What are the main symptoms of oral herpes. How is herpes simplex virus diagnosed. What treatment options are available for HSV infections. How can you prevent the spread of oral herpes. What triggers recurrent outbreaks of HSV.

Understanding Herpes Simplex Virus: Types and Prevalence

Herpes simplex virus (HSV) is a common viral infection that affects millions of people worldwide. There are two main types of HSV: HSV-1 and HSV-2. HSV-1 is primarily associated with oral herpes, while HSV-2 is typically responsible for genital herpes. However, both types can cause infections in either location.

According to the National Institutes of Health, approximately 90% of adults have been exposed to HSV-1 by age 50. The prevalence of oral herpes in the United States is particularly high, with 50% to 80% of adults being affected. Once a person is infected with HSV, the virus remains dormant in their body for life, potentially causing periodic outbreaks.

How common is HSV-1 infection?

HSV-1 infection is extremely common, with a large portion of the global population carrying the virus. In the United States alone, more than half of adults are estimated to have HSV-1. This high prevalence is due to the ease of transmission and the fact that many people are infected during childhood through non-sexual contact.

Recognizing the Symptoms of Oral Herpes

Oral herpes, caused primarily by HSV-1, manifests in various ways. The initial infection is often the most severe, potentially causing flu-like symptoms such as swollen lymph nodes and headaches. However, some individuals may remain asymptomatic during the primary infection.

The most common signs and symptoms of a recurring oral herpes infection include:

• Initial redness, swelling, heat, pain, or itching in the affected area
• Painful, fluid-filled blisters on the lips or under the nose
• Leaking of fluid from blisters as they develop into sores
• Crusting and healing of sores after 4-6 days

Can oral herpes symptoms vary between individuals?

Yes, the severity and frequency of oral herpes symptoms can vary significantly between individuals. Some people may experience frequent outbreaks with noticeable symptoms, while others may have infrequent or even asymptomatic episodes. Factors such as stress, immune system health, and overall well-being can influence the manifestation of symptoms.

Transmission and Prevention of Oral Herpes

Oral herpes is primarily spread through direct physical contact with an infected individual, especially during an active outbreak. The virus is highly contagious and can be transmitted through activities such as kissing or engaging in oral sex with someone who has an active HSV infection.

How can you prevent the spread of oral herpes?

To minimize the risk of transmission, consider the following preventive measures:

1. Avoid physical contact with individuals who have active cold sores
2. Refrain from sharing personal items such as lip balm, utensils, or towels
3. Practice good hygiene, including frequent handwashing
4. Use barrier methods during intimate activities, especially if a partner has an active outbreak
5. Consider antiviral medications to suppress outbreaks and reduce viral shedding

Diagnosing Herpes Simplex Virus Infections

Accurate diagnosis of HSV infections is crucial for proper management and treatment. While healthcare providers may sometimes diagnose oral herpes based on the appearance and location of lesions, laboratory tests are often necessary for confirmation.

What diagnostic methods are used to confirm HSV infections?

Several diagnostic techniques can be employed to confirm an HSV infection:

• Viral culture (PCR): This test involves taking a sample from an active lesion to detect the presence of the virus
• Blood tests: Serological tests can identify HSV antibodies in the blood, indicating past or current infection
• Biopsy: In rare cases, a small tissue sample may be taken for examination

It’s important to note that HSV infections can be confused with other conditions, such as allergic reactions. Therefore, laboratory confirmation is often necessary for an accurate diagnosis.

Factors Triggering Recurrent Outbreaks

While the exact triggers for HSV recurrence are not fully understood, several factors have been identified as potential contributors to outbreaks. Understanding these triggers can help individuals manage their condition more effectively.

What are common triggers for HSV recurrence?

Some factors that may contribute to recurrent HSV outbreaks include:

• Stress: Both physical and emotional stress can weaken the immune system and trigger outbreaks
• Illness or fever: Any condition that compromises the immune system may lead to HSV reactivation
• Hormonal changes: Menstruation, pregnancy, or hormonal imbalances can influence outbreak frequency
• Sun exposure: UV radiation may trigger outbreaks in some individuals
• Dietary factors: Certain foods or nutrient deficiencies may contribute to recurrence
• Fatigue: Lack of sleep or excessive tiredness can weaken the body’s defenses

It’s worth noting that recurrent outbreaks tend to be more common in the first year after the initial infection. However, as the body builds antibodies to the virus, the frequency and severity of outbreaks often decrease over time.

Treatment Options for Oral Herpes

While there is no cure for HSV infections, various treatment options are available to manage symptoms, reduce outbreak duration, and minimize transmission risk. The choice of treatment depends on factors such as the individual’s age, overall health, and personal preferences.

What are the main treatment approaches for oral herpes?

Treatment options for oral herpes typically include:

1. Antiviral oral medications: Drugs such as acyclovir, famciclovir, and valacyclovir are considered the most effective treatments for HSV infections
2. Topical antiviral ointments: Products containing acyclovir or penciclovir can be applied directly to lesions
3. Over-the-counter remedies: Topical anesthetics or anti-inflammatory agents can help alleviate symptoms
4. Proper hygiene: Keeping the affected area clean and dry is essential for healing
5. Supportive care: Adequate rest, hydration, and a balanced diet can support the immune system

In some cases, healthcare providers may recommend long-term suppressive therapy with antiviral medications to reduce the frequency of outbreaks and lower the risk of transmission to partners.

Living with Herpes Simplex Virus: Long-term Management

Living with HSV requires ongoing management and awareness. While the virus remains in the body for life, many individuals learn to effectively control their symptoms and minimize the impact on their daily lives.

How can individuals effectively manage HSV long-term?

Long-term management of HSV infections often involves a combination of strategies:

• Recognizing personal triggers and taking steps to avoid them
• Maintaining a healthy lifestyle to support immune function
• Using antiviral medications as prescribed, either for outbreak treatment or suppression
• Practicing safe intimacy and being open with partners about HSV status
• Seeking support from healthcare providers or support groups when needed
• Staying informed about new developments in HSV research and treatment

With proper management, many individuals with HSV can lead normal, healthy lives with minimal disruption from the virus.

Addressing the Stigma: Myths and Facts about Herpes

Despite its prevalence, herpes simplex virus infections often carry a significant social stigma. This stigma can lead to misunderstandings, anxiety, and unnecessary isolation for those affected. Addressing common myths and promoting accurate information is crucial for reducing stigma and supporting individuals with HSV.

What are some common misconceptions about herpes?

Several myths persist about HSV infections:

• Myth: Only promiscuous people get herpes.
  Fact: HSV can affect anyone, regardless of sexual history.
• Myth: Herpes is always sexually transmitted.
  Fact: HSV-1 is often acquired through non-sexual contact, especially in childhood.
• Myth: People with herpes can’t have relationships.
  Fact: Many people with HSV have successful, healthy relationships.
• Myth: Herpes causes serious health problems.
  Fact: For most people, herpes is a manageable condition with minimal health impacts.
• Myth: You can only transmit herpes during an outbreak.
  Fact: Asymptomatic viral shedding can occur, allowing transmission without visible symptoms.

By dispelling these myths and promoting accurate information, we can foster a more understanding and supportive environment for individuals living with HSV.

How does stigma impact individuals with HSV?

The stigma associated with HSV can have significant psychological and social impacts on affected individuals. It may lead to:

• Feelings of shame or embarrassment
• Anxiety about disclosing HSV status to partners
• Decreased self-esteem and confidence
• Social isolation or avoidance of intimate relationships
• Increased stress, which can potentially trigger outbreaks

Addressing stigma through education and open dialogue is essential for supporting the mental health and well-being of individuals living with HSV.

Future Perspectives: Research and Potential Treatments

While current treatments for HSV focus on managing symptoms and reducing transmission, ongoing research aims to develop more effective therapies and potentially a cure for the virus. Understanding the latest developments in HSV research can provide hope and insight for those affected by the condition.

What are some promising areas of HSV research?

Several avenues of research show potential for improving HSV treatment and prevention:

• Vaccine development: Researchers are working on both preventive and therapeutic vaccines for HSV
• Gene editing techniques: CRISPR and other gene-editing tools are being explored to target the latent virus
• Novel antiviral compounds: New drugs that target different aspects of the viral life cycle are under investigation
• Immunotherapy approaches: Enhancing the body’s immune response to HSV could lead to better control of the virus
• Combination therapies: Using multiple treatment modalities may provide more effective management of HSV infections

While a cure for HSV remains elusive, these research efforts offer hope for improved treatments and potential prevention strategies in the future.

How might future treatments impact individuals with HSV?

Advancements in HSV treatment could significantly improve the quality of life for affected individuals by:

• Reducing the frequency and severity of outbreaks
• Lowering the risk of transmission to partners
• Minimizing the long-term impact of HSV on overall health
• Potentially eliminating the need for lifelong medication
• Addressing complications associated with HSV infections

As research progresses, it’s important for individuals with HSV to stay informed about new developments and discuss emerging treatment options with their healthcare providers.

Oral Herpes | Johns Hopkins Medicine

Whether you call it a cold sore or a fever blister, oral herpes is a common infection of the mouth area that is caused by herpes simplex virus type 1 (HSV-1). Fifty percent to 80 percent of U.S. adults have oral herpes. According to the National Institutes of Health, about 90 percent of adults have been exposed to the virus by age 50.

Once infected, a person will have herpes simplex virus for the rest of his or her life. When inactive, the virus lies dormant in a group of nerve cells. While some people never develop any symptoms from the virus, others will have periodic outbreaks of infections.

Causes of Oral Herpes

Oral herpesis spread most commonly from individuals with an active outbreak or sore. You can catch oral herpes by engaging in intimate or personal contact (e.g., kissing or oral sex) with someone who is infected.

Prevention of Oral Herpes

Since oral herpes is spread through direct, physical contact, the best method of prevention is to avoid physical contact with a person’s herpes sores when they are having an outbreak.

Oral Herpes Symptoms

The initial (primary) infection of oral herpes is usually the worst. It may cause severe, flu-like symptoms, including swollen lymph nodes and headache. However, some people have no symptoms at all. During the initial infection, sores can occur on and around the lips and throughout the mouth. 

Recurring infections tend to be much milder, and the sores usually erupt on the edges of the lips. Some people never have any additional outbreaks beyond the initial infection. The following are the most common signs and symptoms of a recurring oral herpes simplex virus infection.

• Initial redness, swelling, heat/pain or itching may develop in the area where the infection will erupt.

• Painful, fluid-filled blisters may appear on the lips or under the nose. The blisters and fluid are highly contagious.

• The blisters will leak fluid and become sores.

• After about four to six days, the sores will start to crust over and heal.

The signs and symptoms of an oral herpes outbreak may look like other conditions or medical problems. Always consult your health care provider for an accurate diagnosis.

