the house in summer, wear a wide-brimmed hat to protect your face from the sun’s rays. Apply a balm with at least 15 units of sunscreen or more to your lips.

Damage to the lips can also cause a herpes outbreak. Use a moisturizing balm to keep them from cracking.

Source http: // stomat-clinic.ru

90,000 Herpes (cold sores)

Herpes on the lips has several names: “cold” on the lips, fever on the lips, herpes on the lips, herpes labialis, labial or labial herpes.

“Cold” on the lips, mainly caused by herpes simplex virus type I (HSV-I) . 95% of people have this virus in their bodies. In rare cases, the cause of herpes lips is herpes simplex virus type 2 (transmitted through oral sex).

The herpes simplex virus, which causes a “cold” on the lips, remains inside the human body for life. At the moment, no drugs and treatment methods have been developed that would completely destroy the herpes simplex virus in the human body.

Up to 90,025 10,000,000 Russians annually suffer from “colds” on the lips. Approximately one in five Russians falls ill with herpes of the lips 2 to 10 times a year. And only about 5% of the human race has immunity to HSV-I, the reasons for which are still unclear.

The virus enters the body in early childhood: at 3-4 years old, when the antibodies against the herpes virus transmitted to the baby by the mother are depleted. Most often, infection occurs if the carrier of the infection kisses the child. For example, parents, brothers, sisters and other relatives. In addition to kissing, the virus can enter the body along with the biological fluids of others, for example, with saliva.

Having come to our “guests”, it penetrates into the mucous membranes, reaches the nerve endings. Along them, with a stream of fluid feeding the nerves, it rises into the cranial cavity, where it “hides” in the nerve plexus, called the trigeminal ganglion , and “sleeps” there until the moment of reactivation.

Virus reactivation is possible at the moment when immunity “decreases”. “Decreased” immunity can occur under the influence of: colds, flu, menstruation, emotional distress and stress, strong ultraviolet radiation, excessive alcohol consumption, indigestion and fatigue.

Causes of relapse of herpes on the lips:

– Stress or emotional distress;

– Various somatic diseases, in particular colds, flu, diabetes, HIV;

– Poisoning or intoxication;

– Consumption of alcohol, caffeine and smoking;

– Excessive ultraviolet irradiation;

– Hypothermia or overheating;

– The arrival of menstruation;

– Overwork and exhaustion;

– Inadequate nutrition / diet or indigestion;

– Other individual factors for each person;

After “awakening” the virus goes back to the nerves (like a train on rails) leaving the trigeminal ganglion back to the skin.It is important to know that branches that innervate the lips, oral mucosa, gums, skin on the earlobe and part of the cheek depart from the trigeminal plexus. The lesions on the skin will be located in accordance with the outgoing nerves. As it travels through the nerve, the virus causes inflammation of the nerve tissue, which causes pain along the nerve fiber.

Stages of development of “cold” on the lips

In its development, the disease goes through stage IV:

Stage I – tingling.

At this time, most people feel that they are getting sick. Before a “cold” appears, the skin in the corners of the mouth or the inner surface of the lips, or on the tongue, or even all over the face begins to itch.
In a place where a relapse of herpes will soon develop, the harbingers of the disease appear: pain, tingling, tingling, itching. The skin over the site of the future relapse turns red.

The development of the disease can be prevented if at this stage drugs based on acyclovir (Zovirax ointment) are used.If you have severe itching, you can take an aspirin or paracetamol tablet.

Stage II – the stage of inflammation, begins with a small painful blister, which gradually increases in size. The bubble is tense and filled with a clear liquid, which later becomes cloudy.

III stage – stage of ulceration. The bubble bursts, a colorless liquid filled with billions of viral particles flows out of it. An ulcer forms in its place.

At this moment, the sick person is very contagious, as he releases a huge amount of viral particles into the environment. Because of the soreness and ulcers on the face, people are most annoyed by this stage.

IV-th stage scab formation. A crust forms over the sores, which can cause pain and bleeding if damaged.

Herpes rashes are most often located on the red border of the lips, but can also be on the nose, on the cheeks, in the ears, on the forehead, in the mouth: on the gums, the inner surface of the lips and cheeks.

