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 are the potential complications of genital herpes infections.

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). The prevalence of this infection in the United States is significant, with an estimated 572,000 new cases occurring annually. According to recent data, 11.9% of individuals aged 14 to 49 years have HSV-2 infection, with a higher prevalence among women (15.9%) compared to men (8.2%).

The infection rates vary among different demographic groups. For instance, HSV-2 infection is more common among non-Hispanic blacks (34.6%) than non-Hispanic whites (8.1%). Interestingly, these disparities persist even when accounting for similar numbers of lifetime sexual partners.

Trends in Genital Herpes Prevalence

There has been a notable decrease in the age-adjusted percentage of HSV-2 infections in the United States, dropping from 18.0% in 1999-2000 to 12.1% in 2015-2016. However, it’s crucial to note that genital herpes infections are increasingly caused by HSV-1, which is traditionally associated with oral herpes.

Transmission Pathways of Genital Herpes

Genital herpes is primarily transmitted 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.

While HSV-2 infections typically occur through genital contact, HSV-1 genital infections can result from receiving oral sex from a person with an oral HSV-1 infection. It’s important to understand that transmission often occurs from contact with an infected partner who may not have visible lesions and may be unaware of their infection status.

Asymptomatic Shedding and Transmission Risk

Asymptomatic shedding of the virus plays a significant role in transmission. In individuals 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. This highlights the importance of protective measures even in the absence of visible symptoms.

Recognizing Genital Herpes Symptoms

Many individuals infected with HSV are asymptomatic or experience very mild symptoms that may go unnoticed or be mistaken for another skin condition. When symptoms do occur, they typically manifest as one or more vesicles or small blisters on or around the genitals, rectum, or mouth.

The Incubation Period and Initial Outbreak

The average incubation period for an initial herpes infection is 4 days, with a range of 2 to 12 days after exposure. During the first outbreak, the vesicles break and leave painful ulcers that may take two to four weeks to heal. This initial episode is often accompanied by systemic symptoms such as fever, body aches, swollen lymph nodes, or headache.

Recurrent Outbreaks and Their Characteristics

Recurrent outbreaks of genital herpes are common but typically shorter in duration and less severe than the initial outbreak. Many patients experience prodromal symptoms, such as localized genital pain or tingling sensations in the legs, hips, or buttocks, hours to days before the eruption of herpetic lesions.

Long-term studies have indicated that the frequency of symptomatic recurrent outbreaks may decrease over time. It’s worth noting that recurrences and subclinical shedding are less frequent for genital HSV-1 infections compared to genital HSV-2 infections.

Potential Complications of Genital Herpes

While genital herpes is generally manageable, it can lead to various complications, especially in individuals with suppressed immune systems. In such cases, genital herpes may cause severe and persistent painful genital ulcers.

• Aseptic meningitis (inflammation of the linings of the brain) – a rare but serious complication caused by both HSV-1 and HSV-2
• Development of extragenital lesions on areas such as the buttocks, groin, thigh, finger, or eye
• Psychological impact, including concerns about overall health, sex life, and relationships
• Emotional distress, including feelings of embarrassment, shame, and anxiety

Diagnostic Challenges and Underreporting

One of the significant challenges in managing genital herpes is the high rate of undiagnosed cases. In the United States, an estimated 87.4% of 14 to 49 year olds infected with HSV-2 have never received a clinical diagnosis. This underreporting can contribute to inadvertent transmission and delayed treatment.

Factors Contributing to Underdiagnosis

1. Asymptomatic or mild cases that go unnoticed
2. Misdiagnosis due to symptoms mimicking other conditions
3. Stigma associated with STDs, leading to reluctance in seeking medical attention
4. Lack of routine screening for herpes in standard STD panels

Prevention Strategies and Safe Practices

Given the prevalence and ease of transmission of genital herpes, implementing effective prevention strategies is crucial. While complete prevention may not always be possible, several measures can significantly reduce the risk of transmission.

Barrier Methods and Their Effectiveness

Consistent and correct use of latex condoms can reduce the risk of genital herpes transmission. However, it’s important to note that herpes can be transmitted from areas not covered by a condom, so while they provide significant protection, they are not 100% effective.

Antiviral Medications as Prevention

For individuals with known herpes infections, daily suppressive antiviral medication can reduce the frequency of outbreaks and lower the risk of transmission to partners. Commonly prescribed medications include acyclovir, valacyclovir, and famciclovir.

Communication and Testing in Relationships

Open communication about sexual health history and regular testing for STDs, including herpes, can help partners make informed decisions about sexual practices and prevention strategies. Knowing one’s status can lead to more effective management and reduced transmission risk.

Living with Genital Herpes: Management and Support

While genital herpes is a chronic condition, it is manageable with proper care and treatment. Many individuals with herpes lead healthy, active lives with minimal disruption from the virus. However, the psychological impact of a herpes diagnosis can be significant for some.

Medical Management Options

Treatment options for genital herpes include episodic therapy for outbreak management and suppressive therapy for reducing outbreak frequency and transmission risk. Advances in antiviral medications have greatly improved the quality of life for many individuals with herpes.

Psychological Support and Counseling

Addressing the emotional aspects of living with genital herpes is crucial. Many healthcare providers offer counseling services or can refer patients to support groups. These resources can help individuals cope with the diagnosis, manage relationships, and maintain a positive outlook.

Research and Future Prospects in Herpes Management

Ongoing research in the field of herpes virology and immunology continues to advance our understanding of the virus and potential treatment options. While a cure for herpes remains elusive, several promising avenues of research are being explored.

