Incubation period herpes simplex. Genital Herpes: Incubation Period, Symptoms, and Transmission – Comprehensive STD Guide

21.07.202319.07.2023 by alexxlab

What is the incubation period for genital herpes. How common is genital herpes in the United States. What are the primary symptoms of genital herpes. How is genital herpes transmitted between partners. What complications can arise from genital herpes infections. How does genital herpes impact overall health and relationships.

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Understanding Genital Herpes: Causes and Prevalence

Genital herpes is a sexually transmitted disease caused by herpes simplex virus type 1 (HSV-1) or type 2 (HSV-2). It’s a common infection in the United States, with the Centers for Disease Control and Prevention (CDC) estimating 572,000 new cases in a single year. Approximately 11.9% of individuals aged 14 to 49 years have HSV-2 infection, with this percentage rising to 12.1% when adjusted for age.

Is genital herpes more prevalent in certain demographics? Indeed, there are notable disparities:

Women are more commonly affected than men (15.9% vs. 8.2% among 14 to 49-year-olds)
Non-Hispanic blacks have a higher infection rate (34.6%) compared to non-Hispanic whites (8.1%)
An estimated 87.4% of infected individuals aged 14 to 49 are unaware of their HSV-2 infection

Interestingly, the age-adjusted percentage of HSV-2 infections in the U.S. has decreased from 18.0% in 1999-2000 to 12.1% in 2015-2016. However, it’s important to note that genital herpes infections caused by HSV-1 are on the rise, potentially due to decreased childhood exposure to oral HSV-1 infections.

Transmission Dynamics of Genital Herpes

How is genital herpes transmitted? The virus spreads through contact with herpes lesions, mucosal surfaces, genital secretions, or oral secretions. Both HSV-1 and HSV-2 can be shed from normal-appearing oral or genital mucosa or skin, making transmission possible even in the absence of visible symptoms.

Are there specific transmission patterns for different HSV types? Generally:

HSV-2 is typically transmitted through genital contact with an infected partner
HSV-1 can cause genital herpes when transmitted through oral sex from a partner with an oral HSV-1 infection

It’s crucial to understand that transmission often occurs from contact with an infected partner who may not have visible lesions or may be unaware of their infection. In fact, individuals with asymptomatic HSV-2 infections shed the virus on 10.2% of days, compared to 20.1% of days for those with symptomatic infections.

Recognizing Genital Herpes Symptoms and Outbreaks

What are the typical symptoms of genital herpes? Most infected individuals are asymptomatic or experience very mild symptoms that may be mistaken for another skin condition. When symptoms do occur, they usually manifest as:

One or more vesicles (small blisters) on or around the genitals, rectum, or mouth
Painful ulcers that form when the vesicles break
Systemic symptoms during the first outbreak, such as fever, body aches, swollen lymph nodes, or headache

How long does it take for symptoms to appear after exposure? The average incubation period for an initial herpes infection is 4 days, with a range of 2 to 12 days. The first outbreak typically lasts longer, with ulcers taking two to four weeks to heal.

Differences Between Initial and Recurrent Outbreaks

Are there differences between the first and subsequent herpes outbreaks? Yes, there are notable distinctions:

Initial outbreak: Longer duration, increased viral shedding, and more severe systemic symptoms
Recurrent outbreaks: Shorter duration, less severe symptoms, and often preceded by prodromal symptoms like localized genital pain or tingling sensations

Long-term studies suggest that the frequency of symptomatic recurrent outbreaks may decrease over time. It’s worth noting that genital HSV-1 infections typically result in fewer recurrences and less subclinical shedding compared to genital HSV-2 infections.

Potential Complications of Genital Herpes Infections

While genital herpes is generally manageable, it can lead to complications in certain cases. What are some potential complications of genital herpes?

