Do herpes bumps always hurt? What is the difference between HSV-1 and HSV-2? Can you get genital herpes without having visible sores? Get the answers to these burning questions and more.

Understanding the Types of Herpes Simplex Virus

There are two main types of herpes simplex virus (HSV) infections: HSV-1 and HSV-2. HSV-1 is typically responsible for those annoying cold sores that can appear during times of stress or lack of sleep. On the other hand, genital sores are usually caused by HSV-2. However, it’s important to note that HSV-1 can also cause genital ulcers, though these tend to be less severe and less likely to recur.

The Timeline of Herpes Symptoms

It can take as little as a few days and up to a week after exposure before any herpes symptoms appear. The initial symptoms often include redness, tingling, and the development of small, painful bumps that progress into fluid-filled “blisters.” These blisters eventually burst, forming shallow skin ulcers that then crust over and heal gradually over a couple of weeks. An initial genital herpes infection can be quite painful and may also cause fever, body aches, and fatigue. However, recurrent outbreaks tend to be less severe.

The Danger of Asymptomatic Shedding

Can you get genital herpes if your partner doesn’t have any visible sores? The answer is yes. A person can be exposed to the virus and pass it to someone else without ever having symptoms. This is called “asymptomatic shedding of virus,” and it happens more often than you might think. Although there is a higher level of active virus when there are sores, asymptomatic shedding is probably how most people get herpes.

The Importance of Testing and Disclosure

If a person has genital ulcers, it’s important to see a doctor and confirm whether or not it is herpes. Genital herpes outbreaks can be treated with antiviral medications, which can help reduce the number of days of discomfort and have few side effects. Some people even take these drugs daily to prevent outbreaks.

Once someone has been diagnosed with genital herpes, their future partners can have a blood test to determine if they have also been exposed to the same strain of the virus. If the partner tests negative, the person with the infection would be advised to take antiviral therapy daily to help prevent transmission.

The Controversy Around Widespread Screening

If you’ve never had genital ulcers and don’t believe you’ve been exposed, should you get tested for herpes? This is a controversial topic, and the widely followed official guidelines actually discourage widespread screening. The reasoning behind this is that a positive blood test for HSV-2 can be devastating, as it carries a significant social stigma and may lead to false-positive results. Additionally, taking daily antiviral medication for a condition you may or may not have and may or may not spread can seem unreasonable.

However, not all experts agree with the official guidelines. Except for the uncommon case of a false-positive blood test for HSV-2, a seropositive test means one of three things: the person has had herpes with symptoms, the person has had herpes with symptoms but didn’t realize the cause, or the person has the herpes virus and may shed virus from time to time in genital fluids. The only way to know if a person is shedding the virus is with daily tests, which is not practical.

Who Should Consider Getting Tested?

According to some experts, people who should strongly consider getting a blood test for herpes include those with any other sexually transmitted infection. The reasoning behind this is that the presence of another STI may indicate a higher risk of exposure to herpes as well.

The Bottom Line

Genital herpes is a complex and often misunderstood condition. While it’s true that visible sores are a hallmark of herpes, the virus can also be transmitted through asymptomatic shedding, putting many people at risk of infection without their knowledge. Understanding the different types of herpes, the timeline of symptoms, and the importance of testing and disclosure is crucial for reducing the spread of this common, yet often stigmatized, sexually transmitted infection.

Genital herpes: The painful facts about a tricky virus

There are two main types of herpes simplex virus (HSV) infections, HSV-1 and HSV-2. Generally speaking, HSV-1 is responsible for those annoying cold sores that can pop up during times of stress or lack of sleep. Genital sores are usually caused by HSV-2. 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 herpes symptoms appear. First, there will be redness and tingling, followed by small painful bumps that progress to fluid-filled “blisters.” Eventually, these burst to form shallow skin ulcers which then crust over, with gradual healing over a couple weeks. An initial genital herpes infection can be very painful, also cause fever, body aches and fatigue. Recurrent outbreaks tend to cause less severe symptoms. Rarely a genital herpes infection can cause 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.

