Herpes simplex infections

Notification requirement for herpes simplex infections

Notification is not required.

Primary school and children’s services centre exclusion for herpes simplex infections

Young children with cold sores who are unable to comply with good hygiene practices should be excluded while the lesion is weeping. Lesions should be covered by a dressing, where possible.

Infectious agent of herpes simplex infections

Human herpes simplex virus (HSV) types 1 and 2 cause disease.

Identification of herpes simplex infections

Clinical features

HSV has been isolated from nearly all visceral and mucocutaneous sites. The clinical presentation depends on portal of entry, age, immune status and type of HSV (1 or 2) infection.

Cold sores are the most common manifestation of herpetic infection, and are characterised by a perioral primary lesion, latency and a tendency to local recurrence. Anal and perianal infections are common among sexually active populations of men who have sex with men.

In children with atopic dermatitis/eczema and immunosuppressed patients, HSV may cause a generalised eruption that requires hospitalisation for antiviral therapy. Cutaneous HSV infection may become chronic in patients with HIV infection or other immunosuppression, with recalcitrant crusted lesions and ulceration, or the infection may disseminate to cause severe extensive disease with visceral organ involvement. HSV infection may be complicated by erythema multiforme or Bell’s palsy, which is often more disabling than the infection itself.

HSV types 1 and 2 generally produce distinct clinical syndromes, depending on the portal of entry.

HSV-1

The primary infection may be mild and generally occurs in early childhood before the age of 5 years. About 10 per cent of primary infections cause a more severe form of disease manifested by fever and malaise. This may last a week or more, and can be associated with vesicular lesions leading to ulcers in and around the mouth (gingivostomatitis), eye infection (keratoconjunctivitis), a generalised vesicular skin eruption complicating chronic eczema or, more rarely, encephalitis. In immunosuppressed populations, syndromes such as pneumonitis or hepatitis may occur.

Features of gingivostomatitis include ulceration of the tongue, gums, lips and anterior buccal mucosa; severe systemic toxicity; and lymphadenopathy.

Reactivation of latent viral infection in the dorsal root ganglia results in cold sores appearing as clear vesicles on an erythematous base. These usually occur on the face and lips, and crust and heal in a few days. This reactivation may be precipitated by trauma, fever, intercurrent disease, or environmental factors such as windy days or sunburn.

HSV-2

This virus is the usual cause of genital herpes, although genital herpes can also be caused by type 1 virus. Genital herpes occurs mainly in adults and is sexually transmitted. Primary and recurrent infections occur, with or without symptoms.

The principal sites of primary disease in women are the cervix and vulva. Recurrent disease generally involves the vulva, perineal skin, legs and buttocks. In men, lesions appear on the glans penis or prepuce, and in the anus or rectum of those engaging in anal sex. Other genital or perineal sites, as well as the mouth, may also be involved in either gender, depending on sexual practices.

HSV-2 infection is, rarely, associated with aseptic meningitis and radiculitis. It can be a cause of recurrent aseptic meningitis (Mollaret’s) meningitis disease and transverse myelitis.

Diagnosis

The diagnosis may be suggested by cytologic changes in tissue scrapings or biopsy. Confirmation is made by direct fluorescent antibody tests, by isolation of the virus from oral or genital lesions or other sites, or by detection of HSV DNA by nucleic acid testing of lesion fluid or cerebrospinal fluid. Techniques are also available to differentiate type 1 from type 2 antibody, if required. HSV infections are best confirmed by isolation of virus in tissue culture or lesion scrapings, with the greater yield from vesicular lesions. More than 90 per cent of the population has antibodies to HSV-1 by the fifth decade of life.

Incubation period of herpes simplex viruses

The incubation period varies from 2 to 12 days.

Asymptomatic infections with HSV-1 are common. Seventy to ninety per cent of adults have circulating antibodies to HSV-1, indicating previous infection.

HSV-1 is a common cause of meningoencephalitis. Vaginal delivery in pregnant women with active genital infection carries a high risk of disseminated visceral infection, encephalitis and death to the newborn.

HSV-2 is frequently associated with sexually transmitted infections, and 12–15 per cent of adults have antibody evidence of exposure. The prevalence is greater in socioeconomically disadvantaged groups and those with multiple sexual partners.

Reservoir of herpes simplex viruses

Humans are the reservoir.