Persistent and severe genital ulcers in immunosuppressed individuals, such as those with HIV
Rare but serious complications like aseptic meningitis (inflammation of the brain linings)
Development of extragenital lesions on the buttocks, groin, thigh, finger, or eye

Beyond physical complications, genital herpes can have significant psychological and social impacts. Many individuals who contract genital herpes experience concerns about their overall health, sex life, and relationships. The condition can also lead to feelings of embarrassment, shame, and stigma, which may affect mental well-being and social interactions.

The Impact of Genital Herpes on Relationships and Sexual Health

How does genital herpes affect relationships and sexual health? The impact can be multifaceted:

Disclosure concerns: Individuals may struggle with when and how to disclose their HSV status to partners
Intimacy challenges: Fear of transmission may lead to anxiety or avoidance of sexual activity
Self-esteem issues: The stigma associated with herpes can negatively affect self-image
Relationship strain: Misunderstandings about the condition can lead to trust issues or relationship breakdown

Despite these challenges, many people with genital herpes maintain healthy, satisfying relationships. Open communication, education about the condition, and proper management strategies can help mitigate the impact on relationships and sexual health.

Prevention Strategies and Risk Reduction for Genital Herpes

What can be done to prevent or reduce the risk of genital herpes transmission? Several strategies can be employed:

Consistent and correct use of latex condoms during sexual activity
Abstaining from sexual contact during active outbreaks
Using antiviral medications as suppressive therapy to reduce viral shedding
Open communication with sexual partners about HSV status
Regular testing for STDs, including herpes, for sexually active individuals

It’s important to note that while these strategies can significantly reduce the risk of transmission, they cannot eliminate it entirely. The virus can be shed from areas not covered by condoms, and transmission can occur even in the absence of visible symptoms.

The Role of Education in Prevention

How does education contribute to herpes prevention? Comprehensive sexual health education plays a crucial role in preventing the spread of genital herpes and other STDs. This includes:

Understanding the modes of transmission for different STDs
Recognizing symptoms and the importance of testing
Learning about effective prevention methods
Destigmatizing STDs to encourage open communication and testing

By increasing awareness and knowledge about genital herpes, individuals can make informed decisions about their sexual health and take appropriate precautions to protect themselves and their partners.

Diagnosis and Testing for Genital Herpes

How is genital herpes diagnosed? The diagnosis of genital herpes involves several methods:

Clinical examination: A healthcare provider can often diagnose herpes based on the appearance of lesions
Viral culture: Samples from lesions can be tested to confirm the presence of the herpes virus
Polymerase chain reaction (PCR) test: This highly sensitive test detects HSV DNA in samples
Blood tests: Serological tests can detect HSV antibodies, indicating past or current infection

Is testing recommended for everyone? The Centers for Disease Control and Prevention (CDC) does not recommend routine testing for herpes in the general population. However, testing may be advised for individuals who:

Have symptoms suggestive of herpes
Have a sexual partner with genital herpes
Want a comprehensive STD exam, especially if they have multiple partners

It’s important to note that blood tests for herpes can be misleading in some cases, as they don’t distinguish between oral and genital infections. Additionally, false-positive and false-negative results can occur, particularly in low-risk populations.

Treatment Options and Management of Genital Herpes

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

Acyclovir
Valacyclovir
Famciclovir

These medications can be used in different ways:

Episodic therapy: Short-term treatment to reduce the severity and duration of outbreaks
Suppressive therapy: Daily medication to reduce the frequency of recurrences and lower the risk of transmission

How effective are these treatments? Antiviral medications can significantly reduce the frequency, severity, and duration of herpes outbreaks. Suppressive therapy has been shown to reduce the risk of transmission to uninfected partners by up to 50%.

Lifestyle Modifications and Self-Care

Beyond medication, what self-care measures can help manage genital herpes?