Diagnosing Oral Herpes

Since oral herpes can be confused with many other infections, including allergic reactions, a virus culture (PCR), blood test or biopsy are the only ways to confirm your diagnosis. However, your health care provider may also diagnose your condition based on the location and appearance of the blisters.

Recurrence of Oral Herpes

Although the specific triggers that cause oral herpes to recur are unclear, several factors may play a role. These include:

While recurrent outbreaks are more common in the first year after the initial episode, they tend to lessen as the body builds antibodies to the virus.

Oral Herpes Treatment Options

Your health care provider will recommend treatment options based on your:

• Age

• Expected outcome

• Overall health and medical history

• Personal preference

• Tolerance for specific medicines, procedures or therapies

Your specific treatment plan may involve:

• Keeping the infected area clean and dry

• Taking antiviral oral medications, such as acyclovir, famciclovir and valacyclovir (these medications are traditionally the most effective)

• Applying antiviral topical ointments, such as acyclovir and penciclovir

• Using over-the-counter topical anesthetics or anti-inflammatory agents to alleviate symptoms

Herpes Simplex Virus (HSV) Mouth Infection

Not what you’re looking for?

What is a herpes simplex virus (HSV) mouth infection? 

Some people call it a cold sore, others a fever blister. Herpes
simplex virus is the cause of this annoying and often painful chronic condition.

The herpes sores (lesions) typically last a week to 10 days. They
most often occur on the lips, tongue, roof of the mouth, or the gums. The sores
occur first as fluid-filled blisters that burst (rupture) after a day or 2. The
sores will ooze fluid that has the virus. After a few days, the sores will form
crusts or scabs. The virus is highly contagious and can be spread by skin-to-skin
contact such as kissing.

What causes an HSV mouth infection?

The virus is spread by skin-to-skin contact with someone who
carries the virus. Most people with oral herpes were infected during childhood or
as
young adults from nonsexual contact with infected saliva. It can be passed by
kissing, touching the infected person’s skin, or sharing infected objects such as
lip balm, silverware, or razors.

The 2 most common forms of the virus are:

• Herpes simplex virus type 1
  (HSV-1).
  HSV-1 is most often linked to infections of the mouth.
• Herpes simplex virus type 2
  (HSV-2).
  This type is most often linked to genital herpes infections.

Both types of HSV can infect both the mouth and the genitals.

Once infected, a person will have the herpes simplex virus for the
rest of their life. When the virus is not active, it is dormant in a group of nerve
cells. Some people never have any symptoms from the virus while others have periodic
outbreaks of infections.

It is not clear what triggers the virus to return. But the risk
factors below may play a role:

• Long or intense exposure to sunlight
• A recent fever
• Emotional stress
• Menstruation
• Surgery
• Physical injury

Recurrent outbreaks are more common in the first year after the
initial episode. After that, the outbreaks diminish in frequency and severity as the
body builds antibodies to the virus.

What are the symptoms of an HSV mouth infection?

The initial (primary) infection of the oral herpes simplex virus
is often the worst. It may cause severe, flu-like symptoms, swollen lymph nodes, and
headache. But some people have no symptoms at all. In the initial infection, sores
can occur on and around the lips and all over the mouth.

Recurring infections tend to be much milder, and the sores often
erupt in the edges of the lips. Some people never have any more outbreaks beyond the
initial infection. These are the most common symptoms of a recurring oral HSV
infection:

• Initial redness, swelling, heat, and pain, or itching in the
  area where the infection will erupt.
• Painful, fluid-filled blisters may appear on the lips or
  under the nose. These blisters, and the fluid they contain, are highly
  contagious.
• The blisters leak fluids and become sores.
• After about 4 to 6 days, the sores start to crust over and
  heal.

The symptoms of an oral HSV outbreak may look like other
conditions or health problems. Always see your healthcare provider for a
diagnosis.

How is an HSV mouth infection diagnosed?

Herpes simplex virus may be difficult to diagnose because it may
be confused with many other infections, such as allergic reactions. HSV can be
confirmed only with a virus culture, blood test, or biopsy. A healthcare provider
can often diagnose it based on where the blisters are and how they look.  

How is an HSV mouth infection treated?

Treatment will depend on your symptoms, age, and general health.
It will also depend on how severe the condition is.

Treatment may include:

• Keeping the infected area clean and dry
• Antibiotic treatment for any secondary bacterial
  infections
• Topical antiviral creams
• Oral antiviral medicines

What can I do to prevent an HSV mouth infection?

These tips can help you prevent an oral HSV infection:

• Don’t have direct contact with someone with herpes sores.
  According to the CDC, genital herpes (HSV-2) can be contagious without any
  symptoms.
• Don’t share silverware, glasses, straws, or other items with
  someone who has oral herpes.
• Wash bedding and towels in boiling hot water after each
  use.
• Don’t have oral sex if you or your partner have oral herpes
  (HSV-1). HSV-1 can be spread to the genitals, especially if you have oral
  blisters.
• To prevent a possible recurrence, use a sunblock that
  contains zinc oxide on your lips.

Key points about an HSV mouth infection

• A cold sore or fever blister is caused by the herpes simplex
  virus.
• The virus is highly contagious and can be spread by
  skin-to-skin contact such as kissing.
• Once infected, a person will have the herpes simplex virus
  for the rest of their life.
• Herpes sores typically last a week to 10 days. They most
  often occur on the lips, tongue, roof of the mouth, or the gums.

Next steps

Tips to help you get the most from a visit to your healthcare
provider:

• Know the reason for your visit and what you want to
  happen.
• Before your visit, write down questions you want
  answered.
• Bring someone with you to help you ask questions and
  remember what your provider tells you.
• At the visit, write down the name of a new diagnosis and any
  new medicines, treatments, or tests. Also write down any new instructions your
  provider gives you.
• Know why a new medicine or treatment is prescribed and how
  it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the
  results could mean.
• Know what to expect if you do not take the medicine or have
  the test or procedure.
• If you have a follow-up appointment, write down the date,
  time, and purpose for that visit.
• Know how you can contact your provider if you have
  questions.

Medical Reviewer: Michael Kapner MD

Medical Reviewer: Rita Sather RN

Medical Reviewer: Stacey Wojcik MBA BSN RN

© 2000-2021 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional’s instructions.

Not what you’re looking for?

Herpes simplex: Symptoms, pictures, types, treatment

Herpes simplex is a viral infection that typically affects the mouth, genitals, or anal area. It is contagious and can cause outbreaks of sores and other symptoms.

Herpes simplex virus (HSV) is a highly prevalent infection globally, with the most common type affecting around 3.7 billion people under the age of 50 years. It spreads rapidly through direct contact with a person who carries HSV. The sexual transmission of some types of HSV is also possible.

The majority of people with HSV will not show any symptoms at all, but they can still pass on the virus. The symptoms of HSV are typically mild but can cause discomfort.

HSV can be particularly harmful to those with weakened immune systems, such as infants.

This article will outline the symptoms of HSV, the different types of the virus, and how to treat it.

It is common for a person with HSV to have no noticeable symptoms. However, even without having symptoms, a person can still pass the virus on to someone else.

When people do experience symptoms, these will usually include sores. These are blisters that develop on the surface of the skin and may be itchy or uncomfortable. They can break open and ooze fluid.

Sores can develop anywhere, but they usually occur around the mouth, genitals, or anus, depending on the type of HSV. Most sores emerge within the first 20 days after contracting the infection and can last around 7 to 10 days.

Other symptoms of HSV can include:

• localized tingling, itching, or burning
• flu-like symptoms
• problems urinating
• eye infections

The symptoms of HSV typically occur in outbreaks that can last between 2 and 6 weeks, depending on the type of HSV. The frequency of these outbreaks can vary.

There are two main types of HSV:

Herpes simplex virus type 1

Herpes simplex virus type 1 (HSV-1) is the most common form of HSV. Due to its constant presence worldwide, the medical community considers HSV-1 to be an endemic disease.

HSV-1 typically leads to oral herpes, as the vast majority of HSV-1 cases affect the mouth and its surrounding area. However, it is possible for HSV-1 to affect other areas of the body, such as the genitals.

HSV-1 often develops during childhood and is a lifelong condition. It can spread through non-sexual contact with saliva, such as kissing.

Herpes simplex virus type 2

Herpes simplex virus type 2 (HSV-2) spreads through sexual contact and is a type of sexually transmitted infection (STI).

HSV-2 typically leads to genital herpes, which means that symptoms usually develop around the genital and anal areas. It is also a lifelong condition, and symptoms only appear during flare-ups.

Both types of HSV develop as a result of direct contact with the virus.

HSV-1 most commonly spreads through oral-to-oral contact, which can be with sores, saliva, or the area around the mouth. Transmission may also occur due to sharing lip balm, a toothbrush, or any other product that has come into contact with HSV.

People have a much higher risk of contracting HSV-1 if they come into contact with someone who has an active outbreak of symptoms. In some cases, it is also possible for people to transmit HSV-1 during sexual activity.

Transmission of HSV-2 almost always takes place during sexual contact. This includes any contact with the skin, sores, saliva, or bodily fluids of someone with HSV-2, and it can occur during vaginal, oral, or anal sex.

It is usually possible for doctors to diagnose HSV by carrying out a physical examination of symptoms during an outbreak. The sores are easy to identify as a sign of HSV infection.

A doctor will also ask questions about the symptoms. If they suspect HSV-2, they may ask about a person’s sexual health history.

It is also possible that they will take a sample from a sore. Alternatively, if the individual does not have symptoms, the doctor can use a blood test to detect the infection.

Although there is no cure for either type of HSV, symptoms are often not present, and treatment may not be necessary.

When symptoms do occur, they often resolve without treatment after several weeks.

Treatments are available to help control symptoms and reduce the frequency of outbreaks. Some medications can also reduce the risk of transferring HSV to others.

Antiviral creams or ointments are available for the sores. These treatments should help relieve the itching, stinging, and discomfort.

Examples of antiviral medications include:

• acyclovir
• famciclovir
• valacyclovir

These medications are also available in the form of a pill or an injection.

HSV is a highly prevalent viral infection. It spreads rapidly through direct contact, and the chances of contracting the virus are relatively high.

In many cases, a person will not experience any symptoms. When symptoms do occur, they appear in outbreaks. The first outbreak is typically the worst.

There is no cure for HSV, but antiviral treatments can help people manage the condition.

Herpes Simplex Virus (HSV): Overview, Symptoms and Treatment

Herpes simplex virus (HSV) is a virus that causes infections. It is very contagious. There are two types of this virus. One type (HSV-1) usually causes sores around the lips or inside the mouth that are sometimes called fever blisters or cold sores. The other type (HSV-2) usually causes sores on the genitals (private parts). Either type can infect the mouth, genital area or another part of the body.

