What can be mistaken for Herpes?

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Noticing a sign of Herpes can be worrying, but don’t panic. It is easy to mistake Herpes for something else. Here, we explain the other potential causes for Herpes-like symptoms and how to find out if it is Herpes, or not.

The Herpes Simplex Virus, also known as Herpes, is often misunderstood yet an extremely common infection. The symptoms of Herpes usually form as sores and blisters in the oral and/or genital area, depending on which type of Herpes it is. However, it is not always easy to differentiate the symptoms from other health or skin conditions.

The basics

Firstly, let’s understand the two most common types of
Herpes:

• Oral Herpes (HSV-1). This appears around the
  lips and nose or inside the mouth, commonly known as ‘cold sores’ or ‘fever
  blisters’
• Genital
  Herpes (HSV-2). This appears as sores or blisters in the genital area.

Often, people with Herpes will not show any symptoms. In
fact, only 1 in 3 people will have symptoms, whilst the majority will have
either mild symptoms or none. Therefore, it is highly likely that a person may
not even be aware that they have the virus.

If someone
is infected with Herpes, they can spread the virus to another person through skin
to skin contact, including kissing and sex. HSV-2 can be passed to a partner
through oral sex, if the person performing oral sex is infected with HSV-1.

When the virus is passed from one person to another, this most often occurs when either person has active sores or blisters. So, if you have visible symptoms, you should always refrain from sexual contact. However, Herpes can also be passed when symptoms are not present. Using condoms can help to prevent spreading or catching Herpes, but since condoms do not cover the entire genital area, they are not 100% effective.

What else can resemble Herpes?

Herpes
symptoms can be mistaken for many other things, including:

• A different STI which causes visible lesions, such as Syphilis or genital warts (HPV)
• Irritation caused by shaving
• Ingrown hairs
• Bacterial vaginosis (BV)
• Pimples
• Yeast infections
• Haemorrhoids
• Bug bites.

How to be sure whether it is Herpes or not

If you have noticed symptoms that are concerning you, getting
tested is the only way to be sure whether it is Herpes or not. You can choose
to book an appointment at one of our nationwide clinics or test at
home with one of our convenient home test
kits.

If you do have symptoms, a simple swab test can
provide you with the peace of mind you need. Alternatively, why not consider
our Blemish Screen? This swab test will detect Syphilis, Herpes and HPV, so you
can be sure which (if any) is causing your symptoms. This is available as a home test
kit, or you can book in at one of our clinics. Find out
more here.

With our convenient Photo Consultation service, you can send a photo of your lesion(s) to our expert doctor who will review your photograph and recommend the next steps based on your symptoms. If you feel unsure about which test or screen to book, this is the perfect option for you.

If you do not have symptoms but would like to find out
whether you have the Herpes virus, a simple blood test will tell
you this.

Read more about Herpes on our website.

Sources

[1] Health.com

[2] Everyday
Health

Genital herpes: Overview – InformedHealth.org

Created: June 27, 2018; Next update: 2021.

Introduction

Genital herpes is one of the most common sexually transmitted diseases (STDs). Herpes virus infections actually don’t often lead to a disease, though: Up to 90 out of 100 people who are infected will have either no symptoms or hardly noticeable symptoms. For this reason, experts increasingly refer to herpes as a sexually transmitted infection (STI). Once you have been infected with herpes viruses, they stay in your body for the rest of your life.

If symptoms arise, they can be painful and distressing. But there are treatments that can relieve the symptoms and shorten the outbreaks. If you’ve had herpes once, it usually keeps coming back. The good news is that herpes outbreaks become milder and less frequent over time.

But being diagnosed with genital herpes is still quite distressing for many people and brings up a number of questions: Where was I infected? How will I tell my partner – and who else should I even tell? Will I transmit the infection to my child if I’m pregnant? These are some of the questions you may be faced with after being diagnosed with genital herpes.