Maintaining overall health through proper nutrition, exercise, and stress management
Wearing loose-fitting clothing to prevent irritation of affected areas
Using over-the-counter pain relievers to manage discomfort during outbreaks
Applying cool compresses to soothe affected areas
Practicing good hygiene to prevent secondary bacterial infections

These lifestyle modifications, combined with appropriate medical treatment, can help individuals effectively manage their condition and maintain a good quality of life.

The Future of Genital Herpes Research and Treatment

What advancements are being made in herpes research? The field of herpes research is active, with several promising areas of investigation:

Vaccine development: Researchers are working on therapeutic and preventive vaccines
Novel antiviral therapies: New drugs targeting different aspects of the viral life cycle are being studied
Gene editing techniques: CRISPR technology is being explored as a potential way to eliminate latent herpes virus from infected cells
Immunotherapy: Approaches to boost the immune system’s ability to control herpes infections are under investigation

While these research areas show promise, it’s important to note that developing new treatments and potential cures for herpes is a complex process that takes time. Current management strategies remain the most effective approach for individuals living with genital herpes.

The Role of Clinical Trials

How do clinical trials contribute to herpes research? Clinical trials are crucial for advancing our understanding and treatment of genital herpes. They allow researchers to:

Test the safety and efficacy of new treatments
Explore potential vaccines
Investigate novel diagnostic methods
Study the long-term effects of existing treatments

Individuals interested in contributing to herpes research may consider participating in clinical trials. However, it’s important to thoroughly understand the risks and benefits before enrolling in any study.

Detailed STD Facts – Genital Herpes

What is genital herpes?

Genital herpes is a sexually transmitted disease (STD) caused by the herpes simplex virus type 1 (HSV-1) or type 2 (HSV-2).

How common is genital herpes?

Genital herpes infection is common in the United States. CDC estimated that there were 572,000 new genital herpes infections in the United States in a single year.¹ Nationwide, 11.9 % of persons aged 14 to 49 years have HSV-2 infection (12.1% when adjusted for age).² However, the prevalence of genital herpes infection is higher than that because an increasing number of genital herpes infections are caused by HSV-1. ³ Oral HSV-1 infection is typically acquired in childhood; because the prevalence of oral HSV-1 infection has declined in recent decades, people may have become more susceptible to contracting a genital herpes infection from HSV-1. ⁴

HSV-2 infection is more common among women than among men; the percentages of those infected during 2015-2016 were 15. 9% versus 8.2% respectively, among 14 to 49 year olds. ² This is possibly because genital infection is more easily transmitted from men to women than from women to men during penile-vaginal sex. ⁵ HSV-2 infection is more common among non-Hispanic blacks (34.6%) than among non-Hispanic whites (8.1%). ² A previous analysis found that these disparities, exist even among persons with similar numbers of lifetime sexual partners. Most infected persons may be unaware of their infection; in the United States, an estimated 87.4% of 14 to 49 year olds infected with HSV-2 have never received a clinical diagnosis. ⁶

The age-adjusted percentage of persons in the United States infected with HSV-2 decreased from 18.0% in 1999–2000 to 12.1% in 2015-2016. ²

How do people get genital herpes?

Infections are transmitted through contact with HSV in herpes lesions, mucosal surfaces, genital secretions, or oral secretions. ⁵ HSV-1 and HSV-2 can be shed from normal-appearing oral or genital mucosa or skin. ⁷^,8 Generally, a person can only get HSV-2 infection during genital contact with someone who has a genital HSV-2 infection. However, receiving oral sex from a person with an oral HSV-1 infection can result in getting a genital HSV-1 infection. ⁴ Transmission commonly occurs from contact with an infected partner who does not have visible lesions and who may not know that he or she is infected. ⁷ In persons with asymptomatic HSV-2 infections, genital HSV shedding occurs on 10.2% of days, compared to 20.1% of days among those with symptomatic infections. ⁸

What are the symptoms of genital herpes?