HSV spreads most easily when a person comes in direct contact with an infected person’s mucous membranes, saliva, or the oozing fluid from a sore. Mucous membranes are the moist skin that lines the inside parts of the body such as the mouth, nose and vagina. That is why it is extremely important not to kiss or have sex with anyone when herpes sores are present. However, HSV can be spread even when the infected person has no sores or obvious signs of infection. The herpes virus cannot live very long outside of the body. It is unlikely that you can get it from a toilet seat.

Symptoms of Herpes

Symptoms of herpes usually begin within 2 to 20 days after contact with the HSV virus. The skin becomes painful or it may itch, burn or tingle. Then one or more blisters appear. The blisters open and become sores. The sores turn crusty and heal slowly over 1 to 2 weeks. By 3 weeks, the sores have completely healed without leaving a scar. Sometimes flu-like symptoms, such as swollen glands, headache, body aches and fever also develop. For some, the symptoms may be so mild that the person does not get sores and may not even know that he or she is infected.

When the sores have healed and the skin looks normal again, the virus hides in the nerve cells under the surface of the skin. Once someone is infected with the herpes virus, he or she will have the infection for the rest of his life. The sores can come back at any time when you have a lot of stress, get too tired or have illness, irritated skin, sunburn or a poor diet. They can also come back during menstruation. Sometimes the sores can come back for no reason.

How Herpes is Treated

There is no cure for herpes.

• The health care provider may prescribe antiviral medicine to help speed up the healing process. It also shortens the time when the virus can spread from the herpes sores.
• Pain may be treated with medicine such as Tylenol (acetaminophen) or Motrin (ibuprofen) or by applying an ice pack wrapped in a towel to the affected area.
• If sores are in the mouth, avoid foods high in acid, like citrus fruits and juices.
• The infected area should be kept clean and dry.
• Wash hands often and avoid touching the sores to prevent spreading the virus.
• It is important to stay healthy by getting enough rest, having proper nutrition and exercise and managing stress well.

When to Call the Doctor

Even though HSV sores can hurt and be unsightly, most cases of herpes do not cause serious illness. The sores go away in a few days. Contact the health provider if:

• Sores are present and you think it might be a first herpes infection. The diagnosis is usually made by examining the sores. If the sores have not healed, sometimes a laboratory test is done.
• Sores do not heal by themselves or show signs of infection such as pus, spreading redness or fever.
• Sores are near the eyes.
• You have another health condition with a weakened immune system.

Other Important Points    

During a flare-up:

• Avoid touching the sores or the skin around that area. Other parts of the body can become infected. Wash your hands with soap and water right away.
• Protect infants from being kissed by anyone with a cold sore. Babies can get very sick from HSV.
• Do not kiss anyone when mouth sores are present. Do not share things that may have touched the sores.
• Keep drinking glasses, eating utensils, washcloths and towels away from others. Wash these items thoroughly after use.
• Do not have sexual intercourse or oral sex until the sores are completely healed. Latex condoms and dental dams can reduce the risk of spreading or getting herpes. It is best to use them at all times when you have sex.
• If you get pregnant, it is very important to tell your doctor you have herpes. That way, precautions can be taken to keep the baby from coming in contact with the virus.
• In most cases, you can still go to school during a flare-up.

Herpes Simplex Virus (HSV) (PDF)

HH-I-174 6/93 Revised 2/17 Copyright 1993 Nationwide Children’s Hospital

What is Herpes? | Genital Herpes vs Oral Herpes

What is herpes?

Herpes is a common virus that causes sores on your genitals and/or mouth. Herpes can be annoying and painful, but it usually doesn’t lead to serious health problems.

Herpes is a common infection.

Herpes is a super-common infection that stays in your body for life. More than half of Americans have oral herpes, and about 1 out of 6 Americans has genital herpes. So chances are a few people you know are living with herpes.

Herpes is caused by two different but similar viruses: herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2). Both kinds can make sores pop up on and around your vulva, vagina, cervix, anus, penis, scrotum, butt, inner thighs, lips, mouth, throat, and rarely, your eyes.

Herpes is spread from skin-to-skin contact with infected areas, often during vaginal sex, oral sex, anal sex, and kissing. Herpes causes outbreaks of itchy, painful blisters or sores that come and go. Many people with herpes don’t notice the sores or mistake them for something else, so they might not know they’re infected. You can spread herpes even when you don’t have any sores or symptoms.

There’s no cure for herpes, but medication can ease your symptoms and lower your chances of giving the virus to other people. And the good news is, outbreaks usually become less frequent over time, and even though herpes can sometimes be uncomfortable and painful, it’s not dangerous. People with herpes have relationships, have sex, and live perfectly healthy lives.

What’s the difference between genital herpes and oral herpes?

Because there are 2 different kinds of herpes simplex viruses (HSV-1 and HSV-2) that can live on many body parts, lots of people are confused about what to call these infections. But it’s actually pretty simple:

• When you get either HSV-1 or HSV-2 on or around your genitals (vulva, vagina, cervix, anus, penis, scrotum, butt, inner thighs), it’s called genital herpes.

• When you get either HSV-1 or HSV-2 in or around your lips, mouth, and throat, it’s called oral herpes. Oral herpes sores are sometimes called cold sores or fever blisters.

HSV-1 usually causes oral herpes, and HSV-2 usually causes genital herpes — each strain prefers to live on its favorite area. But it’s totally possible for both types of herpes simplex to infect either area. For example, you can get HSV-1 on your genitals if someone with a cold sore on their lips gives you oral sex. And you can get HSV-2 in your mouth if you give oral sex to someone with HSV-2 on their genitals.

How do you get herpes?

Herpes is easily spread from skin-to-skin contact with someone who has the virus. You can get it when your genitals and/or mouth touch their genitals and/or mouth — usually during oral, anal, and vaginal sex.

Herpes can be passed even if the penis or tongue doesn’t go all the way in the vagina, anus, or mouth. You don’t have to cum to spread herpes. All it takes is some quick skin-to-skin touching. You can also get herpes from kissing someone who has oral herpes.

The skin on your genitals, mouth, and eyes can be infected easily. Other areas of skin may get infected if there’s a way for the herpes virus to get in, like through a cut, burn, rash, or other sores. You don’t have to have sex to get herpes. Sometimes herpes can be passed in non-sexual ways, like if a parent with a cold sore gives you a peck on the lips. Most people with oral herpes got it when they were kids.  A mother can pass genital herpes to a baby during vaginal childbirth, but that’s pretty rare.

You can spread herpes to other parts of your body if you touch a herpes sore and then touch your mouth, genitals, or eyes without washing your hands first. You can also pass herpes to someone else this way.

Herpes is most contagious when sores are open and wet, because fluid from herpes blisters easily spreads the virus. But herpes can also “shed” and get passed to others when there are no sores and your skin looks totally normal.

Most people get herpes from someone who doesn’t have any sores. It may live in your body for years without causing any symptoms, so it’s really hard to know for sure when and how you got it. That’s why so many people have herpes — it’s a pretty sneaky infection.

Because the virus dies quickly outside the body, you can’t get herpes from hugging, holding hands, coughing, sneezing, or sitting on toilet seats.

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Oral Herpes Signs Symptoms Treatment

Herpes labialis (Oral herpes simplex)

Oral herpes is an infection caused by the herpes simplex virus, characterized by an eruption of small and usually painful blisters on the skin of the lips, mouth, gums or the skin around the mouth. These blisters are commonly called cold sores or fever blisters.

Causes, incidence, and risk factors

Herpes labialis is an extremely common disease caused by infection of the mouth area with herpes simplex virus, most often type 1. Most Americans are infected with the type 1 virus by the age of 20.

The initial infection may cause no symptoms or mouth ulcers. The virus remains in the nerve tissue of the face. In some people, the virus reactivates and produces recurrent cold sores that are usually in the same area, but are not serious. Herpes virus type 2 usually causes genital herpes and infection of babies at birth (to infected mothers), but may also cause herpes labialis.

Herpes viruses are contagious. Contact may occur directly, or through contact with infected razors, towels, dishes, and other shared articles. Occasionally, oral-to-genital contact may spread oral herpes to the genitals (and vice versa). For this reason, people with active herpes lesions on or around the mouth or on the genitals should avoid oral sex.

The first symptoms usually appear within 1 or 2 weeks—and as late as 3 weeks—after contact with an infected person. The lesions of herpes labialis usually last for 7 to 10 days, then begin to resolve. The virus may become latent, residing in the nerve cells, with recurrence at or near the original site.

Recurrence is usually milder. It may be triggered by menstruation, sun exposure, illness with fever, stress, or other unknown causes.

Symptoms

Warning symptoms of itching, burning, increased sensitivity, or tingling sensation may occur about 2 days before lesions appear.

• Skin lesions or rash around the lips, mouth, and gums

• Small blisters (vesicles) filled with clear yellowish fluid

• Blisters on a raised, red, painful skin area

• Blisters that form, break, and ooze

• Yellow crusts that slough to reveal pink, healing skin

• Several smaller blisters that merge to form a larger blister

• Mild fever (may occur)

Signs and tests

Diagnosis is made on the basis of the appearance or culture of the lesion. Examination may also show enlargement of lymph nodes in the neck or groin.

Viral culture or Tzanck test of the skin lesion may reveal the herpes simplex virus.

Treatment

Untreated, the symptoms will generally subside in 1 to 2 weeks. Antiviral medications given by mouth may shorten the course of the symptoms and decrease pain.

Wash blisters gently with soap and water to minimize the spread of the virus to other areas of skin. An antiseptic soap may be recommended. Applying ice or warmth to the area may reduce pain.

Take precautions to avoid infecting others (see Prevention).

Expectations (prognosis)

Herpes labialis usually disappears spontaneously in 1 to 2 weeks. It may recur. Infection may be severe and dangerous if it occurs in or near the eye, or if it happens in immunosuppressed people.

Complications:

• Spread of herpes to other skin areas

• Secondary bacterial skin infections

• Recurrence of herpes labialis

• Generalized infection—may be life-threatening in immunosuppressed people, including those with atopic dermatitis, cancer, or HIV infections

• Blindness

Herpes infection of the eye is a leading cause of blindness in the US, causing scarring of the cornea.

Calling your health care provider

Call for an appointment with your health care provider if symptoms indicate herpes labialis and symptoms persist for more than 1 or 2 weeks.

Call if symptoms are severe, or if you have a disorder associated with immunosuppression and you develop herpes symptoms.

Prevention

Avoid direct contact with cold sores or other herpes lesions. Minimize the risk of indirect spread by thoroughly washing items in hot (preferably boiling) water before re-use. Do not share items with an infected person, especially when herpes lesions are active. Avoid precipitating causes (especially sun exposure) if prone to oral herpes.

Avoid performing oral sex when you have active herpes lesions on or near your mouth and avoid passive oral sex with someone who has active oral or genital herpes lesions. Condoms can help reduce, but do not entirely eliminate, the risk of transmission via oral or genital sex with an infected person.

Unfortunately, both oral and genital herpes viruses can sometimes be transmitted even when the person does not have active lesions.