Mode of transmission of herpes simplex viruses

Transmission of HSV infections occurs through close contact with a person shedding virus from a peripheral site, at a mucosal surface, or in genital or oral secretions. Inoculation of virus onto susceptible surfaces such as oropharynx, cervix, conjunctivae or small cracks in skin is required for infection. Contact with HSV-1 in the saliva of carriers is the most important mode of spread. Contact of healthcare workers with patients who are shedding HSV may result in an infection of the tip of the finger (herpetic whitlow). It begins with intense itching and pain, and is followed by vesicle formation and then ulceration.

Transmission of HSV-2 to nonimmune adults is usually by sexual contact.

Period of communicability of herpes simplex infections

Secretion of virus in the saliva may occur for up to 7 weeks after recovery from stomatitis.

Patients with primary genital lesions are infective for 7–10 days. Those with recurrent disease are infectious for 4–7 days with each episode.

Susceptibility and resistance to herpes simplex infections

Everyone is susceptible to infection. The disease does not usually confer protective immunity because the virus tends to become latent in dorsal root ganglia of the spine, where it may be reactivated at a later date.

Control measures for herpes simplex infections

Preventive measures

No vaccine is currently available.

Health education and personal hygiene should be directed towards minimising transfer of infectious material and reducing the risk of exposure of high-risk groups.

Emphasise personal hygiene to minimise the transfer of infectious material. Avoiding skin contact from the time of first symptoms (warning ‘tingle’) on the mouth, genitals or anus, and for a week after the symptoms have gone helps prevent transmission. Wear gloves when in direct contact with infectious lesions, and wash hands with soap and water afterwards.

Correct and consistent use of condoms during sexual intercourse decreases the risk of infection.

Preventive antiviral medication (suppressive therapy) when recurrences are frequent can reduce the risk of transmission.

Control of case

Nongenital herpes

For symptomatic treatment of minor attacks, use Betadine (povidone iodine) 10 per cent paint applied three times daily, and/or topical antiviral therapy. Therapy should be self-initiated and commenced at the earliest sign of onset. Consult the current version of the Therapeutic GuidelinesExternal Link.

Sun protection is important in preventing recurrences of facial herpes simplex.

Specialist advice on systemic antiviral treatment should be sought for:

• severe primary or severe recurrent attacks
• attacks complicated by erythema multiforme
• primary or recurrent attacks in HIV-infected patients or the immunosuppressed.
• recurrent episodes of lymphocytic meningitis (Mollaret’s meningitis).

Patients with active lesions should have no contact with newborns, children with burns or eczema, or immunosuppressed patients. Consider caesarean section before the membranes rupture when primary or recurrent genital infections occur in late pregnancy, to minimise the risk of neonatal infection.

Cases of disseminated severe infection and cases in neonates should be managed in isolation under contact precautions because of the risks to other neonates or pregnant women.

Anogenital herpes

Patients should be fully screened for other sexually transmissible infections, including HIV infection, on their first presentation.

Treatment usually consists of valaciclovir, famciclovir or aciclovir. The choice and duration of treatment varies for initial attacks, infrequent recurrent attacks (episodic therapy) or suppression of frequent recurrent attacks (chronic suppressive therapy). Consult the current version of the Therapeutic GuidelinesExternal Link.

If there is breakthrough during prophylaxis, higher doses may be successful. Relapse may occur at the cessation of prophylaxis.

Control of contacts

Not applicable.

Control of environment

Not applicable.

Outbreak measures for herpes simplex infections

Not applicable.

How Long Does Herpes Take to Show Up? What to Know- K Health

Genital herpes is a sexually transmitted infection that can be passed from any type of sexual contact.

HSV-1, also known as oral herpes, can also be passed via non-sexual contact, such as sharing eating utensils or drinks.

If you think you have been exposed, you may wonder how long it could take for an infection to appear.

Some people who get herpes simplex never show signs or symptoms.

For those who do, symptoms may appear as soon as a few days to a few weeks after exposure.

In this article, I’ll outline the symptoms of genital and oral herpes, and talk about their transmission and diagnosis.

I’ll also explain how long it takes for herpes to incubate and appear, list some precautions and preventive steps you can take. 

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Herpes Symptoms

Around half of all American adults under age 50 have a version of herpes simplex.

The virus may go dormant after an initial infection, or may never cause symptoms at all.

Other people may deal with recurrent HSV outbreaks.

It is not always possible to tell whether you have HSV-1 or HSV-2 based on symptoms alone, as the symptoms can overlap.