Symptoms

In genital herpes, the skin in the genital area can become inflamed and painful, and small blisters may develop. The blisters occur in small clusters, and can tear open and weep. They often form scabs when they heal. The skin may also itch or burn. Women often have pain when urinating (peeing).

The symptoms typically affect the penis, foreskin and scrotum in men, and the labia, vagina and cervix in women. The blisters may also occur in the anal region, on the buttocks or on the inner thighs. Some people notice that an outbreak is starting through a tingling sensation in their genitals or pain in their bottom, hips or legs.

The very first outbreak of genital herpes often causes more severe symptoms than later outbreaks. In addition to the typical skin problems, these include fever, headache, general exhaustion and muscle pain, and often swollen lymph nodes in the groin area. Further outbreaks are usually milder.

If you already have a different herpes virus in your body, you may already have a certain amount of immunity to herpes viruses. Then the symptoms may be milder during the first outbreak than in people who haven’t yet come into contact with the virus. If – on the other hand – your immune system is weakened, the symptoms could be more severe and last longer.

Causes

Genital herpes is caused by herpes simplex viruses. There are two different types:

• Herpes simplex virus type 1 (HSV-1)

• Herpes simplex virus type 2 (HSV-2)

Genital herpes is mainly caused by HSV-2. Cold sores on lips are also caused by herpes viruses, but usually by HSV-1. Each virus can cause both cold sores and genital herpes, though. Whether you get genital herpes or a cold sore doesn’t only depend on the type of herpes virus, but also on where the viruses are inside the body.

Herpes viruses that have settled in nerve cell clusters (ganglia) at the lower end of the spine can cause genital herpes. If these viruses multiply in the nerve cell clusters and move along the nerves to the outer layers of the skin, they can lead to genital herpes.

Herpes viruses are transmitted by skin contact, especially during sex, including oral or anal sex. They can also be transmitted through shared sex toys. The herpes viruses can’t survive for long without being on skin. That’s why they’re highly unlikely to be transmitted through things like towels, bedsheets or toilet seats.

Risk factors

The risk of women being infected by a male sex partner is considerably higher than the risk of men being infected by a female sex partner. Experts believe that the virus is most commonly transmitted by people who don’t know that they have it.

You are more likely to get genital herpes if you have multiple sex partners or already have a sexually transmitted infection such as HIV. The risk also increases if you don’t use condoms for protection.

Not everyone who is infected by the herpes virus also goes on to develop genital herpes. No one really knows why some people do and some don’t.

There is hardly any research on possible triggers of recurring outbreaks of genital herpes. Some evidence suggests that constant emotional stress could make them more likely. Other possible triggers are thought to include sunlight, common colds, physical exertion, skin injuries, menstruation, and wearing clothes that are tight or made from rough fabrics.

Prevalence

Genital herpes is one of the most common sexually transmitted infections. It is estimated that 10 to 15 out of 100 people in Germany have the HSV-2 virus in their body. About 10 to 30% of those people develop genital herpes.

This is somewhat more common in women than in men. Women are more susceptible to infection because their mucous membranes are more sensitive.

Outlook

People may have their first outbreak of genital herpes months or even years after being infected by the virus. The first time you have genital herpes, it takes an average of 20 days for it to go away if left untreated. Later episodes are milder, though, and generally go away within 10 days. People who have had genital herpes once will usually keep getting it.

The type of virus will determine how often it recurs:

• HSV-1 causes an average of one further outbreak within one year in about 20 to 50% of people who have the virus.

• HSV-2 causes at least one further outbreak – but an average of four further outbreaks – within one year in about 70 to 90% of people who have the virus.

The outbreaks often become less frequent and less severe over time.

Effects

Genital herpes can lead to complications, especially the first time you have it. The possible complications include vaginal yeast infections (“thrush”), bladder problems with trouble urinating, and – in rare cases – meningitis. Complications are very rare in later outbreaks.

People who have genital herpes are at greater risk of being infected with other sexually transmitted infections such as HIV.