Our thanks to the NIH for allowing us to reprint this article: http://www.nlm.nih.gov/medlineplus/ency/article/000606.htm

Important disclaimer: The information on pkids.org is for educational purposes only and should not be considered to be medical advice. It is not meant to replace the advice of the physician who cares for your child. All medical advice and information should be considered to be incomplete without a physical exam, which is not possible without a visit to your doctor.

Herpes Simplex Type 1 – StatPearls

Continuing Education Activity

Herpes simplex virus type 1 (HSV-1) is a linear dsDNA virus that is a member of the Alphaherpesviridae subfamily. HSV-1 is responsible for establishing primary and recurrent vesicular eruptions, primarily in the orolabial and genital mucosa. HSV-1 infection has a wide variety of presentations, including orolabial herpes, herpetic sycosis (HSV folliculitis), herpes gladiatorum, herpetic whitlow, ocular HSV infection, herpes encephalitis, Kaposi varicelliform eruption (eczema herpeticum), and severe or chronic HSV infection. Antiviral therapy limits the course of HSV infection. This activity describes the evaluation, and treatment herpes simplex virus type 1 and reviews the role of the interprofessional team in evaluating and treating patients with this condition.

Objectives:

• Describe the pathophysiology of a herpes type 1 infection.

• Review the risk factors for herpes type 1 infection.

• Explain the presentation of a patient with herpes type 1 infection.

• Outline the importance of improving care coordination amongst interprofessional team members to improve outcomes for patients affected by the herpes type 1 virus infection.

Earn continuing education credits (CME/CE) on this topic.

Introduction

Herpes simplex virus type 1 (HSV-1) is a member of the Alphaherpesviridae subfamily. Its structure is composed of linear dsDNA, an icosahedral capsid that is 100 to 110 nm in diameter, with a spikey envelope. In general, the pathogenesis of HSV-1 infection follows a cycle of primary infection of epithelial cells, latency primarily in neurons, and reactivation. HSV-1 is responsible for establishing primary and recurrent vesicular eruptions, primarily in the orolabial and genital mucosa. HSV-1 infection has a wide variety of presentations, including orolabial herpes, herpetic sycosis (HSV folliculitis), herpes gladiatorum, herpetic whitlow, ocular HSV infection, herpes encephalitis, Kaposi varicelliform eruption (eczema herpeticum), and severe or chronic HSV infection. Antiviral therapy limits the course of HSV infection.[1][2][3]

Etiology

Risk factors for HSV-1 infection differ depending on the type of HSV-1 infection. In the case of orolabial herpes, risk factors include any activity that exposes one to an infected patient’s saliva, for example, shared drinkware or cosmetics, or mouth to mouth contact.

The major risk factor for herpetic sycosis is close shaving with a razor blade in the presence of an acute orolabial infection.

Risk factors for herpes gladiatorum include participation in high-contact sports such as rugby, wrestling, MMA, and boxing.

Risk factors for herpetic whitlow include thumb sucking and nail biting in the presence of orolabial HSV-1 infection in the child population, and medical/dental profession in the adult population (although HSV-2 most commonly causes herpetic whitlow in adults).

A major risk factor for herpes encephalitis is mutations in the toll-like receptor (TLR-3) or UNC-93B genes. It has been postulated that these mutations inhibit normal interferon-based responses.

The major risk factor for eczema herpeticum is skin barrier dysfunction. This can be seen in atopic dermatitis, Darier disease, Hailey-Hailey disease, mycosis fungoides, and all types of ichthyosis. The increased risk is also associated with mutations in the filaggrin gene, which is seen in atopic dermatitis and ichthyosis vulgaris. Pharmaceutical risk factors for eczema herpeticum include the use of topical calcineurin inhibitors such as pimecrolimus and tacrolimus.

Risk factors for severe or chronic HSV infection include immunocompromised states such as transplant recipients (solid organ or hematopoietic stem cells), HIV infection, or leukemia/lymphoma patients.[4][5]

Epidemiology

It has been hypothesized that approximately one-third of the world’s population has experienced symptomatic HSV-1 at some point throughout his or her lifetime. HSV-1 first establishes primary infection in patients with no existing antibodies to HSV-1 or HSV-2. Non-primary initial infection is defined as infection with one HSV subtype in patients who already have antibodies to the other HSV type (i.e., HSV-1 infection in a patient with HSV-2 antibodies, or vice versa). Reactivation results in recurrent infection and most commonly presents as asymptomatic viral shedding.

Approximately 1 in 1000 newborns in the United States experience a neonatal herpes simplex virus infection, resulting from HSV exposure during vaginal delivery. Women with recurrent genital herpes have a low risk of vertically transmitting HSV to their neonate. However, women who acquire a genital HSV infection during pregnancy have a higher risk.

Epidemiologically, it is important to note that herpes encephalitis is the leading cause of lethal encephalitis in the United States, and ocular HSV infection is a common cause of blindness in the United States.[6][7][8][9][10]

Pathophysiology

HSV-1 is typically spread through direct contact with contaminated saliva or other infected bodily secretions, as opposed to HSV-2, which is spread primarily by sexual contact. HSV-1 begins to replicate at the site of infection (mucocutaneous) and then proceeds to travel by retrograde flow down an axon to the dorsal root ganglia (DRG). It is in the DRG that latency is established. This latency period allows the virus to remain in a non-infectious state for a variable amount of time before reactivation.  HSV-1 is sly in its ability to evade the immune system via several mechanisms. One such mechanism is inducing an intercellular accumulation of CD1d molecules in antigen presenting cells. Normally, these CD1d molecules are transported to the cell surface, where the antigen is presented resulting in the stimulation of natural killer T-cells, thus promoting immune response. When CD1d molecules are sequestered intercellularly, the immune response is inhibited. HSV-1 has several other mechanisms by which it down-regulates various immunologic cells and cytokines.[11][12][13][14][15][16]

Histopathology

Classic, though not pathognomonic, histologic findings for HSV infection include ballooning degeneration of keratinocytes and multinucleated giant cells. Multinucleated keratinocytes may contain Cowdry A inclusions, which are eosinophilic nuclear inclusions that can also be seen in other herpesviruses such as varicella-zoster virus (VZV) and cytomegalovirus (CMV). There is no pathognomonic histologic finding for HSV-1 infection, and therefore, clinical correlation is crucial during histopathologic evaluation.[12]

History and Physical

It is important to note that HSV-1 infection is frequently asymptomatic. When symptoms do occur, there is a wide range of clinical presentations including orolabial herpes, herpetic sycosis (HSV folliculitis), herpes gladiatorum, herpetic whitlow, ocular HSV infection, herpes encephalitis, Kaposi varicelliform eruption (eczema herpeticum), and severe or chronic HSV-1 infection.

HSV-1 is the most common culprit of orolabial herpes (a small percent of cases are attributed to HSV-2). It is important to note that orolabial HSV-1 infection is most commonly asymptomatic. When there are symptoms, the most common manifestation is the “cold sore” or fever blister. In children, symptomatic orolabial HSV-1 infections often present as gingivostomatitis that leads to pain, halitosis, and dysphagia. In adults, it can present as pharyngitis and a mononucleosis-like syndrome.[17]

Symptoms of a primary orolabial infection occur between three days and one week after the exposure. Patients will often experience a viral prodrome consisting of malaise, anorexia, fevers, tender lymphadenopathy, localized pain, tenderness, burning, or tingling prior to the onset of mucocutaneous lesions. Primary HSV-1 lesions usually occur on the mouth and lips. Patients will then demonstrate painful grouped vesicles on an erythematous base. These vesicles exhibit a characteristic scalloped border. These vesicles may then progress to pustules, erosions, and ulcerations. Within 2 to 6 weeks, the lesions crust over and symptoms resolve.[18]

Symptoms of recurrent orolabial infection are typically milder than those of primary infection, with a 24-hour prodrome of tingling, burning, and itch. Recurrent orolabial HSV-1 infections classically affect the vermillion border of the lip (as opposed to the mouth and lips as seen in primary infection).[19]

Initial or recurrent HSV-1 infections may affect the hair follicle, and when this occurs, it is termed herpetic sycosis (HSV folliculitis). This will present on the beard area of a male with a history of close razor blade shaving. Lesions exist on a spectrum ranging from scattered follicular papules with erosion to large lesions involving the entire beard area. Herpetic sycosis is self-limited, with a resolution of eroded papules within 2 to 3 weeks.

Lesions of herpes gladiatorum will be seen on the lateral neck, side of the face, and forearms within 4 to 11 days after exposure. A high suspicion for this diagnosis is crucial in athletes, as this is commonly misdiagnosed as bacterial folliculitis.

HSV-1 infection can also occur on the digits or periungual, causing herpetic whitlow.  Herpetic whitlow presents as deep blisters that may secondarily erode. A common misdiagnosis is an acute paronychia or blistering dactylitis.  Herpetic whitlow can also lead to lymphadenopathy of the epitrochlear or axillary lymph nodes in association with lymphatic streaking, mimicking bacterial cellulitis.

HSV-1 infection of the eye leads to ocular HSV in children and adults. Primary ocular HSV presents with keratoconjunctivitis that can be unilateral or bilateral. There can be associated eyelid tearing, edema, photophobia, chemosis (swelling of the conjunctiva), and preauricular lymphadenopathy. It is common for patients to experience recurrence, and in these cases, it is usually unilateral. Ocular HSV is a common cause of blindness in the United States when it manifests as keratitis or a branching dendritic corneal ulcer (which is pathognomonic for ocular HSV).

Herpes encephalitis is a severe, typically fatal (mortality is greater than 70% if untreated) infection caused by HSV-1. It primarily affects the temporal lobe of the brain leading to bizarre behavior and focal neurological deficits localized to the temporal lobe. Patients may have a fever and altered mental status as well.

Kaposi varicelliform eruption, or eczema herpeticum, presents as an extensive spreading of HSV infection in the setting of a compromised skin barrier (e.g., atopic dermatitis, Darier disease, pemphigus foliaceous, pemphigus vulgaris, Hailey-Hailey disease, mycosis fungoides, ichthyosis). Patients will display 2 to 3 mm punched-out erosions with hemorrhagic crusts in widespread distribution. There may be secondary impetigo with Staphylococcus or Streptococcus species.

Neonatal herpes virus presents at day 5 to 14 of life and favors the scalp and the trunk. It may present with disseminated cutaneous lesions and involvement of oral and ocular mucosa. Central nervous system (CNS) involvement may occur and manifest as encephalitis with lethargy, poor feeding, bulging fontanelle, irritability, and seizures. 

