Herpes Simplex

Herpes is an infection that is caused by a herpes simplex virus (HSV). Oral herpes causes cold sores around the mouth or face. Genital herpes affects the genitals, buttocks or anal area. Genital herpes is a sexually transmitted disease (STD). It affects the genitals, buttocks or anal area. Other herpes infections can affect the eyes, skin, or other parts of the body. The virus can be dangerous in newborn babies or in people with weak immune systems.

THERE ARE TWO TYPES OF HSV:

• HSV type 1 most commonly causes cold sores. It can also cause genital herpes.
• HSV type 2 is the usual cause of genital herpes, but it also can infect the mouth.

HSV spreads through direct contact. Some people have no symptoms. Others get sores near the area where the virus has entered the body. They turn into blisters, become itchy and painful, and then heal.

Most people have outbreaks several times a year. Over time, you get them less often. Medicines to help your body fight the virus can help lessen symptoms and decrease outbreaks.

Prevention

HSV-1: ORAL HERPES

Here are some tips to prevent mouth sores:

• Apply sunblock or lip balm containing zinc oxide to your lips before you go outside.
• Apply a moisturizing balm to prevent the lips from becoming too dry.
• Avoid direct contact with herpes sores.
• Wash items such as towels and linens in boiling hot water after each use.
• Do not share utensils, straws, glasses, or other items if someone has oral herpes.

Do not have oral sex if you have oral herpes, especially if you have blisters. You can spread the virus to the genitals. Both oral and genital herpes viruses can sometimes be spread, even when you do not have mouth sores or blisters.

HSV-2: GENITAL HERPES

If you have genital herpes, you should tell your partner that you have the disease, even if you do not have symptoms.

Condoms are the best way to protect against catching genital herpes during sexual activity.

• Use a condom correctly and consistently to help prevent spread of the disease.
• Only latex condoms prevent infection. Animal membrane (sheepskin) condoms do not work because the virus can pass through them.
• Using the female condom also reduces the risk of spreading genital herpes.
• Although it is much less likely, you can still get genital herpes if you use a condom.

Causes

HSV-1: ORAL HERPES

Oral herpes is a common infection of the mouth area. It is caused by the herpes simplex virus type 1 (HSV-1). Most people in the United States are infected with this virus by age 20.

After the first infection, the virus goes to sleep (becomes dormant) in the nerve tissues in the face. Sometimes, the virus later wakes up (reactivates), causing cold sores.

Herpes virus type 2 (HSV-2) most often causes genital herpes. However, sometimes HSV-2 is spread to the mouth during oral sex, causing oral herpes.

Herpes viruses spread most easily from individuals with an active outbreak or sore. You can catch this virus if you:

• Have intimate or personal contact with someone who is infected
• Touch an open herpes sore or something that has been in contact with the herpes virus, such as infected razors, towels, dishes, and other shared items.

Parents may spread the virus to their children during regular daily activities.

HSV-2: Genital Herpes

Genital herpes affects the skin or mucus membranes of the genitals. The virus is spread from one person to another during sexual contact.

HSV-2 most often causes genital herpes. HSV-2 can be spread through fluids (secretions) from the mouth or genitals.

You may become infected with herpes if your skin, vagina, penis, or mouth comes into contact with someone who already has herpes.

You are most likely to get herpes if you touch the skin of someone who has herpes sores, blisters, or a rash. But the virus can still be spread, even when no sores or other symptoms are present. In some cases, you do not know you are infected.

Genital HSV-2 infections are more common in women than men.

Symptoms

HSV-1: Oral Herpes

Some people get mouth ulcers when they first come into contact with HSV-1 virus. Others have no symptoms. Symptoms most often occur in kids between 1 and 5 years old.

Symptoms may be mild or severe. They most often appear within 1 to 3 weeks after you come into contact with the virus. They may last up to 3 weeks.

Warning symptoms include:

• Itching of the lips or skin around mouth
• Burning near the lips or mouth area
• Tingling near the lips or mouth area

Before blisters appear, you may have:

• Sore throat
• Fever
• Swollen glands
• Painful swallowing

Blisters or a rash may form on your:

• Gums
• Lips
• Mouth
• Throat

Many blisters are called an outbreak. You may have:

• Red blisters that break open and leak
• Small blisters filled with clear yellowish fluid
• Several smaller blisters that may grow together into a large blister
• Yellow and crusty blister as it heals, which eventually turns into pink skin

Symptoms may be triggered by:

• Menstruation or hormone changes
• Being out in the sun
• Fever
• Stress

If the symptoms return later, they are usually more mild.