Many people who learn they have genital herpes are shocked. They often didn’t see any sores on their partner (and they really looked!) or that their partner had never had any ulcers, ever. 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. 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 a person has a blood test that 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, not all experts agree with the official guidelines. Except for the uncommon case of a false positive blood test for HSV-2, a seropositive test 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 and may shed virus from time to time 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. People who should strongly consider getting a blood test include:

• people with any other sexually transmitted infection including chlamydia, human papilloma virus (HPV), etc.
• people in a relationship with a herpes-positive partner, especially if you are a pregnant woman or plan to become pregnant
• any person who asks to be tested.

If you are not sure about getting tested, talk with your doctor.

Adapted from a Harvard Health Blog post by Monique Tello, MD, MPH

Genital herpes: Signs and symptoms

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Genital herpes – symptoms, diagnosis, treatment methods.

Primary infection is when the virus enters the body for the first time and the person has not yet developed antibodies to it. This can manifest itself both with the first rash on the body, and asymptomatically, which happens most often. External manifestations of primary infection with the virus last up to 14-22 days with an increase in symptoms in the first week. The disease can proceed for quite a long time, not only the genitals can be affected, and be accompanied by general and local / local symptoms. Common symptoms include fever, headache, malaise, and myalgia. Local phenomena include pain, painful urination, itching, discharge (from the vagina or urethra). Symptoms may gradually disappear up to 2-3 weeks. Sometimes there may be a more complex course of HSV that require hospitalization (severe aseptic meningitis, disseminated infection, etc.). In such cases, the course of the disease can be delayed up to 1.5 months.

Non-primary infection with occurs in people who have already been exposed to the virus and who have antibodies to it. In these patients, the disease, as a rule, proceeds with less severe symptoms: the duration of which is about 15 days. Sometimes, the virus can be asymptomatic, and the course of the disease lasts 7-8 days.

Recurrent infection is detected in those patients who have both symptoms of genital herpes and antibodies to the reactivated type of virus. The course of relapse can also be asymptomatic, and therefore, HSV can be diagnosed by performing specific research methods. The severity and duration of the course of the disease during relapse is even less than with the above forms of genital infection, and is only 2-3 days. Relapse in type 2 HSV occurs more frequently than in type 1 HSV. The frequency and nature of the appearances in patients can be quite different and affect well-being.

Causes causing activation and/or recurrence of HSV:

• immunosuppression;
• hypothermia or vice versa overheating of the body.
• stress and some physiological conditions of the body.;
• medical manipulations/surgical interventions.
• intercurrent diseases (acute disease, joined to existing chronic ones, for example: secondary infection).

The first manifestation of herpesvirus infection, as a rule, manifests itself more rapidly than subsequent relapses. In some patients, they are short-lived. Most infected people do not have symptoms of genital herpes.

HSV affects the skin and mucous membranes (most often on the face and genitals), the central nervous system, causing meningitis, encephalitis, eyes (conjunctivitis, keratitis). Also, HSV can provoke a pathological course during pregnancy and childbirth, and cause miscarriage, miscarriage, developmental anomalies and / or fetal death, generalized damage by the pathogen of the virus in all organs and systems of the newborn. There has been an association between cervical cancer in women and prostate cancer in men. HSV, like some other herpesviruses, it is capable of a latent course of the process, which subsequently reactivates and can cause constant exacerbations of the disease and asymptomatic isolation of the virus.

Ways of transmission of HSV

Airborne. Contact household. Through non-sterile instruments, personal hygiene products (razors, etc.). Sexually. Vertical transmission of the virus (from mother to fetus). The disease is transmitted mainly through sexual contact, regardless of the form of intimacy (genital, oral, anal) from a patient with genital herpes or a carrier of the virus. Infection can occur when the partner who is the source of the infection has a recurrence of the disease or, most importantly, when he sheds the virus without having clinical symptoms. Sometimes, HSV can infect individuals who do not have active manifestations of the virus at the time of sexual intercourse or even episodes of virus activation, and therefore do not even know that they are infected. It is not excluded the possibility of infection through household through personal hygiene products. HSV is introduced into the body through the skin mucous membranes, after which it is captured using viral receptors by sensory nerve endings. Herpes has a devastating effect on the patient’s immune system and, therefore, becomes the cause of secondary immunodeficiency. Relapses of HSV disrupt the patient’s full-fledged sexual life, and are often the cause of neuropsychiatric and psychological disorders. Manifestations on the mucous membrane and skin are the most common manifestation of the disease, and infection with genital herpes is one of the most common sexually transmitted diseases.