In the immunocompromised patient population, HSV infection can result in severe and chronic infection. The most common presentation of severe and chronic HSV infection is quickly enlarging ulcerations or verrucous/pustular lesions. It is not uncommon for patients to have respiratory or gastrointestinal tract involvement and present with dyspnea or dysphagia.[20][21][22][23][24]

Evaluation

The gold standard for diagnosing HSV-1 infection is HSV-1 serology (antibody detection via western blot). The most sensitive and specific mechanism is viral polymerase chain reaction (PCR). However, serology remains the gold standard. Viral culture, direct fluorescent antibody  (DFA) assay, and Tzanck smear are alternative methods of diagnosing. It is important to note that the Tzanck smear identifies multinucleated giant cells, so it cannot distinguish between HSV and VZV. The DFA assay, however, can distinguish between the 2 entities.[14]

Treatment / Management

For the treatment of orolabial herpes, the current recommendation is oral valacyclovir (2 grams twice daily for one day). If the patient has frequent outbreaks, chronic suppression is warranted. For chronic suppression of immunocompetent patients, oral valacyclovir 500 mg daily (for patients with less than ten outbreaks per year) or oral valacyclovir 1 gram by mouth daily (for patients with greater than 10 outbreaks a year) is recommended.

For the treatment of eczema herpeticum, it is recommended to use 10 to 14 days of either acyclovir (15 mg/kg with a 400 mg maximum) 3 to 5 times daily or Valacyclovir 1 gram by mouth twice a day.

For immunocompromised patients with severe and chronic HSV, treatment is aimed at chronic suppression. For chronic suppression of immunocompromised patients, oral acyclovir 400 to 800 2 to 3 times daily, or oral valacyclovir 500 mg twice daily is recommended.[25][26][27][28]

Differential Diagnosis

The differential diagnosis of orolabial HSV-1 infection includes aphthous stomatitis, Stevens-Johnson syndrome, erythema multiforme (EM) major, and herpangina. These entities can be distinguished from orolabial herpes by history and physical exam findings. The differential diagnosis of herpetic whitlow includes blistering dactylitis and acute or chronic paronychia.

Prognosis

Overall, the vast majority of HSV-1 infections are asymptomatic, and if symptomatic present with mild recurrent mucocutaneous lesions. The prognosis of HSV-1 infection varies depending on the manifestation and location of the HSV-1 infection. The majority of the time, HSV-1 infection follows a chronic course of latency and reactivation. HSV encephalitis is associated with high mortality; approximately 70% of untreated cases are ultimately fatal. The prognosis of ocular HSV can also be grim if the patient develops globe rupture or corneal scarring, as these processes can ultimately lead to blindness.[29]

Enhancing Healthcare Team Outcomes

Herpes type 1 infections are best managed by an interprofessional team that includes the primary provider, pediatrician, nurse practitioner, infectious disease specialist and the internist. The key to treatment is starting the antiviral within 24 hours of symptoms. It is important to understand that most infections spontaneously subside on their own and delayed treatment has no impact on duration or severity of symptoms. During the infection, the patient should be educated on washing hands and avoiding close contact with others.

Continuing Education / Review Questions

Figure

Herpes Simplex. Contributed by DermNetNZ

Figure

A. Herpetic keratitis with neovascularization of the cornea
B. Herpes Simplex I of the lips and skin of the chin
C. Stage 1 Neurotrophic Keratitis: fluorescein epithelial staining together with Gaule spots. Gaule spots are scattered areas of dried epithelium, (more…)

Figure

This image depicts a close view of a patient’s penile shaft, highlighting the presence of a crop of erythematous vesiculopapular lesions, which were determined to have been caused by a herpes genitalis outbreak. Genital herpes is a sexually transmitted (more…)

Figure

Herpes Simplex on genitals. Contributed by Dr. Shyam Verma, MBBS, DVD, FRCP, FAAD, Vadodara, India

Figure

Herpes Simplex mouth. Contributed by Dr. Shyam Verma, MBBS, DVD, FRCP, FAAD, Vadodara, India

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Finger-Jardim F, Avila EC, da Hora VP, Gonçalves CV, de Martinez AMB, Soares MA. Prevalence of herpes simplex virus types 1 and 2 at maternal and fetal sides of the placenta in asymptomatic pregnant women. Am J Reprod Immunol. 2017 Jul;78(1) [PubMed: 28440579]

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Rosenberg J, Galen BT. Recurrent Meningitis. Curr Pain Headache Rep. 2017 Jul;21(7):33. [PubMed: 28551737]

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Cruz AT, Freedman SB, Kulik DM, Okada PJ, Fleming AH, Mistry RD, Thomson JE, Schnadower D, Arms JL, Mahajan P, Garro AC, Pruitt CM, Balamuth F, Uspal NG, Aronson PL, Lyons TW, Thompson AD, Curtis SJ, Ishimine PT, Schmidt SM, Bradin SA, Grether-Jones KL, Miller AS, Louie J, Shah SS, Nigrovic LE., HSV Study Group of the Pediatric Emergency Medicine Collaborative Research Committee. Herpes Simplex Virus Infection in Infants Undergoing Meningitis Evaluation. Pediatrics. 2018 Feb;141(2) [PMC free article: PMC5810597] [PubMed: 29298827]

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Zhang J, Liu H, Wei B. Immune response of T cells during herpes simplex virus type 1 (HSV-1) infection. 2017 Apr.J Zhejiang Univ Sci B. 18(4):277-288. [PMC free article: PMC5394093] [PubMed: 28378566]

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Giraldo D, Wilcox DR, Longnecker R. The Type I Interferon Response and Age-Dependent Susceptibility to Herpes Simplex Virus Infection. DNA Cell Biol. 2017 May;36(5):329-334. [PMC free article: PMC5421632] [PubMed: 28278385]

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Rajasagi NK, Rouse BT. Application of our understanding of pathogenesis of herpetic stromal keratitis for novel therapy. Microbes Infect. 2018 Oct – Nov;20(9-10):526-530. [PMC free article: PMC6037561] [PubMed: 29329934]

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Bin L, Li X, Richers B, Streib JE, Hu JW, Taylor P, Leung DYM. Ankyrin repeat domain 1 regulates innate immune responses against herpes simplex virus 1: A potential role in eczema herpeticum. J Allergy Clin Immunol. 2018 Jun;141(6):2085-2093.e1. [PMC free article: PMC5994174] [PubMed: 29371118]

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Darji K, Frisch S, Adjei Boakye E, Siegfried E. Characterization of children with recurrent eczema herpeticum and response to treatment with interferon-gamma. Pediatr Dermatol. 2017 Nov;34(6):686-689. [PubMed: 29144049]

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Wei EY, Coghlin DT. Beyond Folliculitis: Recognizing Herpes Gladiatorum in Adolescent Athletes. J Pediatr. 2017 Nov;190:283. [PubMed: 28728810]

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Williams C, Wells J, Klein R, Sylvester T, Sunenshine R., Centers for Disease Control and Prevention (CDC). Notes from the field: outbreak of skin lesions among high school wrestlers–Arizona, 2014. MMWR Morb Mortal Wkly Rep. 2015 May 29;64(20):559-60. [PMC free article: PMC4584520] [PubMed: 26020140]

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Kolawole OM, Amuda OO, Nzurumike C, Suleiman MM, Ikhevha Ogah J. Seroprevalence and Co-Infection of Human Immunodeficiency Virus (HIV) and Herpes Simplex Virus (HSV) Among Pregnant Women in Lokoja, North-Central Nigeria. Iran Red Crescent Med J. 2016 Oct;18(10):e25284. [PMC free article: PMC5286443] [PubMed: 28180012]

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El Hayderi L, Rübben A, Nikkels AF. The alpha-herpesviridae in dermatology : Herpes simplex virus types I and II. Hautarzt. 2017 Dec;68(Suppl 1):1-5. [PubMed: 28197698]

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Shenoy R, Mostow E, Cain G. Eczema herpeticum in a wrestler. Clin J Sport Med. 2015 Jan;25(1):e18-9. [PubMed: 24714395]

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Li Z, Breitwieser FP, Lu J, Jun AS, Asnaghi L, Salzberg SL, Eberhart CG. Identifying Corneal Infections in Formalin-Fixed Specimens Using Next Generation Sequencing. Invest Ophthalmol Vis Sci. 2018 Jan 01;59(1):280-288. [PMC free article: PMC5770184] [PubMed: 29340642]

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El Hayderi L, Rübben A, Nikkels AF. [The alpha-herpesviridae in dermatology : Herpes simplex virus types I and II. German version]. Hautarzt. 2017 Mar;68(3):181-186. [PubMed: 28197699]

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Sanders JE, Garcia SE. Pediatric herpes simplex virus infections: an evidence-based approach to treatment. Pediatr Emerg Med Pract. 2014 Jan;11(1):1-19; quiz 19. [PubMed: 24649621]

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Kalogeropoulos D, Geka A, Malamos K, Kanari M, Kalogeropoulos C. New Therapeutic Perceptions in a Patient with Complicated Herpes Simplex Virus 1 Keratitis: A Case Report and Review of the Literature. Am J Case Rep. 2017 Dec 27;18:1382-1389. [PMC free article: PMC5753617] [PubMed: 29279602]

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Anderson BJ, McGuire DP, Reed M, Foster M, Ortiz D. Prophylactic Valacyclovir to Prevent Outbreaks of Primary Herpes Gladiatorum at a 28-Day Wrestling Camp: A 10-Year Review. Clin J Sport Med. 2016 Jul;26(4):272-8. [PubMed: 26540599]

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Herpes / Diseases / Clinic EXPERT

Herpes is a common viral disease caused by the herpes simplex virus (HSV) and is characterized by the appearance of a blistering rash on the skin and mucous membranes of various organs.

Almost all people in the world are carriers of HSV, but only 20% of them are infected.

Usually herpes is manifested by damage to the following organs and structures of the body:

• skin
• mucous membranes of the face and genitals
• eyes
• central nervous system.

The causes of herpes

The development of herpes can be influenced by such factors as:

• weakened immunity
• the presence of certain diseases
• overheating or hypothermia of the body
• surgical procedures and other medical interventions (for example, the installation of an intrauterine device, abortion, etc.)
• some psychological conditions and other factors.

Infection with this disease occurs from a person already sick with herpes, in whom the rash is localized on the outer layer of the mucous membrane.

Types of herpes

In total, there are about two hundred varieties of the herpes virus. Of these, only eight types are distinguished that pose a danger to the human body:

• herpes 1 type: manifested by a rash in the face
• herpes 2 types: localized in the genital area
• herpes 3 types: provokes shingles and chickenpox
• herpes 4 types (Epstein-Barr virus): causes the development of infectious mononucleosis
• herpes type 5 (cytomegalovirus): provokes cytomegalia.

Herpes virus types 6, 7 and 8 are currently not fully understood. They are thought to cause chronic fatigue and manifest as a blistering rash.

Herpes Symptoms

Herpes can manifest itself in different ways depending on the type of disease and the type of virus that caused it. The general symptoms of herpes are as follows:

• itching and redness of the skin area
• the appearance of neoplasms on the skin (blisters, crusts, ulcers)
• general weakness of the body, pain in joints and muscles.

