Herpes

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Introduction

What is herpes?

Herpes is a term that generally refers to a family of viral infections characterized by painful, fluid-filled sores or blisters in and around the mouth or genital region. Herpes is also called herpes simplex, which includes two types:

  • Genital herpes is a common sexually transmitted disease (STD) marked by outbreaks of blisters and lesions in the genital area. Genital herpes is most often caused by infection of the herpes simplex virus type 2 (HSV-2).About one out of six people 14 to 49 years of age has genital herpes caused by the HSV-2 infection, according to the Centers for Disease Control and Infection (Source: CDC).

    Another herpes virus, herpes simplex virus type 1 (HSV-1), which generally causes oral herpes, can also cause genital herpes.

  • Oral herpes (herpes simplex labialis) is a very common disease that causes small, painful cold sores and fever blisters of the mouth, lips or gums. Oral herpes is most often caused by HSV-1, but HSV-2 may also be responsible in some cases. It is estimated that 50% to 80% of all American adults have oral herpes, according to the Centers for Disease Control and Infection.

HSV-1 and HSV-2 are closely related viruses that belong to a larger family of herpes viruses that can cause a variety of other diseases. Other common types of herpes viruses include cytomegalovirus (CMV), herpes zoster (causes shingles and chickenpox), and Epstein-Barr virus (can cause mononucleosis and other infections).

Herpes simplex virus infections are very contagious and can be spread to either the genital or oral areas by direct contact with herpes sores or blisters, or skin, saliva, or mucus membranes infected with a herpes simplex virus. Herpes is not curable, but it is preventable and controllable in many cases.

In some cases, herpes can lead to serious complications, such as meningitis, blindness, or death of a newborn that was exposed to the disease during pregnancy or delivery. Seek prompt medical care if you are pregnant or have a disease or condition that suppresses the immune system, and believe that you have been exposed to herpes or have herpes symptoms, such as sores or blisters in the genital or oral area.

Symptoms

What are the symptoms of herpes?

Symptoms of herpes simplex infection vary among individuals. Both men and women with herpes may have vague or mild symptoms or no symptoms at all. Many, but not all, people with herpes have recurring outbreaks of symptoms during a period of months to years. Recurrences are generally milder in nature and do not last as long as the initial outbreak. Herpes recurrences appear at the same location on the body.

Symptoms of oral herpes

Symptoms of oral herpes include:

  • Fever

  • Itching, discomfort or pain may appear days before the arrival of blisters and sores

  • Small blisters filled with clear yellowish fluid, often on top of raised, red, painful skin areas. They may break and ooze after forming, merging into a larger blister. Eventually yellow crusts form that fall away to reveal pink, healing skin

  • Sore throat

  • Swollen neck lymph nodes

After a period of time, blisters, sores or lesions can reappear due to reactivation of the herpes simplex virus from illness or stress.

Symptoms of genital herpes

Early symptoms of genital herpes occur two to six days after exposure and can include:

  • Decreased appetite

  • Fever

  • General feeling of malaise or not feeling well

  • Headache

  • Muscle aches

  • Pain, sensitivity or itching near or on the penis, vulva or rectum

Later symptoms of genital herpes occur two to three weeks after exposure and can include:

  • Appearance of groups of blisters on areas that were exposed to the herpes simplex virus, such as the genitals, vagina, cervix, thighs, buttocks or anus

  • Blisters that break open and develop into painful lesions or sores that last about two weeks

  • Chills

  • Fatigue

  • Fever

  • Swollen lymph glands

  • Unusual vaginal discharge

Causes

What causes herpes?

Genital and oral herpes can both be caused by an infection of the herpes simplex virus type 1 (HSV-1) or type 2 (HSV-2).HSV-2 is the most common cause of genital herpes and HSV-1 is the most common cause of oral herpes.

Herpes viruses are passed from one person to another during sexual contact that involves touching of the mouth or genitals, or vaginal or anal sex. Oral sex can spread genital herpes to the mouth or transmit oral herpes to the genitals. Oral herpes can also be spread by kissing and other activities in which you are exposed to the mucous membranes or saliva of a person with oral herpes.

Any person who engages in sexual activity can contract and pass on a herpes infection, including heterosexual, homosexual and bisexual men and women. The more sexual partners a person has, the greater the risk of catching a herpes infection. It’s important to know that herpes can be spread between people even when no blisters or symptoms are present. Once herpes is diagnosed, sexual partners should be notified and appropriately treated.

The herpes simplex virus can also be passed from an infected mother to her newborn during vaginal delivery. This type of infection travels to the nervous system and can have devastating consequences.