Pregnant women can transmit the herpes viruses to the child during birth. But this rarely happens. If a woman has an outbreak of genital herpes shortly before giving birth, a Cesarean section (C-section) is often recommended in order to minimize the risk of infecting the child.

In very rare cases, a herpes infection may lead to larger rashes elsewhere on the body or it may affect the eyes.

Diagnosis

In order to diagnose genital herpes, the doctor takes a sample of cells from the affected area of skin. This sample is tested for herpes viruses in a laboratory. Depending on the situation, the type of virus can sometimes be determined as well.

It’s often not possible to get a definitive diagnosis of herpes based solely on the symptoms and appearance of the skin. The typical symptoms don’t always occur. What’s more, genital herpes may occur at the same time as other skin conditions or sexually transmitted infections. Herpes symptoms are sometimes similar to those caused by yeast infections or chlamydia, or by other skin conditions such as psoriasis.

It is more difficult to diagnose a herpes virus infection in people who don’t show any symptoms. Then a test for herpes antibodies can be used to check whether there are antibodies in the bloodstream. If HSV-2 antibodies are found, then the person could develop genital herpes. If there are HSV-1 antibodies, it’s difficult to predict what part of the body might be affected if symptoms occur.

The tests usually can’t offer any information about when you first became infected. But if someone has genital herpes for the first time and no antibodies are found, then they were probably infected recently.

Prevention

Because a lot of people have the herpes virus in their body, anyone who is sexually active can be infected with it. But the risk of infection can be reduced significantly.

People who have genital herpes are advised to avoid sex as soon as they notice signs that an outbreak is starting. This is because the risk of transmitting the virus is greatest during an outbreak.

But the virus can also be transmitted by people who don’t have any symptoms. Condoms can greatly reduce the risk of infection during symptom-free periods. They also protect against other sexually transmitted diseases.

If you have genital herpes, it’s a good idea to talk about it with your partner. If both of you have a blood test for antibodies, it’s possible to find out whether your partner also has herpes viruses in their body, what type of herpes viruses you have – and whether there’s a risk of infection. A partner who has HSV-1 could still become infected with HSV-2, for example.

People who have genital herpes can somewhat lower the risk of infecting others by taking antiviral medication. These medications include aciclovir, famciclovir or valaciclovir. They must be taken daily for a long period of time, though. If you already use condoms for contraception, it’s not clear whether taking antiviral medications can lower the risk of infection even more.

Treatment

The very first outbreak of genital herpes can cause more severe symptoms than later outbreaks, and sometimes complications as well. So it’s normal to take antiviral medications containing the active ingredients aciclovir, famciclovir or valaciclovir the first time you have herpes. These tablets can reduce the severity of symptoms and shorten the length of the outbreak by a few days. Creams or ointments containing antiviral drugs aren’t effective against genital herpes.

In later outbreaks, the symptoms are typically less severe. Treatment is then not absolutely necessary. If you take antiviral medication for later outbreaks, you won’t need to use it for as long. It’s important to start the treatment within the first 24 hours – ideally, as soon as you notice the first signs of an outbreak. This is easier to do if you always have tablets at home or take them with you when you travel.

Preventive treatment with medication may be considered if someone has severe or very frequent herpes outbreaks. Then the medication is taken over a longer time period – during symptom-free phases, too. This can greatly lower the likelihood of outbreaks.

If genital herpes is causing severe pain, painkillers can help. Many women who have pain when peeing find that sitting in warm, shallow water (a sitz bath) can help.

There has hardly been any research on other treatments like laser therapy or applying warmth to the area, so it’s not clear whether they are effective.

Everyday life

Knowing that you have genital herpes can be very distressing. Many people find it hard to talk about it with their partner. Some are afraid that their partner will react with disgust or think that they have been unfaithful. Others may wonder whether they were infected by their partner.

Speaking openly about the disease can help – because it’s often not really possible to tell who you were infected by, or when. After all, many people have herpes viruses in their body, and anyone who is sexually active can become infected. Also, the virus may remain inactive for months or years before causing an outbreak of genital herpes.