Complications of “cold” on the lips

If you do not follow the rules of personal hygiene, the virus can also infect other parts of the body: if you rub your eyes with your hands after touching the bubbles or sores, you can provoke ophthalmic herpes or herpes of the eyes – severe eye damage, sometimes leading to reduced vision and even blindness. Herpetic eczema, a virus affecting the skin of the fingers of the hands, may develop.

Kissing someone with ulcerated lips can transmit the infection to your child or loved ones.

Oral sex with a partner with an active “cold” on the lips can lead to “ genital herpes “. Those. during an outbreak of a “cold” on the lips, herpes can be mechanically transferred from the lips of an “active” sexual partner in oral sex to the genitals of the recipient of oral sex.

Here is how patient M. describes the severe course of herpes infection on the lips:

“ In childhood, there were frequent rashes on the lips, and now they mainly appear on the nasal mucosa or in the form of stomatitis.Do not treat stomatitis, but it stays stable for a week. Headaches and intoxication are very disturbing, as a rule, for no reason at all, symptoms of severe poisoning appear. Tablets from the “head” help with difficulty, more or less an injection of analgin with diphenhydramine saves. Not a single doctor about the headache even wanted to listen to . “

In people with reduced immunity (immunosuppression, HIV infection), necrotic forms of the course with the formation of scars on the skin are possible.

Advice for patients with a cold on the lips

– Strictly follow the rules of personal hygiene .The “cold” is contagious! Always wash your hands with soap and water before and after touching a cold sore, including after applying an antiviral cream.

– Don’t touch your eyes! Especially women when applying makeup;

– Do not use saliva to moisturize contact lenses.

– Despite the itching and pain, should not touch the rash, kiss, especially with children, use someone else’s lipstick or borrow your own, smoke one cigarette with a friend (girlfriend).

– Do not try to remove blisters and crusts to avoid transmission of infection to other parts of the body or bacterial infection.

– Give up oral sex! Oral sex during a “cold” on the lips of an “active” partner can cause genital herpes in a partner who is passively involved in oral sex. In this case, herpes from the lips of the “active” partner can be transferred to the genitals of the partner who is receiving caresses.
– If you have a cold on your lips, use individual dishes or a towel, do not drink from someone else’s glasses…

Newborn care. In order to avoid contracting herpes in a newborn, women who have herpes sores on the lips should wash their hands thoroughly before touching the baby. If there are bubbles or sores on the lips, a disposable surgical mask or gauze dressing should be used while caring for the baby until the sores are dry. When you have a cold on your lips, do not kiss or sniff your child. If herpes is present on any other part of the body, then it must be carefully closed and in no case come into contact with the child’s skin.

REMEMBER:

– When you feel a tingling sensation, the action of the virus has already begun, which means it is time, without delay, to start using antiviral cream or other antiviral drugs prescribed by a doctor;

– Use medicines!

Medicines will help stop the development of a relapse or speed up recovery.

Use acyclovir-based creams and ointments, which will help the rapid healing of vesicles and ulcers, food supplements containing either zinc or L-LYSINE.Remember that the use of corticosteroids (hydrocortisone ointment) reduces itching, but dramatically increases the area and severity of the lesions and the duration of the painful period.

– Apply antiviral ointment with cosmetic sticks.

To apply antiviral ointments (Acyclovir, Zovirax) to herpetic eruptions, use special cosmetic sticks, as shown in this figure.

Applying ointments to the lesion directly with the fingers can cause the virus to be transferred from the lips to the skin of the fingers.

– If you have frequent relapses, make sure that the medicine is always at hand. Keep it with you as a passport or money;

– Acyclovir-based creams and ointments should be used at least 4 times a day for 5 days.

– Valacyclovir can be prescribed for a one-day treatment of herpes of the lips as directed by a doctor. If you take two tablets of valacyclovir 500 mg, first in the morning and then in the evening, within 24 hours from the onset of the disease, then a cold on the lips will not develop or the healing of herpetic lesions will occur faster.