Most individuals infected with HSV are asymptomatic or have very mild symptoms that go unnoticed or are mistaken for another skin condition. ⁹ When symptoms do occur, herpes lesions typically appear as one or more vesicles, or small blisters, on or around the genitals, rectum or mouth. The average incubation period for an initial herpes infection is 4 days (range, 2 to 12) after exposure. ¹⁰ The vesicles break and leave painful ulcers that may take two to four weeks to heal after the initial herpes infection. ^5,10 Experiencing these symptoms is referred to as having a first herpes “outbreak” or episode.

Clinical manifestations of genital herpes differ between the first and recurrent (i.e., subsequent) outbreaks. The first outbreak of herpes is often associated with a longer duration of herpetic lesions, increased viral shedding (making HSV transmission more likely) and systemic symptoms including fever, body aches, swollen lymph nodes, or headache. ⁵^,10 Recurrent outbreaks of genital herpes are common, and many patients who recognize recurrences have prodromal symptoms, either localized genital pain, or tingling or shooting pains in the legs, hips or buttocks, which occur hours to days before the eruption of herpetic lesions. ⁵ Symptoms of recurrent outbreaks are typically shorter in duration and less severe than the first outbreak of genital herpes. ⁵ Long-term studies have indicated that the number of symptomatic recurrent outbreaks may decrease over time. ⁵ Recurrences and subclinical shedding are much less frequent for genital HSV-1 infection than for genital HSV-2 infection.⁵

What are the complications of genital herpes?

Genital herpes may cause painful genital ulcers that can be severe and persistent in persons with suppressed immune systems, such as HIV-infected persons. ⁵ Both HSV-1 and HSV-2 can also cause rare but serious complications such as aseptic meningitis (inflammation of the linings of the brain). ⁵ Development of extragenital lesions (e.g. buttocks, groin, thigh, finger, or eye) may occur during the course of infection. ⁵

Some persons who contract genital herpes have concerns about how it will impact their overall health, sex life, and relationships. ^5,¹¹ There can also be considerable embarrassment, shame, and stigma associated with a herpes diagnosis that can substantially interfere with a patient’s relationships. ¹⁰ Clinicians can address these concerns by encouraging patients to recognize that while herpes is not curable, it is a manageable condition. ⁵ Three important steps that providers can take for their newly-diagnosed patients are: giving information, providing support resources, and helping define treatment and prevention options. ¹² Patients can be counseled that risk of genital herpes transmission can be reduced, but not eliminated, by disclosure of infection to sexual partners, ⁵ avoiding sex during a recurrent outbreak, ⁵ use of suppressive antiviral therapy, ^5,¹⁰ and consistent condom use. ⁷Since a diagnosis of genital herpes may affect perceptions about existing or future sexual relationships, it is important for patients to understand how to talk to sexual partners about STDs. One resource can be found here: www.gytnow.org/talking-to-your-partner

There are also potential complications for a pregnant woman and her newborn child. See “How does herpes infection affect a pregnant woman and her baby?” below for information about this.

What is the link between genital herpes and HIV?

Genital ulcerative disease caused by herpes makes it easier to transmit and acquire HIV infection sexually. There is an estimated 2- to 4-fold increased risk of acquiring HIV, if individuals with genital herpes infection are genitally exposed to HIV. ^13-15 Ulcers or breaks in the skin or mucous membranes (lining of the mouth, vagina, and rectum) from a herpes infection may compromise the protection normally provided by the skin and mucous membranes against infections, including HIV. ¹⁴ In addition, having genital herpes increases the number of CD4 cells (the target cell for HIV entry) in the genital mucosa. In persons with both HIV and genital herpes, local activation of HIV replication at the site of genital herpes infection can increase the risk that HIV will be transmitted during contact with the mouth, vagina, or rectum of an HIV-uninfected sex partner. ¹⁴

How does genital herpes affect a pregnant woman and her baby?