Sources

• Feltner C, Grodensky C, Ebel C, Middleton JC, Harris RP, Ashok M et al. Serological Screening for Genital Herpes: An Evidence Review for the U.S. Preventive Services Task Force. December 2016. (AHRQ Evidence Syntheses; Volume 149).

• Heslop R, Roberts H, Flower D, Jordan V. Interventions for men and women with their first episode of genital herpes. Cochrane Database Syst Rev 2016; (8): CD010684. [PMC free article: PMC8502075] [PubMed: 27575957]

• Hollier LM, Eppes C. Genital herpes: oral anti viral treatments. BMJ Clin Evid 2015: pii: 1603.

• Korr G, Thamm M, Czogiel I, Poethko-Mueller C, Bremer V, Jansen K. Decreasing seroprevalence of herpes simplex virus type 1 and type 2 in Germany leaves many people susceptible to genital infection: time to raise awareness and enhance control. BMC Infect Dis 2017; 17(1): 471. [PMC free article: PMC5500947] [PubMed: 28683784]

• Le Cleach L, Trinquart L, Do G, Maruani A, Lebrun-Vignes B, Ravaud P et al. Oral antiviral therapy for prevention of genital herpes outbreaks in immunocompetent and nonpregnant patients. Cochrane Database Syst Rev 2014; (8): CD009036. [PubMed: 25086573]

• Patel R, Alderson S, Geretti A, Nilsen A, Foley E, Lautenschlager S et al. European guideline for the management of genital herpes, 2010. Int J STD AIDS 2011; 22(1): 1-10. [PubMed: 21364059]

• IQWiG health information is written with the aim of helping
  people understand the advantages and disadvantages of the main treatment options and health
  care services.

  Because IQWiG is a German institute, some of the information provided here is specific to the
  German health care system. The suitability of any of the described options in an individual
  case can be determined by talking to a doctor. We do not offer individual consultations.

  Our information is based on the results of good-quality studies. It is written by a
  team of
  health care professionals, scientists and editors, and reviewed by external experts. You can
  find a detailed description of how our health information is produced and updated in
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Herpes zoster – causes, symptoms, treatment in adults

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Effective treatment of herpes zoster and post-herpetic neuralgic pain in Hadassah Medical Clinic. All analyzes and consultations in one place for the convenience of patients. The selection of an individual treatment plan and a multidisciplinary approach make it possible to successfully cure the infection even in immunocompromised patients.

Shingles (herpes zoster) is a viral infection that affects the skin and nervous system. It is caused by the causative agent Varicella zoster (VZV) – type 3 herpesvirus. The disease is manifested by blisters along the nerves and burning pains that bother a person for several months. Herpes zoster is dangerous not only with subjective symptoms, but also with complications from the brain and sensory organs.

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Zhukova
Daria Grigoryevna

Allergist-immunologist, Ph.D.

Work experience: 14 years

Admission fee: from 9000 ₽

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Galina Valerievna

Allergist-immunologist

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Benefits of treatment at the Hadassah clinic

Rapid diagnosis

Analyzes are performed in our own laboratory, which is equipped with modern equipment and test systems for all types of research.

Multidisciplinary approach

Herpes zoster will be treated by neurologists, infectious disease specialists, immunologists and other specialists, if the patient’s health condition so requires.

Personalized therapy program

Our doctors follow the principle of “treat the patient, not the disease”, so they are attentive to each situation and take into account the characteristics of a particular person when choosing a therapeutic program.

Evidence-based medicine

In our work, we use only generally recognized clinical protocols, international recommendations, and the results of randomized trials.

Original drugs

The clinic cooperates with leading pharmaceutical companies, which allows you to purchase certified and high-quality medicines.

Rehabilitation

We pay great attention to the restoration of a full life of the patient, the elimination of residual pain and other symptoms that interfere with normal activities.