– If within 10 days the “cold” has not gone away, be sure to consult a dermatologist, as a “cold” on the lips can be a symptom of other serious diseases that require specialized treatment.

– A prolonged course of a cold on the lips (more than 30 days) can be a sign of a sharp decrease in immunity, benign tumors and oncological diseases, HIV infection, lymphoproliferative diseases.

Genital herpes

Genital herpes ranks second (after trichomoniasis) among sexually transmitted infections.Diseases caused by herpes rank second after influenza in mortality from viral infections (excluding AIDS). This infection occurs in more than 90% of the world’s population. Most people are passive carriers of the virus, and certain clinical manifestations of herpes are found in only 20%. Herpes simplex virus (HSV) is of two types, which are conventionally referred to as HSV-1 and HSV-2. Viruses are very similar to each other and, entering the body, cause the same symptoms of the disease.

Genital herpes. What to do

Usually, the manifestations of herpes or their absence depend on the state of the immune system of the carrier of the virus and the general state of his health. HSV is one of those viruses that, once introduced into the body, remain in it for life. Another thing is that, with a good tension of immunity, as well as with the observance of certain norms of a healthy lifestyle, the body does not allow a small number of dormant viruses to be activated so as to cause clinical signs of the disease.Remember: the most famous manifestation of herpes is the so-called. “Cold” on the lips, most often occurs during acute respiratory viral infections, flu or other diseases that weaken the immune system.

More often women suffer from genital herpes – its prevalence among them is almost 6 times higher than among men. By the way, if in the middle of the 20th century the types of HSV-1 and HSV-2 clearly differed in the place of localization, now there are more and more cases of infection of the genitals with both types of HSV. Therefore, many modern test systems for detecting herpes simplex virus respond to both types of virus without differentiating them.

It is customary to isolate primary and recurrent genital herpes. The most striking clinical manifestations are characteristic of the first clinical episode of primary genital herpes: about 2-7 days after sexual contact with an infected person, grouped painful vesicles are found in the area of ​​external and internal genital organs . The vesicles develop into pustules, which break open to form ulcers. Around the ulcers, grayish crusts remain, covering the walls of the vesicles.At the same time, patients have a feverish state, headache, general malaise. New rashes may appear up to 10 days after the onset of the disease. Herpetic lesions outside the genitals as a result of self-infection are more often observed in women, mainly on the fingers. The full cycle of the primary disease lasts up to 3 weeks, and it is often possible to simultaneously observe lesions in different stages of development.

Relapses of genital herpes can be triggered by both a decrease in immunological reactivity and hypothermia or overheating (bath), physical or mental trauma, light exposure, alcohol intake, hormonal cycles, medical interventions, including abortion and the introduction of an intrauterine device.The clinical symptoms of recurrence in most cases are less severe and lasting than in the first episode of genital herpes.

In addition, herpes simplex virus can become the causative agent or a concomitant factor of inflammatory diseases of the central nervous system, eyes, respiratory system, cardiovascular system, gastrointestinal tract, genitourinary system. And it is especially unpleasant that the herpes simplex virus can cause pathology of pregnancy and childbirth, often leading even to miscarriages or fetal death, and in milder cases, causing an infection in newborns.

Currently, there are no treatment methods that can completely rid the human body of HSV. Therefore, the goal of treatment is to suppress the reproduction of HSV during an exacerbation, the formation of a sufficient immune response and its long-term preservation to block the reactivation of the virus. Primary Treatment Tasks:

Herpes is a very unpleasant and difficult to tolerate disease that undermines our immune system. We remind you that no article or website can make a correct diagnosis.For all questions of diagnosis and treatment of genital herpes, you can always contact the gynecologists and urologists of the LeVita Medical Center.

90,000 Herpes in children

What is herpes?

Herpes is a collective name for viral diseases caused by different types of herpes viruses. The herpes virus is polytropene, that is, it is capable of infecting almost any organ in the human body. To date, there are 8 types of herpes that affect humans.

Children are susceptible to herpes in the same way as adults. Most often, infection occurs from parents in the family or already sick children.