Vaccine Development Efforts

Multiple research teams around the world are working on developing vaccines for both prevention and treatment of herpes infections. While no vaccine is currently available, several candidates are in various stages of clinical trials.

Novel Therapeutic Approaches

Researchers are investigating new therapeutic strategies, including gene editing techniques and immunotherapy, which could potentially offer more effective ways to control the virus and reduce outbreaks. These approaches aim to target the virus at the cellular level, offering hope for more comprehensive management of herpes infections.

As our understanding of genital herpes continues to evolve, so do the strategies for prevention, management, and potential cures. Staying informed about the latest developments in herpes research and treatment options can empower individuals to make informed decisions about their health and well-being. Regular consultations with healthcare providers and participation in ongoing medical care are essential components of effectively managing genital herpes and maintaining overall sexual health.

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. ⁷ Since 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.

25. Martin ET, Krantz A, Gottlieb SL, et al. A pooled analysis of the effect of condoms in preventing HSV-2 acquisition. Arch Intern Med, 2009. 169(13): 1233–40.

26. Wald A, Langenberg AGM, Link K, et al. Effect of condoms on reducing the transmission of herpes simplex virus type 2 from men to women. JAMA, 2001. 285(24): 3100–6.

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?

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.

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What you need to know about herpes? Herpes virus: its types and symptoms

The source of infection is sick people who transmit the virus through shared objects or through direct contact. The causative agent of herpes is also transmitted by airborne droplets and from mother to fetus.

Herpes virus (Herpesviridae) is a DNA-containing virus consisting of three subfamilies – alpha, beta, gamma.

Diseases caused by the herpes virus (Herpesviridae) are divided into:

• herpes simplex
• genital herpes
• Kaposi’s eczema herpetiformis
• chickenpox and herpes zoster.

Herpes simplex (blister lichen, Herpes simplex)

After entering the body, the herpes simplex virus spreads through the lymph and nerve fibers, penetrates into the lymphatic and circulatory systems, and internal organs.

It accumulates in the ganglia (aggregation of nerve cells) of the nervous system, where it lives in a dormant state for a long time. After the virus enters the body, antibodies to the causative agent of herpes simplex are formed, which remain at approximately the same level throughout life, regardless of the clinical manifestations of the disease. When activated, the herpes simplex virus (during the acute period of the disease) reproduces its copies, which causes the death of the infected cell.

The first episode of the disease usually occurs in childhood after infection. The incubation period lasts from 1-2 days to 2 weeks. Small blisters appear on the skin of the lips or nose. Patients report soreness and itching. The disease can occur in the form of herpetic stomatitis, with fever, headache and malaise, swollen lymph nodes. Grouped bubbles appear on the mucous membrane of the cheeks, the inner surface of the lips, tongue, tonsils, and palate against the background of specific reddening of the skin. Then painful erosions form.

Relapses of herpes simplex virus (HSV) can occur up to several times a year, and there are cases of a continuous course of the disease for several years. Burning, pain, itching are felt before the appearance of a blistering rash on the skin. The size of the bubbles is 1-2 mm, with transparent contents. Over time, the contents of the bubbles become cloudy, they burst with the formation of painful erosions.
In the process of healing, erosions become covered with crusts. When the bacterial flora is attached, the defects heal more slowly, ulcers form.

Herpes simplex virus usually manifests as a rash on the skin of the cheeks, lips, nose, but can occur on the skin of the genitals, buttocks, sacrum, thighs, hands2.

Kaposi’s eczema herpetiformis (Exzema hertipetiformis)

Predisposing dermatological background – the presence of eczema, atopic dermatitis and other diseases in which the integrity of the skin is disturbed.

The incubation period is up to 7 days. There is a deterioration in well-being, an increase in lymph nodes and an increase in body temperature up to 40 ° C. After a few days, multiple grouped small vesicles appear on the affected areas of the skin. Pustules form. Elements shrink into a brown crust. The mucous membrane of the mouth, genitals, conjunctiva of the eyes may be affected. The disease can be complicated by a bacterial infection, a state of shock. In severe cases, it can lead to the death of the patient.

Genital herpes (Herpes progenitalis)

Herpetic rash occurs on the skin of the genitals and in the anus (anus). The main route of transmission is sexual or orogenital, through contact with a patient with or without symptoms, that is, when carrying the virus. The household route through contaminated common items is also possible. The risk of infection of a child neonatally from a mother when a woman becomes infected closer to childbirth is up to 50%2.

Herpes zoster

At the beginning of the disease, there is pain along the affected nerves, then a rash appears: redness and vesicles with clear and cloudy contents. Bubbles shrink into brown crusts. The disease lasts up to 3 weeks.

In atypical cases, the rash may present with only redness without vesicles or large blistering. Sometimes sores are formed, healing with the formation of scars.

Varicella (chickenpox)

The incubation period lasts up to 3 weeks. At the onset of the disease, body temperature rises, headache occurs, and a widespread small-spotted rash appears. Then the spot turns into a knot, on which a bubble appears. Bubbles first appear on the trunk, face, scalp. Bubbles shrink into crusts. In a severe form of the course of the disease, a rash can occur on the skin of the palms and feet. A characteristic feature of the disease is a false variety of forms (polymorphism) – on one part of the body there may be spots, nodules and vesicles, since the rashes appear jerkily.

The mild form of the disease is characterized by an increase in temperature
up to 38.5°C for several days. The rash is not numerous, there are several days.

In the moderate form, the temperature reaches 39.5°C, there are many rashes, the duration is 1 week.

Severe course of the disease lasts up to 10 days with fever above 39.5°C, seizures, with profuse large rashes.