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Symptoms of herpes Zoster

Up to 80% of cases of the disease begin with a prodromal period. Patients experience moderate pain, itching and tingling in the area of ​​one dermatome – where a rash appears after 3-4 days. It is also characterized by fever, malaise, headaches.

Eruptions have characteristic features:

• initially pink spots 3-5 cm in diameter with indistinct edges appear;
• a day later, small blisters form in their place, similar to a rash with chickenpox;
• vesicles are usually located on the chest or abdomen, which corresponds to the course of one of the sensory nerves;
• the appearance of signs of herpes on the back, neck, limbs is typical for a generalized form of the disease and is mainly associated with immunodeficiencies;
• rashes gradually shrink into crusts that fall off after a few weeks, leaving behind unstable pigmentation on the skin.

The acute period is always accompanied by intense burning pains in the area of ​​the affected nerve. Pain is aggravated by touch. They can be permanent or paroxysmal in nature, some patients describe the symptoms as “electric shock”.

You can see a photo of what shingles looks like, but do not use the information as a way for self-diagnosis and self-treatment. This is a dangerous disease that should be treated under the supervision of an infectious disease specialist and a neurologist.

Causes of occurrence

Most people come into contact with the pathogen in childhood, when they fall ill with classic chicken pox or endure it in an erased form. After the initial infection, the virus does not disappear from the body anywhere. It remains in the nerve ganglia and can remain there in a latent state for decades. Under adverse conditions, it again manifests itself, causing shingles.

VZV reactivation occurs when the body’s immune defenses decrease due to the following factors:

• hypothermia or overheating;
• chronic stress;
• excess ultraviolet exposure;
• unbalanced diet, beriberi;
• acute respiratory diseases;
• injuries, surgical operations;
• acute and chronic diseases of internal organs;
• secondary immunodeficiency states;
• receiving immunosuppressive, antibacterial therapy.

One of the most important predisposing factors is called HIV infection. When the level of CD4-lymphocytes falls below 500 cells per μl, the body’s resistance to latent infection is sharply reduced, and symptoms of herpes zoster appear.

Diagnosis

The diagnosis of herpes zoster is usually based on pathognomonic lesions and pain. Herpes simplex virus (HSV) can cause nearly identical lesions, but unlike herpes zoster, HSV tends to recur and is not dermatomal (associated with a specific nerve). Before treating herpes zoster, the doctor must be completely sure of the diagnosis, so clarifying examinations are prescribed:

PCR test

to identify the genetic material of the pathogen;

ELISA

to detect antibodies to herpesvirus;

Clinical blood test

in which the specialist is interested in the level of leukocytes and the ratio of different fractions of white blood cells;

Microscopy of impression smears from affected areas of the skin

to detect multinucleated giant cells.

It is important to clarify what led to the manifestation of the disease. If there are no obvious causes, it is worth looking for a disease that initially does not cause independent symptoms, but reduces immunity (cancer or infection with the human immunodeficiency virus). Exclusion of HIV infection is necessary in all patients under 50 years of age.

Methods of treatment of herpes zoster in the Hadassah clinic

Therapy is carried out in two directions: etiotropic drugs to fight a viral infection and painkillers to alleviate a person’s condition. The best clinical results can be achieved with the start of pharmacotherapy in the first 72 hours from the appearance of rashes. The main drugs for the treatment of herpes zoster in adults are representatives of the acyclovir group, which are used according to an individual scheme.

All patients are prescribed analgesics in tablets and injections; local anesthetics are also used for post-herpetic pain. With intense pain syndrome, the treatment of herpes Zoster is supplemented with centrally acting medicines: antidepressants, tranquilizers, anticonvulsants. According to indications, methods of physiotherapy are used.

Blisters on the skin contain a large number of viral particles that pose an epidemiological hazard to others. Herpes zoster itself is not transmitted because it is associated with the reactivation of an existing infection, but the patient can become a source of chickenpox for children and previously healthy adults. Since a person with skin manifestations of shingles is contagious to others, it is recommended to limit close contact with family members and others who have not yet encountered chickenpox.