Susceptibility to the virus, depending on age

This disease is of several types, however, primary herpes is characteristic of children. Babies of the first years of life rarely get sick with them, since they are immune from their mother. They become more susceptible to the virus by 3-4 years, but by about 5 years from 60% to 80% of their number already have antibodies to it.

Types of herpes in children

It is worth distinguishing between herpes simplex viruses type 1. It is the most well-known type of herpes simplex virus, which manifests itself on the lip of a child, is characterized by general malaise, sometimes there is a slight fever. Oral ulcers are most common in children aged 1-2 years, but they can appear in people in any age and at any time of the year.

Crust on the lip of a child with herpes. Photo: victoriafly / freepik.com

The second type of herpes is genital, which manifests itself in a similar way. During childbirth, if the mother suffers from genital herpes, the baby can become infected by passing through the birth canal. The manifestations of this type of herpes in children are more difficult than in adults. Children can suffer from herpes sore throat and stomatitis.

Herpes simplex virus type 3 (varicella-zoster virus) in children with primary infection causes chickenpox in the secondary manifestation of the virus, the disease passes as herpes zoster (shingles).

Chickenpox. Photo: freepik.com

Herpes type 6 in children causes baby roseola – pink maculopapular rashes. Basically, it affects babies under the age of 2 years. At first, a fever develops, then the temperature decreases for 3-6 days. After a decrease in temperature, an exanthema appears on the skin – pink maculopapular rashes of 1-3 mm, pale when pressed (this is one of the distinguishing features, with the same rubella, the rash does not fade after pressure). They can disappear within a few hours, or they can persist for up to several days.The rash is localized mainly on the body, spreading to the neck, face and limbs

Children’s roseola. Photo: Wikipedia (Public Domain)

Herpetic viruses of types 4, 5, 6 can cause infectious mononucleosis – an acute infectious disease characterized by a febrile condition, sore throat, enlarged lymph nodes, liver and spleen, lymphocytosis, the appearance of atypical mononuclear cells in the peripheral blood.

Cytomegalovirus, a member of the type 6 herpesvirus family, is one of the most common viruses.Children usually contract cytomegalovirus infection in early childhood – for example, in a nursery or kindergarten. Cytomegalovirus transmission can only occur through direct contact with an infected person, and babies can also become infected with the virus during fetal development. The infected medium is blood, urine, saliva and other biological substrates. Usually, cytomegalovirus in healthy children is asymptomatic or accompanied by minor symptoms similar to those of mononucleosis and disappearing after a few days or weeks.

Enlarged lymph nodes in the neck of a child with infectious mononucleosis. Photo: GMS current topics in otorhinolaryngology, head and neck surgery / Open-i (CC BY-NC-ND 3.0)

Human herpesvirus types 6 and 7, when initially infected, cause exanthema of newborns in infants. Only a specialist can accurately diagnose the health of a child …

Herpes in infants

Herpes can be more difficult in children than in adults. Herpes is an insidious infection, herpes in infants can cause severe damage to the nervous system and internal organs.With damage to the visual organs, keratitis, phlebothrombosis, chorioretinitis, iridocyclitis occur. With the defeat of the ENT organs, sudden deafness, herpetic sore throat and damage to the inner ear may occur. Damage to the cardiovascular system is manifested in the form of myocarditis, atherosclerosis, myocardiopathy. If the herpes virus enters the central nervous system, then there is a risk of encephalopathy, meningitis, and the nerve plexuses are affected. Herpes can also lead to schizophrenia and depressive disorders.On the part of the reproductive system, fertility disorders, urethritis, prostatitis (in men), colpitis, endometritis and chorionitis (in women) are possible.

Herpes symptoms

Symptoms of herpes in children are traditional: there may be fever, fatigue, muscle pain, irritability. At the site of future rashes of infection, pain, burning, tingling and itching occur. The rash is followed by ulceration and wound formation. Children tend to scratch the wounds until they bleed, touch them constantly, peel off the formed crusts, which complicates healing and prolongs its period.Herpes simplex on a child’s lip heals within a few days at best. Ulcers can also occur in the mouth: on the gums, front of the tongue, inside of the cheeks, throat, and palate. The gums may be slightly swollen, red, and may bleed. They can also spread down the chin and neck. The lymph nodes in the neck often swell and become painful. In children, the herpes virus can affect the throat mucosa with the formation of small ulcers and a grayish coating on the tonsils.Because the ulcers are painful, it can be difficult to eat or drink. A sick child should not eat solid or hot food during the onset of herpes in the mouth. With permanent injury, the wound healing can take two weeks or more. Parents need to control this process.