What are the risk factors for herpes?

Certain factors increase herpes infection risks. These include:

  • Born to a mother with active genital herpes during pregnancy or delivery

  • Compromised immune system because of medications and chemotherapy, or conditions such as HIV/AIDS

  • Direct exposure to the saliva or mucous membranes of a person with oral herpes

  • Female (although men are also at risk)

  • History of another sexually transmitted disease (STD)

  • Unprotected sex, including vaginal, oral or anal sex

Reducing your risk of herpes

Herpes is preventable and is most contagious during an outbreak when blisters or lesions are present. Not everyone at risk will develop herpes, but you can lower your risk of contracting and spreading herpes by :

  • Abstaining from kissing and sexual activity until all blisters and lesions have completely healed

  • Engaging in sexual activities only within a mutually monogamous relationship, in which neither partner is infected with herpes or has its risk factors

  • Getting regular, routine medical care

  • Not sharing items exposed to the mouth, such as drinking glasses, silverware, toothbrushes, or mouth guards

  • Seeking medical care as soon as possible after possible exposure to herpes or after high-risk sexual activity

  • Seeking prenatal care early and regularly during pregnancy

  • Using latex condoms properly

  • Using proper hygiene practices, such as frequent hand washing

Treatments

How is herpes treated?

There is no cure for herpes, but prompt diagnosis and treatment can help reduce or delay the onset of serious complications, improve the quality of life, and minimize the spread of the disease to others. You can best manage genital herpes by consistently following your treatment plan, which generally includes medications and other treatments.

Antiretroviral medications for herpes

Herpes can be controlled to various degrees with oral antiviral medications. These drugs do not cure genital herpes but can help speed the healing of blisters and reduce the amount of time in which the disease is most contagious. These medications are most effective if taken before sores appear. Medications may include:

  • Acyclovir (Zovirax), available as a pill, for genital and possibly oral herpes, and a cream, for both genital and oral herpes

  • Docosanol (Abreva) cream for oral herpes

  • Famciclovir (Famvir), a pill for genital and possibly oral herpes

  • Penciclovir cream (Denavir) for oral herpes

  • Valacyclovir (Valtrex), a pill for genital and possibly oral herpes

Other treatments for herpes

Other measures that help treat and prevent herpes include:

  • Applying a sun block or lip balm containing zinc oxide to protect lips when outdoors

  • Applying cold or warm packs to affected areas to reduce pain

  • Avoiding touching affected areas during outbreaks

  • For pregnant women, having a Cesarean section delivery, especially if you have active genital herpes

  • Keeping affected areas clean and dry

  • Not sharing items exposed to the mouth, such as drinking glasses, silverware, toothbrushes, or mouth guards

  • Washing hands thoroughly with soap and water before eating and after using the bathroom or touching affected areas

What are the possible complications of herpes?

Complications of herpes can be serious in some cases. People at risk for serious complications include those with impaired immune systems due to such conditions as HIV/AIDS or chemotherapy. You can minimize risks by following the treatment plan including medications, designed by you and your health care professional.

Serious complications of herpes

Serious complications of herpes include:

  • Blindness

  • Increased risk of contracting other sexually transmitted diseases, including HIV/AIDS

  • Severe, recurrent outbreaks and symptoms

  • Skin infections

  • Spread of herpes infection through the bloodstream into other organs and tissues of the body

Life-threatening newborn complications of prenatal herpes

Newborns whose mothers have genital herpes, especially active genital herpes, during pregnancy or vaginal delivery are at risk for life-threatening complications. Exposure to the herpes virus is dangerous because a newborn’s immune system is not yet fully developed. Complications include:

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2019 Jan 5
  1. Genital Herpes. Centers for Disease Control and Prevention (CDC). http://www.cdc.gov/std/Herpes/default.htm
  2. Herpes. Planned Parenthood. http://www.plannedparenthood.org/health-topics/stds-hiv-safer-sex/herpes-4271.htm
  3. Herpes Labialis. Medline Plus, a service of the National Library of Medicine National Institutes of Health. http://www.nlm.nih.gov/medlineplus/ency/article/000606.htm
  4. Herpes Simplex. American Academy of Dermatology. https://www.aad.org/public/diseases/contagious-skin-diseases/herpes-simplex
  5. Herpes resource center. American Social Health Association. http://www.ashasexualhealth.org/stdsstis/herpes/
  6. Gupta R, Warren T, Wald A. Genital herpes. Lancet 2007; 370:2127
  7. Bope ET, Kellerman RD (Eds.) Conn’s Current Therapy.Philadelphia: Saunders
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