Diagnostics of herpes

For the diagnosis of herpes in the EXPERT Clinic, the following laboratory tests are carried out:

• virological method for the determination of herpes simplex virus
• polymerase chain reaction (PCR)
• determination of herpes antigens
• test for a simple immune response herpes
• cytomorphological method
• enzyme immunoassay
• other analyzes.

Treating herpes

Because the herpes virus cannot be completely cured, treatment for this disease is aimed at reducing the number of relapses and alleviating symptoms.Treatment of herpes at the EXPERT Clinic is planned by an experienced immunologist after a thorough diagnosis and implies therapy with antiviral drugs according to various schemes. The dosage of the drug is calculated individually for each patient.

Antiherpes therapy can be shown to the patient not only with exacerbation of herpes, but also during periods of remission of the disease for preventive purposes.

Forecast

Primary local herpes in a patient in the absence of concomitant pathologies, as a rule, goes away on its own in 7-14 days.A high risk of death is observed in newborns with disseminated herpes and in infants with severely impaired immune system functions. In the absence of adequate treatment, complications may appear: herpetic eye disease can lead to scarring of the cornea and even complete loss of vision. An exacerbation of herpes with low immunity can also lead to serious complications.

Timely diagnosis and treatment of herpes significantly improve the prognosis of the disease.

Prevention of herpes

In order to avoid contracting herpes, immunologists advise adhering to the following recommendations:

• Limit contact with a person already sick with herpes
• Use only personal hygiene items
• Avoid promiscuous and unprotected sex in order to avoid genital herpes
• careful use of public toilets, if possible, treat sitting with antiseptic agents
• avoid overheating and hypothermia
• adhere to a healthy lifestyle.

In order to avoid negative consequences for your health, at the first signs of herpes, make an appointment with an immunologist. Your doctor will provide you with quality medical care and help reduce the likelihood of further exacerbations of herpes.

Skin infections caused by herpes simplex virus

Main

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

Etiology

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

Prevalence

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

Symptoms

• Symptoms and clinical presentation of the disease are often typical, and the diagnosis is based on clinical manifestations.
• Soreness, burning and tingling of the affected area usually occurs before the appearance of the rash.
• First, focal erythema with clear boundaries is formed; later, grouped vesicles with transparent contents appear.
• Individual vesicles can transform into pustules or vesicles with hemorrhagic contents.
• Grouped vesicles may also appear on nearby skin areas. After opening the vesicles, small irregular erosions remain on the skin.
• The illness usually lasts 1 to 2 weeks, but in some cases the duration is longer.
• The typical lesions are the skin of the perioral region, face, genital region, buttocks, perianal region, hands and fingers.
• Cutaneous manifestations of herpes usually indicate reactivation of latent infection.
• Factors provoking such reactivation are cold or flu, mechanical injury, medical or dental manipulations, injury, stress, sun exposure, menstruation, secondary infection through fingers, for example, lips or genital area (self-infection).
• Generalization of infection (disseminated disease) is possible in people with immunodeficiency (for example, HIV infection) and / or receiving immunosuppressive therapy (for example, antirheumatic drugs, cytostatics).
• The infection can also spread in patients with atopic eczema, mainly affecting the face (Kaposi’s herpetic eczema). This does not indicate the presence of immunodeficiency.

Survey

• In typical cases, there is no need for additional examination, the clinical picture is enough.
• The virus can be typed by detecting its antigen or by culture.
• A sample for culture is best taken by piercing the vesicle and holding a cotton swab over the exposed eroded surface.
• A negative culture result is possible, especially if the material is taken long after the onset of symptoms.
• Antibody tests confirm the carriage of the virus, but do not provide information on the timing or area of ​​infection.The level of antibodies in isolated skin infection (reactivation) is usually not increased, its slight increase is possible with primary infection. It is useless to assess the levels of antibodies for herpes lesions of the skin.
• For the diagnosis of HSV infection of the central nervous system and neonatal herpes, if necessary, use PCR (in cerebrospinal fluid) and determination of the level of antibodies.
• In unclear cases or in the absence of a response to empiric therapy, samples should be taken for bacteriological and / or mycological examination from the surface of the affected skin area.
• Allergic contact dermatitis is diagnosed by skin tests.
• In case of severe clinical manifestations and low effectiveness of therapy, one should not forget about the possibility of immunodeficiency (for example, HIV infection, hemoblastosis, other malignant diseases).

Treatment

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

Recurrent herpes infection

• In case of rare relapses, a course of treatment with the aforementioned antiviral drugs is used.A prescription should be written in advance so that the patient can quickly begin treatment as soon as symptoms appear.
• With frequent relapses of the disease (to reduce their frequency), antiviral drugs are prescribed prophylactically for a period of 6-12 months.
  • Treatment should be selected individually, depending on the severity of the manifestations. If possible, pauses between courses of treatment and assessment of indications for further preventive therapy are necessary.
  • For initially severe clinical manifestations or recurrence of infection during prophylactic therapy, higher starting doses are recommended, for example, Valacyclovirum (valacyclovir) 500 mg twice a day.
  • During the prophylactic use of antiviral drugs, resistance to therapy often develops in immunocompromised patients. Therefore, in this group of patients, the use of higher daily doses is recommended (for example, Valacyclovirum (valacyclovir) 500 mg twice a day).
  • Short term prophylaxis is a short course of treatment lasting 1 to 2 weeks, e.g. during holidays, menses, etc.

Specialist consultation

• In case of immunodeficiency, the presence of even a mild form of herpes infection or suspicion of it requires the fastest possible initiation of systemic therapy, preferably at the stage of primary care.
• Patients with severe generalized forms, especially in the presence of immunodeficiency (cancer patients, patients receiving immunosuppressants), are shown parenteral use of Acyclovirum (acyclovir), most often as an emergency therapy in a hospital. Consultation of a specialist is required.
• Localization of herpes infection in the eye area, even with minor manifestations, is an indication for emergency consultation with an ophthalmologist.

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Herpes

Herpes is an infection caused by herpes viruses.Most of the world’s population is infected with them.

Herpes virus infection in figures and facts:

· There are 8 types of herpesviruses that cause diseases in humans: herpes simplex virus (HSV) type 1 causes “cold blisters” on the lips, HSV of the second type – genital herpes, varicella-zoster virus (type 3) – chickenpox and shingles, Epstein virus -Barr (type 4) – infectious mononucleosis, cytomegalovirus (type 5) – cytomegalovirus infection. The role of viruses of 6-8 types is not well understood, and it is believed that they cause chronic fatigue syndrome.In this article, we will only talk about HSV types 1 and 2 – in fact, they cause a disease known as herpes.

· According to experts from the World Health Organization (WHO), there are 3.7 billion people under 50 (67% of the population) infected with HSV-1 and 417 million (11%) infected with HSV-2 in the world.

· Most often, herpesvirus infection is asymptomatic.

· Infection occurs from a sick person, including asymptomatic carriers.

· After infection, the virus remains in the body for life.

Symptoms

The symptoms of the disease are very characteristic and easily recognizable: first, itching, burning occurs on the affected mucous membrane or skin, then the skin or mucous membrane becomes inflamed, redness appears, and on it there are bubbles filled with transparent liquid. They are opened, and small ulcers appear in their place, which subsequently heal without leaving any traces. Some patients are worried about malaise, the body temperature rises.Infection with HSV-2 (genital herpes) may cause pain when urinating, and in women, vaginal discharge.

The manifestations of herpesvirus infection occur 2–12 days after infection, on average – after 4 days. Many people become infected with herpes simplex virus type 1 during early childhood.

With an infection with herpes simplex virus type 1, blisters appear on the mucous membrane of the mouth and on the skin around the mouth, sometimes in the genital area.HSV type 2 affects only the genitals.

After some time after recovery, a relapse may occur, and the symptoms will be weaker and go away faster, within 10 days.

At first glance, it may seem that herpesvirus infection is quite harmless. But in fact, it can lead to serious complications:

· In people with a weakened immune system (eg, HIV-infected), herpes is more severe and often recurs. In rare cases, HSV-1 causes encephalitis (inflammation in the substance of the brain), keratitis (inflammation of the cornea of ​​the eye).

· HSV-2 infection increases the risk of contracting the human immunodeficiency virus.

· In 1 in 10,000 cases, a baby becomes infected during childbirth, and neonatal herpes develops, which leads to severe neurological disorders and death of the newborn. The risks are especially high if the expectant mother becomes infected late in her pregnancy.

· Herpes virus infection can lead to psychological problems. A person is worried about his illness, he is ashamed of it.As a result, the quality of life decreases, and problems arise in the intimate sphere.

Other, sometimes serious, medical conditions can also present with symptoms similar to those of herpes. Make an appointment with a doctor at the SOVA clinic: he will establish an accurate diagnosis and recommend the correct treatment.

Diagnostic Methods

There are special tests that help confirm that a person has herpes. They are different. Using different methods, the DNA of the virus itself (PCR), its antigens (immunofluorescence reaction), antibodies that the body produces against it (enzyme-linked immunosorbent assay) are detected.

Usually, such tests are prescribed to women during pregnancy planning, before organ transplantation, to people who have had sexual intercourse with patients, or if a patient has come to the clinic with symptoms of herpes, but the doctor after the examination is not sure of the diagnosis.

How is herpesvirus infection treated?

Antiviral drugs such as acyclovir, valacyclovir, famciclovir are effective against herpes. However, you need to understand that medications will only help to cope with symptoms, prevent recurrent relapses, and make them less frequent and severe.It is impossible to completely remove the virus from the body; a person remains infected for life.

Are there effective prevention methods?

Several measures can help reduce the risks of infection:

· A person who has developed symptoms of HSV-1 infection should not kiss other people, share utensils or other objects that can be infected.

· If symptoms of genital herpes appear, sexual intercourse is contraindicated.

· Protection is provided by condoms – but only partially, because the virus can be in the skin in places that are not covered by a condom.

· Male circumcision provides partial lifelong protection.

The disease is most contagious when a person has overt symptoms, but the virus can also be obtained from an asymptomatic carrier. Infection is especially dangerous for women in the last weeks of pregnancy, they need to especially carefully follow preventive measures, and if symptoms of herpes appear, immediately consult a doctor.

There is currently no vaccine against HSV. But scientists are working to create them.

If you have symptoms that resemble herpes, you should not wait for it to “pass by itself” and self-medicate. Contact an experienced doctor at the SOVA clinic, he will prescribe effective medications.

Genital herpes – causes, signs, symptoms and treatment: diagnosis of herpes

Today, one of the most common viral diseases is herpes.This dormant, periodically exacerbating infectious process with characteristic vesicular rashes on the skin and mucous membranes is caused by two types of herpesvirus: HSV-1 and HSV-2.