Treatment of herpes in children

Antiviral drugs, immunostimulants, interferons are used for the treatment of herpes infection. Treatment of an infection should be started at the first suspicion of a disease, recovery depends on this, an advanced infection becomes chronic or recurrent, and the likelihood of complications increases.Treatment of herpes in children is aimed at minimizing the manifestation of symptoms, suppressing the activity of the virus. For this, antiviral drugs are used – ointments and tablets that relieve itching and soreness. It is necessary to take a large amount of fluids, as well as antipyretics when the body temperature rises to high numbers.

Photo: MedPortal

The antiviral drug used for herpes infection is acyclovir. This medication can be used either as an intravenous injection or as a tablet.The route of administration of the drug depends on the severity of the disease and its form. The drug is administered intravenously at a dosage of 30-60 mg / kg of the child’s body weight, through the mouth – 90 mg / kg. Taking the drug must be divided into 3-4 parts. Also, this drug can be used externally in the form of an ointment. It must be applied to the affected skin and mucous membranes 4-5 times a day.

Immunostimulating drugs help the child’s body to fight the virus more effectively and prevent the virus from infecting new areas of the mucous membranes and internal organs.For treatment, you can use such immunostimulating drugs as immunal, groprinosin, arpetol.

Interferons help destroy viruses and prevent them from multiplying uncontrollably. They can be used both in tablet form and in the form of suppositories. Suppositories are injected into the child’s anus 2 times a day for 5 days, repeat the course 2-3 times with an interval of 5 days.

With a fairly frequent recurrence of the disease, you need to contact a specialist immunologist who will give qualified advice, which can significantly increase the immunity of a weakened child.Among other things, the treatment of herpes in children should be monitored by a doctor, since only a specialist can calculate the correct dosage that is safe for the child’s body.

The herpes virus, once in a child’s body, remains in it for life, periodically aggravating, causing temporary discomfort. The main task of parents is to help the child, strictly following the instructions of the pediatrician. When solving the existing problem, special attention is paid to the observance of hygiene, providing the baby with individual means, such as a towel, soap, and a washcloth.The child should wash his hands more often. If there is a herpes in the mouth, the child should not be allowed to injure herpes sores.

Prevention of herpes in children

For the prevention of herpes, it is necessary to observe the rules of personal hygiene and not to use other people’s personal belongings, to avoid close contact with people with herpes. To strengthen the child’s immune system, proper nutrition, vitamin therapy in the autumn-spring period, the use of immunostimulating drugs in prophylactic doses in the winter period are necessary.Prophylactic use of antiviral ointments during an influenza epidemic by putting in the nose 1-2 times a day.

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DNA of herpes simplex virus types 1 and 2 (HSV1,2 DNA) – SYNLAB Eesti

Herpes simplex virus belongs to the Herpesvirus family and is a DNA virus, the two serovariants of which HSV1 and HSV2 can cause infection of the face, mouth, pharynx, genitals. Infection occurs through direct contact with a person actively secreting viruses. The acquired infection remains for life, the initial and subsequent episodes of the disease, as a rule, are self-limiting, the latent infection persists in the dorsal nerve ganglia.In 70-90% of HSV2 causes genital herpes, the primary disease is almost always associated with sexual contact.

HSV2 causes painful bilateral ulcerative and exudative lesions of the skin and mucous membranes of the genitals, which may be accompanied by general symptoms such as fever, headache and muscle pain. The defeat of the urethra can be in both men and women. Depending on sexual habits, the perianal, rectal, or oral cavity may be infected.