Neonatal herpes is one of the most serious complications of genital herpes.^5,¹⁶ Healthcare providers should ask all pregnant women if they have a history of genital herpes.¹¹ Herpes infection can be passed from mother to child during pregnancy or childbirth, or babies may be infected shortly after birth, resulting in a potentially fatal neonatal herpes infection. ¹⁷ Infants born to women who acquire genital herpes close to the time of delivery and are shedding virus at delivery are at a much higher risk for developing neonatal herpes, compared with women who have recurrent genital herpes . ^16,^18-20 Thus, it is important that women avoid contracting herpes during pregnancy. Women should be counseled to abstain from intercourse during the third trimester with partners known to have or suspected of having genital herpes. ^5,¹¹

While women with genital herpes may be offered antiviral medication late in pregnancy through delivery to reduce the risk of a recurrent herpes outbreak, third trimester antiviral prophylaxis has not been shown to decrease the risk of herpes transmission to the neonate. ^11,^21,²² Routine serologic HSV screening of pregnant women is not recommended. ¹¹ However, at onset of labor, all women should undergo careful examination and questioning to evaluate for presence of prodromal symptoms or herpetic lesions. ¹¹ If herpes symptoms are present a cesarean delivery is recommended to prevent HSV transmission to the infant.^5,^11,²³ There are detailed guidelines for how to manage asymptomatic infants born to women with active genital herpes lesions.²⁴

How is genital herpes diagnosed?

HSV nucleic acid amplification tests (NAAT) are the most sensitive and highly specific tests available for diagnosing herpes. However, in some settings viral culture is the only test available. The sensitivity of viral culture can be low, especially among people who have recurrent or healing lesions. Because viral shedding is intermittent, it is possible for someone to have a genital herpes infection even though it was not detected by NAAT or culture. ¹¹

Type-specific virologic tests can be used for diagnosing genital herpes when a person has recurrent symptoms or lesion without a confirmatory NAAT, culture result, or has a partner with genital herpes. Both virologic tests and type-specific serologic tests should be available in clinical settings serving patients with, or at risk for, sexually transmitted infections. ¹¹

Given performance limitations with commercially available type-specific serologic tests (especially with low index value results [<3]), a confirmatory test (Biokit or Western Blot) with a second method should be performed before test interpretation. If confirmatory tests are unavailable, patients should be counseled about the limitations of available testing before serologic testing. Healthcare providers should also be aware that false-positive results occur. In instances of suspected recent acquisition, serologic testing within 12 weeks after acquisition may be associated with false negative test results. ¹¹

HSV-1 serologic testing does not distinguish between oral and genital infection, and typically should not be performed for diagnosing genital HSV-1 infection. Diagnosis of genital HSV-1 infection is confirmed by virologic tests from lesions. ¹¹

CDC does not recommend screening for HSV-1 or HSV-2 in the general population due to limitations of the type specific serologic testing. ¹¹ Several scenarios where type-specific serologic HSV tests may be useful include:

Patients with recurrent genital symptoms or atypical symptoms and negative HSV NAAT or culture;
Patients with a clinical diagnosis of genital herpes but no laboratory confirmation; and
Patients who report having a partner with genital herpes. ¹¹

Patients who are at higher risk of infection (e.g., presenting for an STI evaluation, especially those with multiple sex partners), and people with HIV might need to be assessed for a history of genital herpes symptoms, followed by serology testing in those with genital symptoms. ¹¹

Providers are strongly encouraged to look at CDC’s STI Treatment Guidelines for further diagnostic considerations.

Is there a cure or treatment for herpes?

There is no cure for herpes. Antiviral medications can, however, prevent or shorten outbreaks during the period of time the person takes the medication.¹¹ In addition, daily suppressive therapy (i.e., daily use of antiviral medication) for herpes can reduce the likelihood of transmission to partners.¹¹

There is currently no commercially available vaccine that is protective against genital herpes infection. Candidate vaccines are in clinical trials.

How can herpes be prevented?