Types of herpes simplex virus

HSV-1, or simple labial herpes (the so-called fever on the lips), is transmitted by airborne droplets or by contact (with particles of infected saliva when coughing and sneezing, when kissing, using someone else’s cups, spoons, etc.) … It can be asymptomatic or with rashes on the mucous membrane of the mouth, on the lips and on the wings of the nose.After the obvious signs of the disease disappear, the herpes virus does not die, but penetrates the trigeminal nerve node along the sensitive fibers and integrates into the genetic apparatus of nerve cells. With hypothermia, stress and other negative influences leading to a weakening of the body’s immune forces, the pathogen provokes relapses of the disease.

HSV-2, or genital herpes , affects the external genital organs and leads to the development of nonspecific diseases of the urogenital sphere.In this case, infection occurs through unprotected sexual intercourse. Just like herpesvirus type I, the pathogen penetrates the nerve cells located in the lumbar region and until a certain moment is there in a dormant state. In addition, in recent decades, due to the spread of the practice of oral sex, HSV-1 becomes the cause of genital herpes in 10–30% of cases.

How to recognize genital herpes

During an exacerbation, herpes in the intimate area causes the development of symptoms such as malaise, aching joints and muscles, a slight increase in body temperature.The characteristic signs of the disease include itching, tingling in the groin, in the genital area and anus, lumbago in the lower back, swelling and redness of the genitals, an increase in the inguinal nodes.

1-2 days after the initial manifestations of herpesvirus infection, rashes appear on the skin and mucous membranes in the form of small painful vesicles filled with a cloudy liquid. In men, as a rule, they are localized on the foreskin and on the coronal sulcus, less often they spread over the entire surface of the penis, and affect the pubis and scrotum.In women, genital herpes manifests itself in the form of a bubble rash on the labia, in the perineum and anus, in especially severe cases, vesicles are localized in the vagina and on the cervix (so-called vaginal and cervical herpes).

Relapses of the disease can be repeated 5–20 times a year and last for 2–3 weeks. During this period, a sick person is the most infectious (1 ml of bubble liquid can contain from 1 to 10 million viral particles).

Treatment of genital herpes

In the presence of symptoms of genital herpes, in order to avoid the development of complications, compulsory treatment with the use of drugs of specific antiviral chemotherapy is required.Their use (especially in the first knocks from the moment the rash appears) prevents the multiplication of the virus and thereby significantly alleviates the patient’s condition.

Drugs with proven efficacy used in the treatment of herpes include drugs based on acyclovir. With frequent exacerbations of the infectious process, in order to reduce the frequency of relapses, it is recommended to use them for several months (after consulting a specialist). Mild local analgesics are used to relieve itching, burning and pain.

Treatment of herpes in children: prices, reviews

Herpes, or herpes (herpesvirus) infection, is an inflammatory disease of the skin or mucous membranes caused by the virus of the same name. The diagnosis and treatment of such an ailment in young patients is carried out by a pediatrician, infectious disease specialist or pediatric dermatologist.

What is herpes

Herpesvirus infection is a collective term, because there are several varieties of the herpes virus. The most widespread in pediatric practice is herpes type 1, it causes a rash on the lips known to everyone.The course of such a disease is usually chronic, and it is often impossible to completely get rid of the virus. However, treating herpes in children can achieve sustained remission and minimize the frequency of exacerbations.

During the period of remission, the virus remains inactive in the nerve nodes. When favorable conditions arise, namely the weakening of the local and general defenses of the body, it is activated again.

Another common type of herpesvirus infection is chickenpox, or the familiar chickenpox, which is caused by a type 3 virus.After recovery, the causative agent of the disease also goes into a latent form, most people develop lifelong immunity. When activated, the type 3 virus can cause herpes zoster, which is characterized by more pronounced and severe symptoms, feeling unwell, and a rash along the intercostal nerves.

Symptoms of herpes infection

Symptoms of herpes infection in a child are specific, the following manifestations of the disease are usually noted:

• the appearance of characteristic bubbles with liquid contents;

• itching, burning, tingling before the rash;

• loss of appetite, difficulty eating;

• weakness, moodiness;

• symptoms of general intoxication;

• rarely – an increase in body temperature up to 37.5 ° C.

Type 1 virus primarily affects the skin of the lips and oral mucous membranes. Chickenpox spreads over the skin and mucous membranes of the whole body, including pustules on the scalp, elements on the genitals, etc. After opening the loose element, a crust forms. Chickenpox is characterized by an increase in body temperature up to 39 ° C. Difficult to control itching is observed. The severity of the condition is determined by the child’s age, individual health characteristics, and the state of the immune system.

With herpes zoster, the rash is localized along the intercostal nerves. This form of infection is characterized by severe pain at the site of the spread of elements, high fever, signs of severe intoxication.

The appearance of the listed symptoms is a reason to consult a pediatrician. Chickenpox can also be severe and with complications, so a doctor’s consultation is necessary in any case. Herpes zoster often requires a hospital stay.

Causes of herpes

The causes of herpes in children are the primary infection with the virus or its activation, if it is already in the child’s body. And if for the first time a baby meets herpes upon contact with an infected person, then the activation of a sleeping pathogen of the disease can be triggered by a number of reasons:

• hypothermia;

• SARS or other infections;

• exacerbation of chronic diseases: pyelonephritis, tonsillitis, sinusitis, etc.;

• hypovitaminosis;

• suffered injuries and operations.

The virus is transmitted from a sick person through healthy airborne droplets, so it is difficult to prevent primary infection, especially if a child is attending a preschool or school. However, it is in your power to prevent relapses. A timely visit to the doctor will help you quickly cope with the disease and take effective preventive measures.

Diagnostics of herpes virus infection

Symptoms of herpes in children are the basis for suspecting an ailment: this disease has rather typical manifestations. The standards of care provide for a detailed comprehensive diagnosis, which includes the following methods:

• laboratory blood tests: general and biochemical analyzes;

• specific tests: ELISA to detect antibodies to a particular type of pathogen;

• PCR is a method for determining the virus in the body.

The equipment of the Family Doctor clinic will allow you to pass the necessary tests and get the help of any narrow profile specialists: infectious disease specialist, pediatrician, pediatric dentist.

Herpes Treatment

The tactics of treating herpes in children is selected strictly individually. Much is determined by the type of virus, the severity of the condition, the age and the initial state of health of the little patient. The following medicines are traditionally used:

• specific antiviral drugs aimed at destroying type 1 virus;

• symptomatic agents: antipyretic and analgesic, antipruritic and decongestant;

• local preparations: solutions of antiseptics, gels and ointments, which help to reduce itching and pain, preparations for the treatment of elements on the mucous membranes.

Also, a condition for effective treatment is compliance with the following recommendations:

• plentiful drinking: will help to cope with the intoxication caused by the multiplication of the virus;

• a balanced diet: it is important to reinforce shaky strength and prevent the development or aggravation of hypovitaminosis;

• bed rest with poor health.

Prevention of herpesvirus infection

The main recommendations for the prevention of herpes: washing hands, limiting contact with infected people, adherence to the daily regimen and a balanced diet. Some parents want their child to get chickenpox as early as possible. It is believed that the disease is more severe in adulthood. A more effective and safer solution is vaccination. Vaccination helps prevent infection or severe illness.

At the Family Doctor clinic you can get help from a pediatrician and pediatric dermatologist. We are successfully treating all types of herpesvirus infections in children. Our doctors have all the diagnostic capabilities, you can immediately pass the necessary tests. Based on the results of the examination, you will receive effective prescriptions and recommendations for the treatment and prevention of herpes. Also, our patients have access to vaccination against chickenpox with a preliminary examination by a highly qualified pediatrician.

To make an appointment at a convenient time for you, call the unified contact center in Moscow +7 (495) 775 75 66, use the online appointment service, or contact the clinic’s registry.

Cost

dermatovenerologist, oncologist, cosmetologist, candidate of medical sciences, leading specialist of the clinic

dermatovenerologist, cosmetologist, trichologist

dermatovenerologist, trichologist, Ph.MD, associate professor

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90,000 Herpetic infections in children

Herpesvirus infections are a group of infectious diseases that are caused by viruses from the Herpesviridae family, can occur in the form of localized, generalized, recurrent forms of the disease, have the ability to persist (constant presence of the virus) in the human body.

Herpesvirus infections (HVI) are among the most common viral diseases in humans.Infection and incidence of them increases every year. In all countries of the world, 60-90% of the population is infected with one or another herpesvirus.

Etiology

Herpesviruses contain double-stranded DNA and have a glyco-lipoprotein envelope. The sizes of viral particles are from 120 to 220 nm.

Today, 8 types of herpes viruses have been described that have been identified in humans:

• two types of herpes simplex virus (HSV-1, HSV-2),
• varicella-zoster virus and herpes zoster (VZV or HHV-3),
• Epstein-Barr virus (EBV or HHV-4),
• cytomegalovirus (CMV or HHV-5), HHV-6, HHV-7, HHV-8.

Based on the biological properties of viruses, 3 subfamilies of herpes viruses have been formed: (alpha-herpes viruses, beta-herpes viruses and gamma-herpes viruses). A-herpes viruses include HSV-1, HSV-2, VZV.

Beta herpes viruses include CMV, HHV-6, HHV-7. They, as a rule, multiply slowly in cells, cause an increase in the affected cells (cytomegaly), are capable of persistence, mainly in the salivary glands and kidneys, and can cause congenital infections. Gamma herpes viruses include EBV and HHV-8.

Herpes simplex virus types 1 and 2

The term herpes infection (HS) is commonly used in reference to diseases caused by HSV-1 and HSV-2. The source of HSV infection is sick people with various forms of the disease, including latent, as well as virus carriers.

HSV-1 is transmitted by airborne droplets and by contact. A virus that gets on the skin during a cough or sneeze, which is in droplets of saliva, survives for an hour. On wet surfaces (washbasin, bath, etc.), it remains viable for 3-4 hours, which is often the cause of disease outbreaks in preschool institutions.Infection can be carried out by kissing, as well as through household items that are infected with the saliva of a patient or a virus carrier. HSV-2 is transmitted sexually or vertically. With the latter, infection occurs during childbirth (contact with the birth canal of the mother), transplacentally or through the cervical canal in the uterine cavity. Due to the fact that during the generalization of infection, viremia occurs, a transfusion or parenteral route of transmission of HSV-2 infection is also possible. HSV-2 usually causes genital and neonatal herpes.

The greatest susceptibility to GI in children aged 5 months to 3 years. Depending on the mechanism of infection, the acquired and congenital forms of GI are distinguished. Acquired GI can be primary and secondary (recurrent), localized and generalized. The latent form of GI is also distinguished.

No other infection has such a variety of clinical manifestations as herpesvirus. It can cause damage to the eyes, nervous system, internal organs, mucous membrane of the gastrointestinal tract, oral cavity, genitals, can cause cancer, has a certain value in neonatal pathology and the occurrence of hypertension.The spread of the virus in the body occurs in a hematogenous, lymphogenous, neurogenic way.