HSV-1 vs HSV-2 Symptoms

While most people generally refer to herpes, there are two viruses: HSV-1 (oral herpes) and HSV-2 (genital herpes). Both strains can cause sores in either the mouth or the genital area.

Symptoms of an initial outbreak or a reactivated virus are similar between HSV-1 and HSV-2.

Both viruses may lead to painful sores or blisters that form in or around the mouth, nose, chin, cheeks, eyes, genitals, anus, and inner thighs.

HSV-1 most commonly causes cold sores around the mouth or on the face, while HSV-2 most commonly causes sores around the genitals, anus, or thighs.

Worldwide, 67% of the population under age 50 has HSV-1, while just 13% of the world’s population in the same age group have HSV-2.

Additionally, both viruses may also cause:

• Tingling, itching, burning, or numbness 1-3 days before sore outbreaks
• Fever
• Headaches
• Body aches
• Swollen lymph nodes
• Fatigue

Both viruses can also show no symptoms at all, even when someone is contagious.

How long does it take for symptoms to appear?

After a first exposure, it can take 2-12 days after exposure to herpes simplex virus for symptoms to appear.

Herpes Average Incubation Period

Both HSV-1 and HSV-2 cause painful sores and blisters that present in five stages:

• Stage 1: About 1-2 days before the cold sore or blister appears, tingling, itching, burning, or numbing sensation starts where the outbreak will occur.

• Stage 2: One or more painful sores appear, typically around the mouth or the genitals.

• Stage 3: Several days later, the sores burst, which allows the fluid inside to escape. This fluid can easily transmit the virus to others—this is a highly contagious time.

• Stage 4: A crust forms, covering the sores as they dry out.

• Stage 5: A scab forms over the crust, and eventually flakes off once the sore is fully healed.

From start to finish, a herpes simplex sore outbreak typically lasts 1-2 weeks.

How soon can you test for herpes?

Your doctor will likely suggest waiting until at least 12 days after exposure before testing.

If you get tested for herpes too soon after exposure, you may get a false negative result.

It takes time for the body to produce antibodies in response to a viral infection. 

Herpes Tests & Diagnosis

Depending on where you are in the stage of exposure or infection, your medical provider may perform an examination or run tests to provide an accurate diagnosis.

• Physical examination: If you have active sores, your doctor may examine them to determine if they appear like HSV-1 or HSV-2 sores.

• Fluid sample: If you have active sores, your medical provider may swab a sore and send the fluid to the laboratory for testing, which can confirm that it is caused by either HSV-1 or HSV-2.

• Blood tests: If you do not have any active sores or other specific physical signs of herpes simplex, your doctor can order blood tests to identify viral antibodies to confirm a diagnosis.

If you are diagnosed with HSV-1 or HSV-2, your doctor may be able to prescribe antiviral medication to shorten an active outbreak or help alleviate symptoms.

They may also recommend over-the-counter antiviral creams or other products to provide pain relief.

Some medications, when taken orally or applied topically, can prevent outbreaks if used at the first sign of a sore, such as the initial feelings of tingling that precede the formation of a sore.

How is Herpes Transmitted?

Herpes simplex is highly contagious. It is primarily transmitted via contact with an infected person, either with saliva or through direct contact with fluids from herpes sores.

Herpes may be transmitted either through sexual contact or non-sexual contact. HSV-1 is much more common than HSV-2.

It is not possible to get herpes from:

• Holding hands or hugging
• Coughing or sneezing
• Toilet seats

The CDC estimates that around 48% of the U.S. population have HSV-1, which causes oral herpes, while around 12% have HSV-2, or genital herpes.

Herpes simplex viruses may be spread by:

• Kissing (either from a parent to child, or between sexual partners)
• Oral sex
• Less commonly, shared objects that touch the sores or saliva of someone with an active outbreak (razors, lipstick, cosmetic products, etc.)

In some cases, while not as common, herpes simplex can be passed from a pregnant person to their baby during birth.

Both types of herpes simplex can be asymptomatic. A person with no symptoms may still be able to spread the virus via saliva or other body fluids if it is actively shedding.

Viral infections never leave the body.

They may go dormant, during which time a person is not contagious.

Herpes simplex virus does not always reactivate, but is contagious from someone experiencing an outbreak, whether it is their first or one of many.

Most people are contagious a few days before sores appear and until the sores are fully crusted over and no longer producing liquid.

Precautions and Prevention of Herpes

It is not possible to prevent all exposure to herpes simplex.