Why the disease is dangerous

One of the main problems is postherpetic neuralgia, which can occur even with properly selected drugs for the treatment of herpes zoster in adults. The frequency of complications increases in direct proportion to age – more than 50% of patients over 60 suffer from this disease. Pain phenomena at the site of the rash persist for several months, in 10-15% of cases the symptoms last for six months.

Other negative effects of the infection are much less common, but are a serious health hazard. These include:

• transverse myelitis – inflammation of the segments of the spinal cord located close to the affected dermatome;
• meningitis, encephalitis – inflammation of the membranes and substance of the brain;
• ophthalmic herpes – damage to the eyeball, which is fraught with decreased vision and the development of glaucoma;
• pyoderma – suppuration of rash areas due to the addition of a secondary bacterial infection.

Such manifestations are more common in elderly patients, people with a weakened immune system, patients who have recently undergone serious illness or surgery.

To reduce the risk of dangerous complications from the nervous system, it is necessary to consult a doctor in a timely manner, who knows how to treat herpes zoster according to modern protocols from the standpoint of evidence-based medicine.

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Disease prevention

In people who have recovered from chickenpox, preventive measures are aimed at preventing VZV reactivation in regional nerve structures. For this purpose, it is recommended to strengthen the immune system and health-improving procedures, which include:

• balanced and fortified nutrition;
• prolonged sleep;
• avoidance of mental and physical overwork;
• timely treatment of somatic diseases, metabolic disorders;
• practicing safe sex to prevent HIV infection.

The only way to specifically protect against the Varicella Zoster virus is timely vaccination before the person has come into contact with the virus. Children are usually vaccinated to protect them from infection. However, immunization according to strict indications is also carried out for the elderly and debilitated people who are at high risk of developing symptoms of herpes zoster. Vaccination helps build immunity against infection and prevent it from reactivating.

For effective and evidence-based treatment of herpes zoster in adults, contact the Hadassah clinic in Moscow. Our doctors will conduct a comprehensive diagnosis and select a personal treatment plan. Specialists also treat postherpetic neuralgia and other complications, helping the patient return to a full life after illness.

#ZhukovaDYu

Zhukova
Daria Grigorievna

Allergist-immunologist, PhD

Work experience: 14 years

Published: 07/09/2023

The information provided on the site is for reference only and cannot serve as a basis for making a diagnosis or prescribing treatment. Internal consultation of the expert is necessary.

SOURCES

• Herpes zoster. Clinical recommendations of the All-Russian public organization “Russian Society of Dermatovenerologists and Cosmetologists”. – 2020.
• Isakov DV, Isakov VA Herpes simplex and herpes zoster (clinic, treatment and prevention). – 2021.
• Cairo A. N., Lavrov V. F. Herpes zoster: epidemiological features of incidence in 2019 // Epidemiology and vaccine prevention. – 2020. – T. 19. – No. 5. – S. 93-97.
• Ryumin AM et al. Neurological manifestations of herpes zoster virus reactivation //Journal of Infectology. – 2022. – T. 14. – No. 1. – S. 31-42.
• Ignatovsky AV Herpes zoster – modern approaches to diagnosis and treatment //Doctor/Vrach. – 2022. – T. 33. – No. 10.
• Avdeeva M.G., Alikeeva G.K., Antonova M.V. etc. Infectious diseases. National leadership. Ed. N.D. Yushchuk, Yu.Ya. Vengerov. M.; GOETAR; 2018.
• Polyakova D.M., Nikiforov V.V., Shakhmardanov M.Z. Immunity and vaccination in adults with infection caused by the Varicella zoster virus. Epidemiology and infectious diseases. 2019; 24(2): 84-7.
• Dooling K.L., Guo A., Patel M., Lee G.M., et al. Recommendations of the advisory committee on immunization practices for use of herpes zoster vaccines // Centers for disease control and prevention.