Correct and consistent use of latex condoms can reduce, but not eliminate, the risk of transmitting or acquiring genital herpes because herpes virus shedding can occur in areas that are not covered by a condom.^25,²⁶

The surest way to avoid transmission of STDs, including genital herpes, is to abstain from sexual contact, or to be in a long-term mutually monogamous relationship with a partner who has been tested for STDs and is known to be uninfected.

Persons with herpes should abstain from sexual activity with partners when herpes lesions or other symptoms of herpes are present. It is important to know that even if a person does not have any symptoms, he or she can still infect sex partners. Sex partners of infected persons should be advised that they may become infected and they should use condoms to reduce the risk. Sex partners can seek testing to determine if they are infected with HSV.

Daily treatment with valacyclovir decreases the rate of HSV-2 transmission in discordant, heterosexual couples in which the source partner has a history of genital HSV-2 infection. ²⁷ Such couples should be encouraged to consider suppressive antiviral therapy as part of a strategy to prevent transmission, in addition to consistent condom use and avoidance of sexual activity during recurrences.

Counseling those with genital herpes, as well as their sex partners, is critical. It can help patients cope with the infection and prevent further spread into the community. The STI Treatment Guidelines includes messaging broken down by herpes type. ¹¹

Sources:

1. Kreisel KM, Spicknall IH, Gargano JW, Lewis FM, Lewis RM, Markowitz LE, Roberts H, Satcher Johnson A, Song R, St. Cyr SB, Weston EJ, Torrone EA, Weinstock HS. Sexually transmitted infections among US women and men: Prevalence and incidence estimates, 2018. Sex Transm Dis 2021; in press.

2. McQuillan G, Kruszon-Moran D, Flagg EW, Paulose-Ram R. Prevalence of herpes simplex virus type 1 and type 2 in persons aged 14–49: United States, 2015–2016. NCHS Data Brief, no 304. Hyattsville, MD: National Center for Health Statistics. 2018

3. Xu F, Sternberg MR, Kottiri BJ, et al. Trends in herpes simplex virus type 1 and type 2 seroprevalence in the United States. JAMA, 2006. 296(8): 964–73.

4. Bradley H, Markowitz L, Gibson T, et al. Seroprevalence of herpes simplex virus types 1 and 2—United States, 1999–2010. J Infect Dis, 2014. 209(3):325-33.

5. Corey L, Wald A. Genital Herpes. In: Holmes KK, Sparling PF, Stamm WE, et al. (editors). Sexually Transmitted Diseases. 4th ed. New York: McGraw-Hill; 2008: 399–437.

6. Fanfair RN, Zaidi A, Taylor LD, Xu F, Gottlieb S, Markowitz L. Trends in seroprevalence of herpes simplex virus type 2 among non-Hispanic blacks and non-Hispanic whites aged 14 to 49 years–United States, 1988 to 2010. Sex Transm Dis, 2013. 40(11):860-4.

7. Mertz GJ. Asymptomatic shedding of herpes simplex virus 1 and 2: implications for prevention of transmission. J Infect Dis, 2008. 198(8): 1098–1100.

8. Tronstein E, Johnston C, Huang M, et al. Genital shedding of herpes simplex virus among symptomatic and asymptomatic persons with HSV-2 infection. JAMA, 2011. 305(14): 1441–9.

9. Wald A, Zeh J, Selke S, et al. Reactivation of genital herpes simplex virus type 2 infection in asymptomatic seropositive persons. New Engl J Med, 2000. 342(12): 844–50.

10. Kimberlin DW, Rouse DJ. Genital Herpes. N Engl J Med, 2004. 350(19): 1970–7.

11. Workowski, KA, Bachmann, LH, Chang, PA, et. al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep 2021; 70(No. 4): 1-187.

12. Alexander L, Naisbett B. Patient and physician partnerships in managing genital herpes. J Infect Dis, 2002. 186(Suppl 1): S57–S65.