The virus is common, and is not always transmitted via sexual contact.

Many people who have HSV-1 do not even know they were exposed. It is possible to get exposed in childhood and never have active outbreaks.

It is possible to practice safe sexual hygiene and prevent the transmission of genital herpes.

You can minimize this risk by:

• Avoiding sexual contact, kissing, or any type of contact with active sores from someone who is having a current outbreak

• Using condoms and dental dams during all types of sexual contact

• Not sharing utensils and cosmetics with someone who has an active herpes outbreak

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When to See a Doctor

If you develop sores around your mouth or genitals and you have never had a known herpes simplex outbreak before, see your healthcare provider.

They can perform a physical examination and run other necessary tests to determine the cause.

Some other types of sexually transmitted infections may also cause sores, as well as other types of viruses, and your doctor will want to ensure that you get the right treatment.

In most cases, herpes simplex does not require medical treatment.

Most outbreaks clear on their own in 1-2 weeks.

Prescription or over-the-counter medication may be able to shorten the duration of an outbreak or alleviate pain associated with sores.

How K Health Can Help

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Download K Health to check your symptoms, explore conditions and treatments, and if needed text with a healthcare provider in minutes.  

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Frequently Asked Questions

How long can it take for herpes to show up after exposure?

It takes 2-12 days for herpes sores or signs of an infection to appear after exposure.

How long can you have herpes without knowing?

Even if you test positive for herpes simplex in the blood, you can go your entire life without having an active herpes outbreak. Some people only ever have asymptomatic infections.

What are the first signs of herpes 1?

The first signs of HSV-1 are typically feelings of burning, tingling, or stinging sensations that may precede sore outbreaks by 1-3 days.

K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

K Health has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions,
and medical associations. We avoid using tertiary references.

• Herpes simplex virus. (2022).
  https://www.who.int/en/news-room/fact-sheets/detail/herpes-simplex-virus

• Herpes simplex. (2016).
  https://medlineplus.gov/herpessimplex.html

• Genital herpes — CDC Fact Sheet. (2021).
  https://www.cdc.gov/std/herpes/stdfact-herpes-detailed.htm

• Prevalence of Herpes Simplex Virus Type 1 and Type 2 in Persons Aged 14–49: United States, 2015–2016. (2018).
  https://www.cdc.gov/nchs/products/databriefs/db304.htm

Genital herpes | Medical and Diagnostic Center “Avicenna”

Herpes is an infectious disease caused by a virus. Penetrating into the human body, the herpes virus is embedded in the cells and has a devastating effect on the human immune system, weakens it. The herpes simplex virus, or HSV, has 2 types: HSV-1 and HSV-2. Both forms are in the human body all their lives.

Common types of herpes

HSV-1
Herpes simplex virus 1, or HSV-1, also often referred to as “colds on the lips.” Herpes of the oral type, as a rule, manifests itself on the lips. But sometimes it can spread to the wings of the nose, the skin of the cheeks, and the chin.
HSV-2
Hepatitis simplex virus 2, or HSV-2, is predominantly genital herpes. It affects the mucous membranes of the human genital organs, buttocks, perineum.

Why does genital herpes occur?

The disease is transmitted through sexual contact: both vaginally and anally. Also, genital herpes can be caused by the HSV-1 virus during oral contact with the genitals. There is also a route of infection from mother to child during pregnancy.

The following may increase the risk of infection:

How does the disease progress?

The incubation period is 3 to 8 days after exposure to the virus.

Often, infection with the virus is asymptomatic, so at first the patient does not even realize that he is infected and that he is the source of the infection.
The disease itself begins with an acute form: on the inside of the foreskin or on the scrotum, in the perineum. Bursting, the bubbles leave erosion in place, which can later merge. The same phenomena can occur on the mucous membrane of the urethra.
The main complaints of patients: itching, burning, pain, fever.

In women, the blisters are localized in the areas of the vagina, vulva, cervix. Then they burst, and in their place ulcers appear, which heal in about a few weeks. The main complaints of patients: itching, burning, feeling of heaviness in the lower abdomen.

Diagnosis and treatment of genital herpes

Diagnosis of the disease is based on the detection of the virus and its antibodies in the blood of patients and smears from the affected areas. You can take tests in Pushkin at the Avicenna medical center.

If you experience symptoms of genital herpes, do not self-medicate. Contact a specialist dermatovenereologist at the Avicenna Medical Center in Pushkin! He will prescribe the necessary tests and treatment for you.