The risk of infection of the baby during pregnancy and childbirth depends on many factors, and can reach a 75% probability. Intrauterine infection caused by HSV-2 is less common. In the vast majority of cases, infection of the newborn occurs during childbirth when the baby passes through the birth canal of the mother. Moreover, the transmission of infection is possible both in the presence of lesions in the cervix and vulva, and with asymptomatic isolation of the virus. When the virus is isolated during pregnancy, it can cause fetal death, causing missed / non-developing pregnancies and provoke miscarriages, both in the early and late stages of gestation. HSV takes the 2nd place after the rubella virus in terms of fetal abnormalities. Possible, infection of the newborn and after childbirth, with active manifestation in the woman in labor and honey. personnel, but this happens very rarely.

Symptoms

Typical localization in women: on the large and small labia, on the vulva, clitoris, in the vagina, and on the cervix, and also often on the perianal region, and buttocks. In men, these are the glans penis, foreskin, and urethra.

There are several forms of recurrent genital herpes:

1. Manifest form of recurrent herpes is characterized by the presence of herpetic elements in the lesion. Typical manifestations of the disease are vesicles, erosion, sores, exudation, recurrent nature of the disease. Some patients with genital herpes complain of general malaise throughout the body, headaches, fever to subfebrile values, some have disturbed sleep, and also anxiety and irritability appear. As a rule, at the stage of development of the disease, patients note a burning sensation, itching, “irritation and” tickling “, pain in the genital area. The affected area becomes somewhat edematous, reddens, and then, single or multiple small vesicles up to 2-3 mm appear. The contents of these vesicles are initially transparent, then cloudy, and become purulent. Within a few days, the blisters empty, dry up, crusts form, which gradually fall off, and spots remain in place of these rashes for several days, and subsequently disappear completely.
2. Atypical form occurs in the form of swelling and itching. The affected area is represented by deep recurrent cracks in the skin, genital mucosa and underlying soft tissues, which heal in 4-5 days.
3. Abortive herpes is most common in patients who have already received antiviral drugs and vaccine therapy. Herpetic lesions in this form of herpes bypass the stages due to the manifest form, and may appear as itchy spots or papules that resolve on their own within 1-3 days. Abortive forms of herpes include: erythematous, papular, and prurigoneurotic, in which there are no vesicular elements. Diagnosis of varieties of genital herpes, occurring in an erased abortive form, sometimes causes great difficulties. The disease is usually recognized when the typical recurrences of herpes alternate with rashes or occur simultaneously with them.
4. Subclinical form of genital herpes is mainly detected when examining individuals with STDs (sexually transmitted diseases), or in married couples with impaired reproductive functions. This form is characterized by “microsymptoms” (short-term appearance of mild, superficial cracks, accompanied by slight itching), or the complete absence of any external manifestations.

Patients with genital herpes are conditionally divided into three stages depending on the location and severity:

• Stage 1 – damage to the external genital organs.
• Stage 2 – herpetic colpitis, cervicitis, urethritis.
• Stage 3 – herpetic endometritis (virus infection of the uterine mucosa), salpingitis (fallopian tubes) or cystitis (inflammation of the bladder).