13. Freeman EE, Weiss HA, Glynn JR, Cross PL, Whitworth JA, Hayes RJ. Herpes simplex virus 2 infection increases HIV acquisition in men and women: systematic review and meta-analysis of longitudinal studies. AIDS, 2006. 20(1): 73–83.

14. Barnabas RV, Celum C. Infectious co-factors in HIV-1 transmission. Herpes simplex virus type-2 and HIV-1: new insights and interventions. Curr HIV Res, 2012. 10(3): 228–37

15. Corey L, Wald A, Celum CL, Quinn TC. The effects of herpes simplex virus-2 on HIV-1 acquisition and transmission: a review of two overlapping epidemics. JAIDS, 2004. 35(5): 435–45.

16. Brown ZA, Selke S, Zeh J, et al. The acquisition of herpes simplex virus during pregnancy. N Engl J Med, 1997. 337(8): 509–15.

17. Kimberlin DW. Herpes simplex virus infections in the newborn. Semin Perinatol, 2007. 31(2): 19–25.

18. Brown ZA, Wald A, Morrow RA, Selke S, Zeh J, Corey L. Effect of serologic status and cesarean delivery on transmission rates of herpes simplex virus from mother to infant. JAMA, 2003. 289(2):203–9

19. Brown ZA, Benedetti J, Ashley R, et al. Neonatal herpes simplex virus infection in relation to asymptomatic maternal infection at the time of labor. N Engl J Med, 1991. 324(18):1247–52

20. Brown ZA, Vontver LA, Benedetti J, et al. Effects on infants of a first episode of genital herpes during pregnancy. N Engl J Med, 1987. 317(20):1246–51

21. Hollier LM, Wendel GD. Third trimester antiviral prophylaxis for preventing maternal genital herpes simplex virus (HSV) recurrences and neonatal infection. Cochrane Database Syst Rev, 2008. Issue 1: Art. No. CD004946.

22. Pinninti SG, Angara R, Feja KN, et al. Neonatal herpes disease following maternal antenatal antiviral suppressive therapy: a multicenter case series. J Pediatr, 2012. 161(1):134-8.

23. American College of Obstetricians and Gynecologists (ACOG). ACOG Practice Bulletin. Clinical management guidelines for obstetrician-gynecologists. No. 82 June 2007. Management of herpes in pregnancy. Obstet Gynecol, 2007. 109(6): 1489–98.

24. Kimberlin DW, Balely J, Committee on Infectious Diseases, Committee on Fetus and Newborn. Guidance on management of asymptomatic neonates born to women with active genital herpes lesions. Pediatrics, 2013. 131(2):e635-46.

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27. Corey L, Wald A, Patel R, et al. Once-daily valacyclovir to reduce the risk of transmission of genital herpes. N Engl J Med, 2004. 350:11–20.

Herpes Simplex Virus &nbsp|&nbsp American Skin Association

What is Herpes?

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

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

Type 1 Herpes (Oral Herpes)

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

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

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

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

Type 2 Herpes (Genital Herpes)

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

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

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

How do I get tested?

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

How do I get treated?

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

How can I prevent myself from getting herpes?

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

Herpes simplex – symptoms and diagnosis, prices for the treatment of herpes simplex in Moscow at the Hadassah clinic

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Herpes simplex (herpes virus type 1,2) is an infectious disease that manifests itself mainly in the appearance of blisters on the skin or mucous membranes. Symptoms occur mainly in the lips, eyelids or genitals. Herpes affects more women than men. Herpes simplex type 1 is the main cause of

blisters characteristic of this disease in the lips. Herpes simplex type 2 blisters appear mainly in the genital area. The disease of herpes simplex most often does not lead to death. It can be life-threatening for infants (if the virus enters the brain and causes encephalitis) and for patients with weakened immune systems.