The incidence of primary herpesvirus infection increases in children after 6 months of life, when the antibodies received from the mother disappear. The peak incidence occurs at the age of 2-3 years. Often, GI also occurs in newborns; according to a number of authors, it is diagnosed in 8% of newborns with general somatic pathology and in 11% of premature babies.

According to the WHO, diseases caused by the herpes simplex virus (HSV) are the second leading cause of death from viral infections after influenza.Solving the problem of diagnosing and treating herpesvirus infection with manifestations on the oral mucosa is one of the most important tasks of practical medicine.

In the last decade, the importance of herpesvirus diseases as a public health problem has been steadily growing throughout the world. Representatives of the human herpesvirus family affect up to 95% of the world’s population.

The primary forms of GI include: infection of newborns (generalized herpes, encephalitis, herpes of the skin and mucous membranes), encephalitis, gingivostomatitis, Kaposi’s herpetiformis, primary herpes of the skin, eyes, herpes felon, keratitis.Primary GI occurs as a result of a person’s initial contact with HSV. As a rule, this occurs in early childhood (up to 5 years). In adults aged 16-25 who do not have antiviral immunity, primary GI is more likely to be due to HSV-2. 80-90% of initially infected children latently carry the disease, and clinical manifestations of the disease are observed only in 10-20% of cases.

Secondary, recurrent forms of GI are herpes of the skin and mucous membranes, ophthalmic herpes, genital herpes.

Epstein-Barr virus infection

An infectious disease caused by the Epstein-Barr virus (EBV) and is characterized by a systemic lymphoproliferative process with a benign or malignant course.

EBV is excreted from the body of a patient or virus carrier with oropharyngeal secretions. The transmission of infection occurs through airborne droplets through saliva, often during kisses by the mother of her child, which is why sometimes EBV infection is called “kissing disease”.Children often become infected with EBV through toys contaminated with the saliva of a sick child or a virus carrier, when using common utensils, linen. Possible blood transfusion transmission of infection, as well as sexual. Cases of vertical transmission of EBV from mother to fetus have been described, suggesting that the virus may be the cause of intrauterine developmental abnormalities. The contagiousness in EBV infection is moderate, which is probably due to the low concentration of the virus in saliva. The activation of infection is influenced by factors that reduce general and local immunity.The causative agent of EBV infection has a tropism for the lymphoid-reticular system. The virus enters the B-lymphoid tissues of the oropharynx, and then spreads throughout the entire lymphatic system of the body. Infection of circulating B-lymphocytes occurs. The DNA of the virus penetrates into the nuclei of the cells, while the proteins of the virus give the infected B-lymphocytes the ability to multiply continuously, causing the so-called “immortality” of B-lymphocytes. This process is a characteristic feature of all forms of EBV infection.

EBV can cause: infectious mononucleosis, Burkitt’s lymphoma, nasopharyngeal carcinoma, chronic active EBV infection, leiomyosarcoma, lymphoid interstitial pneumonia, hairy leukoplakia, non-Hodgkin’s lymphoma, congenital EBV infection.

Varicella-zoster infection

Varicella-zoster virus causes chickenpox and herpes zoster. The source of chickenpox infection can only be a person with chickenpox or herpes zoster, including the last 24-48 hours of the incubation period. Chickenpox reconvalescents remain infectious for 3-5 days after the skin rash stops. The disease is not transmitted through a third party. It is possible intrauterine infection with chickenpox in case of illness of a pregnant woman.Chickenpox can occur at any age, but in modern conditions, the maximum number of patients falls on children aged 2 to 7 years. Herpes zoster develops after a primary infection with the Varicella-zoster virus, after the transition of the infection to a latent form, in which the virus is localized in the spinal, trigeminal, sacral and other nerve ganglia. Endogenous reactivation of the infection is possible.

Cytomegalovirus infection

An infectious disease caused by cytomegalovirus (CMV) and characterized by various clinical forms (from asymptomatic to severe generalized with damage to many organs) and course (acute or chronic).Transmission factors for CMV can be almost all biological substrates and human secretions that contain the virus: blood, saliva, urine, cerebrospinal fluid, vaginal secretions, semen, amniotic fluid, breast milk. A potential source of infection is organs and tissues in transplantation, as well as blood and its products in transfusiology. Ways of transmission of CMV infection: airborne, sexual, vertical and parenteral.

Distinguish between congenital and acquired forms of CMV infection.Congenital CMV infection. With antenatal infection of the fetus, infection occurs mainly transplacentally. With intrapartum infection, CMV enters the body through the aspiration of infected amniotic fluid or secretions from the mother’s birth canal.

In older children, acquired CMV infection occurs in 99% of cases in a subclinical form. The most common manifestation of this form of CMV infection in children over the age of one year is mononucleosis-like syndrome.As a rule, there is a clinic of acute respiratory disease in the form of pharyngitis, laryngitis, bronchitis.

Infections caused by the sixth, seventh and eighth types of herpesviruses Herpesviruses of the sixth type (HHV-6) can cause erythematous and roseolous rashes (sudden exanthema), lesions of the central nervous system and bone marrow in immunocompromised children. Herpesviruses of the seventh type (HHV-7) cause exanthema of newborns

Cytological, immunofluorescent, serological and PCR methods are valuable for the diagnosis of herpes infection.
Virological examination for herpes infection reveals complement-binding antibodies to HSV-1 or -2 in the mother’s blood, fetal cord blood and amniotic fluid.
PCR method. The material for research on herpes is blood, swabs from the pharynx, the contents of the vesicles, ulcers, urine.

It is important to study specific antibodies of various subclasses: IgM, IgG1-2, IgG3 and IgG4 to herpes viruses. The detection of specific immunoglobulins M, IgG3, IgG1-2 in the blood serum of children in a titer> 1:20, viral antigen and specific immune complexes with the antigen indicates the severity of the infectious process (active phase), and the determination of only specific IgG4 is regarded as a latent phase of infection or carriage of maternal antibodies.

Treatment

Herpes infection occurs in 3 stages:

• Stage 1 – in the active stage or with exacerbation of the chronic course of the disease;
• Stage 2 – prolonged treatment with maintenance doses during remission;
• Stage 3 – identification and rehabilitation of chronic foci of infection, examination of family members to identify the source of infection.

In all cases, the drugs, their combination and duration are selected individually, taking into account the manifestations of the disease, the characteristics of the child’s immune system, age, course of the disease.

90,000 Herpetic infections and their treatment

Today, herpes infections are the most common infectious diseases in the human population, affecting almost all organs and systems of a person, having a negative impact on both the health of the person himself and the health of his offspring.

Herpes viruses that cause human pathology belong to the Herpesviridae family. Of about 100 known herpesviruses, 8 cause human disease.

• Herpes simplex virus type 1 causes herpetic lesions of the skin of the face and mucous membranes, recurrent meningoencephalitis.
• Herpes simplex virus type 2 – recurrent genital herpes.
• Varicella-zoster virus-3 type-herpes-zoster-Chickenpox and shingles.
• Human herpes virus type 4 – Epstein-Barr virus – causes Infectious mononucleosis, B-lymphoproliferative diseases.
• Human herpesvirus type 5-human cytomegalovirus-cytomegalovirus infection.
• Herpes viruses of types 6 and 7, they are associated with exanthema of newborns and chronic fatigue syndrome in adults.
• Human herpesvirus type 8, the development of Kaposi’s sarcoma is associated with it.

Herpes virus A DNA-containing virus with a high affinity for human nervous tissue. The source of herpes infection is a sick person or a virus carrier.The herpes simplex virus is transmitted by contact, airborne droplets, as well as by transfusion, transplacental and during organ and tissue transplantation. The most frequent route of transmission is contact, while, during the initial contact of the human body with the virus, infection of the skin and mucous membranes occurs, and then the virus moves to the nerve nodes and, with satisfactory immunity of the carrier, survives in them, without causing concern to the human carrier. However, in case of violation of human immunity, hypothermia, fatigue, the virus becomes active and the disease develops.

In the practice of a dermatologist and dermatovenerologist, most often one has to deal with the results of the effects on the human body of herpes simplex viruses type 1, 2, as well as with manifestations of herpes zoster infection. There are the following methods for the laboratory determination of herpes infection: cultural – the cultivation of the virus on media, microscopic, PCR diagnostics, as well as the determination of specific immunoglobulins in the patient’s blood – antibodies to the virus. However, it should be noted that laboratory diagnostic methods are auxiliary to the data of the clinical picture of the disease and can be used at the discretion of the doctor.

The most common patients of a dermatovenerologist are patients with recurrent genital herpes, with manifestations of inflammation on the skin of the genitals, as well as itching and soreness, herpes simplex viruses of types 1 and 2 become the causative factor of these manifestations. Abortive forms of infection are not uncommon, without signs of itching, as well as without specific herpes lesions – intradermal vesicular rashes, with local redness and slight infiltration. It should be remembered that both sexual partners are subject to treatment for recurrent genital herpetic lesions, even in the absence of clinical symptoms in the second partner.Only timely and high-quality treatment of genital herpes of both partners can help to cure and prevent complications of herpes infection, – the development of pathology of pregnancy and fetus, as well as reduce the risk of developing an oncological process of the cervix in women.

In addition, quite often patients with manifestations of herpes zoster, rashes caused by herpes simplex virus type 3 turn to a dermatovenerologist. Rashes with this pathology can be extensive, accompanied by severe itching and soreness and are located along the nerve fibers.Pain syndrome in this pathology accompanies, and often outstrips cutaneous symptoms, and can simulate attacks of myocardial infarction, peptic ulcer and other conditions. The manifestations of herpes infection with shingles can be accompanied by severe general symptoms, in the form of an increase in body temperature, malaise, and can cause temporary disability. In some cases, the course of the pathological process leads to the development of persistent pain syndrome. Timely started and well-carried out antiviral treatment contributes to the rapid localization of the cutaneous process, is the prevention of the development of complications of herpes zoster.

Treatment of herpes infection

Long-term experience in the treatment of herpes infection in patients in the dermatology department of Uro-Pro clinics, a multipurpose integrated approach in the treatment of herpes pathology, combining the use of antiviral agents, as well as immunomodulators, an individual approach to the choice of therapy provides a quick and lasting clinical effect in the treatment of herpes infection …

When choosing drug treatment in the treatment of herpes infections, we proceed primarily from the concept of effectiveness and appropriateness.All medicines we use are certified and undergo strict clinical controls. We use the most modern medical techniques, with a high degree of efficiency, and almost complete absence of negative effects on the body. In the treatment of recurrent genital herpes, we follow the standards of anonymity and ethics when offering treatment for pathology to partners. It is important for us to contribute to the improvement of the sexual health of the couple, with a decrease in the risks of the development of pathology in their future children, which may be associated with the carriage of herpes infection.Sincerity and trust in the treatment of pathology associated with genital herpes infections are the key to the success of the therapy in patients, as well as the guarantee of the health of their future offspring.

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