Herpetic vesicles form characteristic polycyclic scalloped figures. Subsequently, superficial, covered with a grayish coating of sores are formed according to the number of former bubbles or continuous erosion with a smooth bottom and not undermined edges, surrounded by a bright red rim. The sores are not deep and do not bleed. Herpetic ulcers are sometimes very painful. Sores and erosions heal without leaving scars. Herpetic eruptions on the labia minora and vulva in women, in some cases, cause significant swelling of the labia. With herpetic cervicitis, the cervix is ​​edematous, often has erosion. Relapses occur either spontaneously, or after sexual intercourse, or before and after menstruation. Often the appearance of genital herpes is provoked by other infections. Herpetic recurrent infection can be localized not only in the area of ​​the external genitalia, but also affect the mucous membrane of the vagina, cervix and ascending through the mucosa of the uterine cavity, fallopian tubes, mucosa of the urethra and bladder, and cause a specific lesion in them.

The clinical picture of lesions of the herpes virus in men appear most often in the form of small bubbles, and the formation of superficial ulcers on the glans penis, foreskin, groove area. The course of the disease is characterized by recurrent episodes. Complaints with herpetic urethritis in men begin with the appearance of pain, with irradiation to the scrotum, penis, urethra, legs, buttocks, perineum, burning sensation in the urethra. Patients also note these complaints during urination, the appearance of light or yellowish discharge from the urethra, redness and swelling in the area of ​​​​the opening of the urethra. At the stage of erosion healing, erythematous or pigmented spots are visualized in this place. The chronic course of recurrent balanoposthitis is detected in most patients with herpes.

Infection of the genitals caused by HSV in some patients provokes psychological and even psychosexual disorders, in the form of embarrassment, fear of sexual intercourse, depression, loss of self-confidence, mental trauma, anger, decreased self-esteem, loss of self-esteem, increased anxiety, negative emotions, hostility and even aggressiveness towards the source of infection. Many, out of fear of rejection, hide the information that they have genital herpes. Women perceive and endure this news more emotionally, due to the psychological characteristics of the weaker sex. Moreover, in those patients who first encountered genital herpes, there are deeper psychological problems than with other sexually transmitted diseases. Frequent exacerbations, and pronounced manifestations of the disease can affect his behavior and even change the character of the patient.

Herpes simplex skin infections

Herpes simplex skin infections

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Main

• In addition to the mucous membranes of the mouth and genitals, Herpes simplex virus can also cause skin lesions.
• Diagnosis is based on the clinical picture and recurrence of lesions with the same localization.
• Herpes infection of the periorbital region requires immediate consultation with an ophthalmologist.
• Antiviral drugs are used to relieve symptoms and shorten the duration of the illness; the virus cannot be completely eliminated.
• With frequent recurrence of herpes infection, antiviral drugs are prescribed for prophylactic purposes.

Etiology

• Virus Herpes simplex (HSV-1 and HSV-2) causes skin infections. HSV-1 most often affects the skin, HSV-2 – the genital area.
• Primary HSV-1 infection usually occurs during childhood. An oligosymptomatic or asymptomatic course leads to the fact that the primary infection often goes unnoticed. HSV-2 infection usually occurs in adulthood.
• In some people, primary infection is accompanied by severe symptoms (eg, gingivostomatitis, pharyngitis, genital herpes).
• Primary skin infection is rare.
• The virus is in a latent state in the nervous system and is activated from time to time under the influence of environmental factors.

Prevalence

• Herpesvirus carriage is widespread among the adult population: 50 – 60% and 15 – 20% of HSV-1 and HSV-2, respectively. Most carriers are asymptomatic.

Symptoms

• The symptoms and clinical picture of the disease are often typical, and the diagnosis is based on clinical manifestations.
• Soreness, burning and tingling of the affected area usually occurs before the rash appears.
• First, focal erythema with clear boundaries develops, later clustered vesicles with transparent contents appear.
• Individual vesicles may transform into pustules or vesicles with hemorrhagic contents.
• Clustered vesicles may also appear on nearby skin. After the opening of the vesicles, small irregularly shaped erosions remain on the skin.
• The illness usually lasts 1-2 weeks, but in some cases the course is longer.
• Typical lesions are the skin of the perioral region, face, genital region, buttocks, perianal region, hands and fingers.
• Skin manifestations of herpes usually indicate reactivation of a latent infection.
• Factors provoking such reactivation are a cold or flu, mechanical trauma, medical or dental procedures, injury, stress, insolation, menstruation, secondary infection through fingers, for example, lips or genital area (self-infection).
• Generalization of infection (disseminated disease) may occur in individuals who are immunocompromised (eg, HIV infection) and/or receiving immunosuppressive therapy (eg, antirheumatic drugs, cytotoxic drugs).
• Infection can also spread in patients with atopic eczema, predominantly affecting the face (Kaposi’s herpetic eczema). This does not indicate the presence of immunodeficiency.