HSV1 infection occurs during childhood, causing gingivostomatitis, pharyngitis, conjunctivitis, or trigeminal nerve damage. When the infection is disseminated, meningoencephalitis, pneumonia, esophagitis, hepatitis, proctitis can develop. Eye infections are predominantly promoted by HSV1, causing conjunctivitis, cretoconjunctivitis, or keratitis. Recurrent keratitis can, in turn, contribute to keratouveitis and subsequent corneal scarring with loss of vision.

70-85% of HSV infections of the fetus and newborn are caused by HSV 2.In the third trimester of pregnancy in a mother with a primary infection of genital herpes or infection with another serotype, the risk of infection in a newborn increases to 33% compared to reactivation – 3%. Most mothers who have herpes infection in their children have had it asymptomatically. In 50% of children, skin changes may not appear when infected.

The newborn may have lesions of the skin, eyes, oral mucosa, central nervous system, or disseminated infection.

Indications: Suspected herpes virus infection (urogenital infections, central nervous system infections, neonatal and congenital infections)

Test material: Contents of herpetic bladder, scraping from an ulcer, cerebrospinal fluid, scraping from the conjunctiva, other ocular material, amniotic fluid, plasma in newborns (tube with EDTA addition).

Analysis method: PCR (polymerase chain reaction), Luminex xMAP

Reference value: Negative

Result interpretation:

• A positive result confirms an HSV1 or HSV2 infection.
• A negative result does not exclude infection, but indicates the absence of HSV1 and HSV2 in this material, or their number is less than the limit determined by this method. Correct sampling of the test material is important.

In case of systemic infections, a false-negative result may occur if the material is taken 1-3 days after the onset of symptoms or if antiviral therapy was started before taking the cerebrospinal fluid for research.

The sensitivity of the PCR method decreases 10-12 days from the onset of the disease.

For the diagnosis of herpes infection in newborns, cerebrospinal fluid alone is not enough; urine, blood and material from skin rashes should also be taken, which increases the likelihood of detecting the virus.

90,000 What is stomatitis, what types are there and how to treat it?

Stomatitis is considered to be a childhood disease, but it can appear at any age. Among adults, older people and smokers are more susceptible to stomatitis. Also, the risk factors include poor oral hygiene and micronutrient deficiencies in the body.

Causes of stomatitis

The main cause of stomatitis is infection: viral, bacterial or fungal. But by themselves, viruses and bacteria are not terrible for the body, the disease develops only under certain conditions:

• damage to mucous membranes: biting the inside of the cheek, burns, trauma to the sharp edge of a chipped tooth or solid dry food, etc. A small wound is enough for the infection to develop for the disease to develop;
• Poor oral hygiene, hard dental plaque;
• deficiency of vitamins B, zinc, folic acid, iron;
• smoking: causes an imbalance in the microflora of the oral cavity and the constant negative effect of hot smoke on the mucous membranes, which over time can lead to the so-called “smoker’s stomatitis”;
• decreased salivation: occurs due to the use of certain drugs, dehydration, against the background of stress and a number of diseases;
• Using sodium lauryl sulfate (SLS) toothpastes and brushing your teeth too often;
• Incorrectly installed dentures or their poor quality;
• changes in hormonal levels during pregnancy, menopause, adolescence.

In the clinic “PROPRICUS” in Moscow, the treatment of stomatitis is prescribed only after a thorough diagnosis and identification of the cause of the disease. This allows you to choose the most effective therapy depending on the type of stomatitis.

Types of stomatitis: symptoms and treatment

Stomatitis is a common name for various inflammations of the mucous membranes in the oral cavity: on the palate, the inner surface of the cheeks, under the tongue, in the throat, on the lips or gums.Therefore, with stomatitis, the symptoms and treatment are due to the causes of the disease and the affected area.

Inflammation of the gums (gingivitis)

It manifests itself in bleeding, swelling of the gums and discomfort when pressed. It is accompanied by an unpleasant odor from the mouth. Sometimes it leads to tooth mobility. With gingivitis, professional hygiene is often carried out, and then the periodontium determines how to treat stomatitis in the mouth and strengthen the gums: he can prescribe rinsing, recommend a therapeutic toothpaste and an electric toothbrush with a special nozzle.