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Symptoms of a herpes infection

HSV-1 manifests itself as transparent and fluid-filled blisters. Herpes simplex virus type 1 rarely causes pimples on the genitals – mostly on the face. When initially infected with the virus, acne appears only in about 10% of patients 2-20 days after contact with an infectious person. There may be several wounds or one. Before the appearance of acne, there are such precursors as itching and burning of the skin.

A pimple may burst when struck or scratched and release fluid. After the wound heals, a crust remains on it, which dries up and leaves. The duration until recovery is about 10 days. At the end of recovery, the skin usually recovers completely.

Even after the initial wound has healed, the virus remains in the body. It penetrates the nerve cells and remains in them in an inactive state until the right conditions arise. Any “awakening” can cause bubbles to appear in or near the same spot.

Primary infection with herpes simplex virus type 2 usually manifests as blisters on the surface of the genitals, buttocks, or cervix 2-20 days after exposure to a carrier of the virus. Herpes simplex virus type 2 can cause symptoms to appear elsewhere, but it usually attacks below the waist. A second outbreak of the virus can cause the symptoms of a herpes infection, such as itching, painful pimples, fever, muscle pain, and burning when urinating.

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Zhukova
Daria Grigoryevna

Allergist-immunologist, Ph.D.

Work experience: 14 years

Cost of admission: from 9000 ₽

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Zaitseva
Galina Valerievna

Allergist-immunologist

Work experience: 10 years

Admission fee: from 6500 ₽

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Causes of herpes simplex

The herpes virus is transmitted by direct contact of infected skin with the skin of a healthy person, in the mouth or genital area. The penetration of the virus is possible only through a skin defect (wound or scratch), mainly in the area of the penis and vulva, rectum and cervix.

In most cases, herpes simplex type 1 infection occurs in childhood through close contact with peers or family members who are carriers of the virus. The infection can be transmitted with a kiss, through ordinary cutlery or lipstick.

Herpes type 2 infection usually occurs through sexual contact with a carrier of the virus. The virus is present in 20% of sexually active people. As far as we know, this form of infectious disease (genital herpes type 2) cannot be contracted through contact with objects such as a toilet seat, toilet paper or towel. This is because the herpes virus is very sensitive to environmental conditions and does not survive outside the body.

Among the predisposing factors activating the “dormant” virus in the body, it should be noted:

colds;
fever;
prolonged sun exposure;
menstrual cycle;
severe emotional stress;
injury to the skin or mucosa.

With both types of herpes simplex, the recurrence rate can vary. Pimples can spread to different parts of the body due to constant scratching.

Methods for diagnosing herpes virus 1.2 type

Herpes is relatively easy to diagnose. Usually, the diagnosis of herpes type 1.2 is necessary for patients suffering from impaired immune function, those undergoing chemotherapy and patients with AIDS. The following diagnostic measures are recommended:

Laboratory tests

include microscopic and other tests of blood or fluid from the pimple to detect antibodies against the virus; some tests are valid only in the initial stages of the disease

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Treatments for herpes simplex

Existing technologies do not allow to clear the hereditary material of the virus from the DNA of nerve cells, and the displacement of the ganglia will cause much more acute side effects (for example, paralysis of the lips). That is why today the disease is incurable.

Treatment for herpes simplex is directed at controlling the symptoms and preventing complications. Antiviral drugs used to treat rashes are prescribed (Acyclovir, Gerpevir, etc.)

After stopping the acute process, a herpes vaccine is recommended, which allows achieving a stable remission. Among the physiotherapeutic methods of treatment, infrared and UV radiation, OCU therapy and laser therapy should be distinguished.

Treatment of herpes simplex in the Hadassah clinic

For the treatment of herpes types 1 and 2, please contact the Hadassah clinic in Moscow. We have doctors with extensive practical experience, we have modern equipment that simplifies the diagnosis.

Text checked by an expert doctor

Zhukova
Daria Grigorievna