Avicenna Medical Center provides a wide range of services: we offer medical examinations, driving commissions, ultrasound, dentistry in Pushkin. You can also get advice from an ENT specialist, endocrinologist, ophthalmologist and other specialists.

Sign up for a consultation with a dermatovenereologist by phone: 8 (812) 717-8217 or 8 (981) 886-8468

Contacts

Medical Center in Pushkin “Avicenna”

Genital herpes (lichen lichen simplex)

• Updated: 05/31/2023

  Genital herpes is a viral sexually transmitted disease.
  The causative agent is the herpes simplex virus (HSV) type I or II.

  It has been proven that HSV type I affects mainly the red border of the human lips in 80% of cases, HSV type II affects the lips in 20% of cases. The defeat of the genitals of HSV types I and II occurs in inverse proportion.

  Ways of infection:

  Infection with genital herpes occurs mainly through sexual contact. Infection of newborns is possible during childbirth, if the disease occurs at the time of birth. It is noted that most cases of infection occur from individuals with an asymptomatic course of the disease.

  Age.

  The disease occurs at any age. Most often, people aged 25-35 years are infected, while women are sick and infected with HSV more often than men.

  Incubation period.
  The incubation period averages 1 week.

  Clinical picture.

  After the incubation period, grouped small painful vesicles appear, usually located in the area of ​​​​the external and internal genital organs. Bubbles open with the formation of punctate erosions or with the formation of infected ulcers. Some patients have fever (increased t), headache, general malaise. Viruses are isolated from infected tissues for 10-12 days, that is, patients during this period are most contagious. In typical cases, the entire process of evolution of genital herpes takes from 15 to 20 days. Typical lesions in men are located on the glans penis and coronal groove, on the body of the penis, or in the perianal region. Less common in the urethra, scrotum, perineum, thighs, or buttocks.
  In women, the entrance to the vagina, the mouth of the urethra or the labia are most often affected, but extragenital lesions of the perineum, perianal region, thighs, buttocks may occur. In 70-90% of cases, there is a lesion of the cervix.

  Distinguish:

  1. Primary clinical episode.
  2. Recurrent genital herpes.
  3. Asymptomatic herpes.
  The duration of the initial episode without treatment is usually 2-3 weeks. The disease occurs acutely, sometimes accompanied by fever, general malaise, itching and tingling in the affected area, followed by the formation of grouped small bubble elements in this place, small ones up to the size of a pinhead, followed by their rapid opening.
  The duration of herpes recurrence without treatment is usually 5-7 days. There are no prodromes. Subjectively itching and tingling at the site of vesicles. The local process is not of an acute inflammatory nature.
  Asymptomatic herpes is characterized by reactivation of the herpes virus, without clinical manifestations, when blood tests for antibodies to HSV type I-II become positive, which in the past were negative.
  The clinical manifestations of genital herpes caused by the two types of herpes are virtually identical, and the severity of the disease is determined mainly by previous exposure to HSV.

  Diagnostics.

  For the diagnosis of HSV use:
  1. PCR method.
  2. Detection of antibodies in the blood (IgM, IgG) with the determination of their avidity.
  3. Detection and identification of HSV by cultivation.

  Treatment.

  Currently, antiviral drugs have become widespread, which, although not able to completely eliminate HSV from organic matter, can reduce the severity of the disease and significantly reduce the number of relapses of the disease. It should be emphasized that all of them are most effective in the first 24-36 hours from the onset of the disease, as they affect the multiplying HSV.

  Distinguish:

  1. Treatment of the primary clinical episode.
  2. Treatment of recurrent genital herpes (exacerbation).
  3. Preventive treatment (suppressive therapy) – in order to prevent recurrence of the disease, the duration of which is selected individually.
  Treatment of pregnant women, in order to prevent herpes in newborns, is mandatory. In the presence of herpetic eruptions on the genitals or in the primary clinical episode in the mother during the last month of pregnancy, a caesarean section is indicated. In other cases, natural delivery is possible.

  Sex partners.

  Sexual partners of patients with genital herpes should be examined and, if they have elements of genital herpes, treated. Patients should be advised to refrain from sexual activity until the manifestations of genital herpes disappear. During this period, the use of a condom should be mandatory for all forms of sexual intercourse.

  Control examination.

  The absence of manifestations of genital herpes with negative tests for HSV on the 7-10th day after the end of treatment.