Stomatitis on the lip (cheilitis)

Symptoms can be different: “cold” on the lip, severe peeling, inflammation of the border of the lips, cracks along the entire surface of the lips. How and how to treat stomatitis on the lip in an adult depends on the nature of the inflammation. An integrated approach is practiced:

• elimination of acute symptoms: for pain, anesthetics are prescribed, at high temperatures – antipyretic drugs;
• topical treatment: drugs are used to relieve inflammation and promote tissue healing;
• correction of the state of the immune system.

But before treating stomatitis on the lip, it is necessary to determine the cause of the appearance of this disease, since without eliminating it, there is a high probability that the problem will soon recur. Taking into account the nature of the infection, it is prescribed to take medications (antibiotics, antiviral drugs, etc.), vitamin therapy and adherence to a sparing diet.

Inflammation of the tongue (glossitis)

Signs: swelling of the tongue, discoloration to burgundy or bright red, the appearance of plaque, the formation of painful ulcers.The general approach to how to treat stomatitis in the tongue in adult patients involves two directions: the removal of local symptoms (antiseptic rinsing, applications, etc.) and the impact on the main cause of inflammation.

Stomatitis in the throat

Sore throat is characterized by painful sensations when swallowing, headache; the temperature may rise. To understand how to treat stomatitis in the throat in adults, blood tests, saliva tests (bacterial cultures), and cytological smear tests are often prescribed.For treatment, antiseptic sprays and rinses are used, drugs aimed at eliminating the causative agent of stomatitis, and anti-inflammatory drugs.

In addition to following the doctor’s recommendations, with stomatitis in the throat, it is advisable to drink decoctions of herbs, avoid overheating (baths, saunas, hot baths) and physical activity.

Acute herpetic stomatitis

It is caused by the herpes virus and usually proceeds with fever, vomiting and diarrhea; vesicles appear on the mucous membranes, turning into sores, which heal after a few days.When diagnosed with herpetic stomatitis, treatment is aimed at relieving symptoms and immunocorrection.

Fungal stomatitis

Stomatitis caused by candidiasis (fungal infection) is characterized by the appearance of a white coating of curd consistency, a feeling of dryness and burning in the mouth. During the treatment of candidal stomatitis, it is important to observe hygiene: thoroughly wash your hands and dishes, rinse your mouth before and after meals. The diet should consist of warm food and plenty of drink, it is necessary to exclude smoked, salty, spicy foods.The oral cavity is treated with antifungal and anti-inflammatory agents.

Medical stomatitis

This type of stomatitis is the result of an allergic reaction to antibiotics and other medications. Symptoms include the formation of spots, blisters, and ulcers on the mucous membrane, accompanied by painful sensations and bad breath.

Comprehensive treatment of medical stomatitis consists of several stages:

• exclusion of the drug that caused stomatitis;
• taking antihistamines;
• diet correction;
• Sprays or ointments are used to heal affected areas, often with an anesthetic in the composition to relieve pain.

Stages of stomatitis

According to the clinical picture, there are three types of stomatitis.

Catarrhal stomatitis

The most common type of stomatitis caused by poor oral hygiene, tartar and dental disease. The mucous membranes become inflamed, reddened and swollen, but ulcers and deep defects are absent. It is accompanied by bad breath, increased salivation, dryness and soreness of the mucous membranes.

With catarrhal stomatitis in the mouth in adults, treatment is primarily aimed at relieving inflammation, for which antiseptic solutions, rinses, lozenges, etc. are used. A sparing diet is required to avoid further injury to the mucous membranes.

After eliminating the symptoms of stomatitis, you can treat your teeth and carry out professional hygiene to get rid of tartar and prevent stomatitis in the future.

Ulcerative stomatitis

As a rule, this is the next stage of catarrhal stomatitis.The smell from the mouth increases, sores appear with a gray coating, food intake is accompanied by pain. In some cases, the temperature rises and the lymph nodes enlarge.

At this stage, only the doctor decides how to treat severe stomatitis and what combination of drugs is suitable in this case: they usually combine pain relievers, antihistamines, vitamins, healing agents with antibiotics and treatment of rashes.