Examination

• In typical cases, there is no need for additional examination, the clinical picture is sufficient.
• The virus can be typed by detection of its antigen or by culture.
• The culture specimen is best taken by puncturing the vesicle and running a cotton swab over the exposed eroded surface.
• Culture may be negative, especially if collected long after symptom onset.
• Antibody tests confirm the presence of the virus, but do not provide information on the timing or area of ​​infection. The level of antibodies in isolated skin infection (reactivation) is usually not elevated, its slight increase is possible with primary infection. Assessing antibody levels in herpetic skin lesions is useless.
• For the diagnosis of HSV infection of the central nervous system and neonatal herpes, if necessary, use PCR (in cerebrospinal fluid) and the determination of the level of antibodies.
• In unclear cases or in the absence of response to empirical therapy, samples should be taken for bacteriological and/or mycological examination from the surface of the affected area of ​​the skin.
• Allergic contact dermatitis is diagnosed by skin tests.
• With severe clinical manifestations and low efficacy of therapy, one should not forget about the possibility of immunodeficiency (for example, HIV infection, hemoblastoses, other malignant diseases).

Treatment

• Local lesions in herpetic infection do not require mandatory drug therapy.
• In the treatment of herpetic infections of the skin, mucous membranes and genital area, the effectiveness of antiviral drugs has been proven.
• The earlier treatment is started, the more effective it is.
• The patient must learn to recognize the first signs of the disease and begin therapy on their own.
• In immunocompromised patients, systemic antivirals (oral or intravenous, depending on the clinical presentation) are started even with mild symptoms or suspected herpes infection to avoid its possible generalization and / or progression to the development of a necrotizing lesion.
• Systemic therapy
  • Duration of treatment is 5 days; in patients with severe manifestations, it is possible to extend the duration of treatment up to 7-10 days.
  • Higher doses are recommended in immunocompromised patients (eg, Valacyclovirum (valaciclovir) 500 mg, 2 tablets twice daily).
  • Topical treatment
    • There is no strong evidence for the effectiveness of topical therapy for herpetic skin infections, but it may be sufficient for mild cases.
    • In mild cases, antiviral drugs (Acyclovirum (acyclovir) or Pencyclovirum (penciclovir)) can be applied topically in the form of a cream or ointment every 2-4 hours during the day for 5-10 days.
    • In the stage of blistering, use lotions that dry the skin, for example, 15 minutes 2-3 times a day, then apply zinc paste or lotion
    • Some patients require analgesics.

Recurrent herpetic infection

• For rare relapses, a course of treatment with the above antiviral drugs is used. A prescription should be written in advance so that the patient can quickly begin treatment immediately after the onset of symptoms.
• In case of frequent relapses of the disease (to reduce their frequency), antiviral drugs are prescribed for prophylactic purposes for a period of 6-12 months.
  • Treatment should be individualized, depending on the severity of manifestations. If possible, pauses between courses of treatment and evaluation of indications for further prophylactic therapy are necessary.
  • Higher starting doses, such as Valacyclovirum (valaciclovir) 500 mg twice daily, are recommended for prophylactic therapy in patients with severe symptoms or recurrence of infection during prophylactic therapy.
  • During the prophylactic use of antiviral drugs in patients with immunodeficiency, resistance to therapy often develops. Therefore, in this group of patients, the use of higher daily doses (for example, Valacyclovirum (valaciclovir) 500 mg twice a day) is recommended.