HSV-2: GENITAL HERPES

Many people with genital herpes never have sores. Or they have very mild symptoms that go unnoticed or are mistaken for insect bites or another skin condition.

If signs and symptoms do occur during the first outbreak, they can be severe. This first outbreak most often happens within 2 days to 2 weeks of being infected.

General symptoms may include:

• Decreased appetite
• Fever
• General sick feeling (malaise)
• Muscle aches in the lower back, buttocks, thighs, or knees
• Swollen and tender lymph nodes in the groin

Genital symptoms include small, painful blisters filled with clear or straw-colored fluid. Areas where the sores may found include:

• Outer vaginal lips (labia), vagina, cervix, around the anus, and on the thighs or buttocks (in women)
• Penis, scrotum, around the anus, on the thighs or buttocks (in men)
• Tongue, mouth, eyes, gums, lips, fingers, and other parts of the body (in both genders)

Before the blisters appear, there may be tingling, burning, itching, or pain at the site where the blisters will appear. When the blisters break, they leave shallow ulcers that are very painful. These ulcers crust over and heal in 7 to 14 days or more.

Other symptoms may include:

• Painful urination
• Vaginal discharge (in women) or inability to empty the bladder that requires a urinary catheter

A second outbreak can appear weeks or months later. It is usually less severe and it goes away sooner than the first outbreak. Over time, the number of outbreaks may decrease.

Diagnosis

HSV-1: ORAL HERPES

Your health care provider can diagnose oral herpes by looking at your mouth area. Sometimes, a sample of the sore is taken and sent to a laboratory for closer examination. Tests may include:

• Viral culture
• Viral DNA test
• Tzanck test to check for HSV

HSV-2: Genital Herpes

Tests can be done on skin sores or blisters to diagnose herpes. These tests are most often done when someone has a first outbreak and when a pregnant women develops genital herpes symptoms. Tests include:

• Culture of fluid from a blister or open sore. This test may be positive for herpes simplex virus. It is most useful during the first outbreak.
• Polymerase chain reaction (PCR) done on fluid from a blister. This is the most accurate test to tell whether the herpes virus is present in the blister.
• Blood tests that check for antibody level to the herpes virus. These tests can identify whether a person has been infected with the herpes virus, even between outbreaks. A positive test result when a person has never had an outbreak would indicate exposure to the virus at some time in the past.

Treatment

HSV-1: ORAL HERPES

Symptoms may go away on their own without treatment in 1 to 2 weeks.

Your health care provider can prescribe medicines to fight the virus. This is called antiviral medicine. It can help reduce pain and make your symptoms go away sooner.

Antiviral medicines work best if you take them when you have warning signs of a mouth sore, before any blisters develop. If you get mouth sores frequently, you may need to take these medicines all the time.

• Antiviral skin creams may also be used. However, they are expensive and often only shorten the outbreak by a few hours to a day.

The following steps can also help make you feel better:

• Apply ice or a warm washcloth to the sores to help ease pain.
• Wash the blisters gently with germ-fighting (antiseptic) soap and water. This helps prevent spreading the virus to other body areas.
• Avoid hot beverages, spicy and salty foods, and citrus.
• Gargle with cool water or eat popsicles.
• Rinse with salt water.
• Take a pain reliever such as acetaminophen.

HSV-2: GENITAL HERPES

Genital herpes cannot be cured. Antiviral medicines may be prescribed.

• These medicines help relieve pain and discomfort during an outbreak by healing the sores more quickly. They seem to work better during a first attack than in later outbreaks.
• For repeat outbreaks, the medicine should be taken as soon as tingling, burning, or itching begins, or as soon as blisters appear.
• Persons who have many outbreaks may take these medicines daily over a period of time. This helps prevent outbreaks or shorten their length. It can also reduce the chance of giving herpes to someone else.

Pregnant women may be treated for herpes during the last month of pregnancy to reduce the chance of having an outbreak at the time of delivery. If there is an outbreak around the time of delivery, a C-section will be recommended to reduce the chance of infecting the baby.

Recovery

HSV-1: ORAL HERPES

Oral herpes most often goes away by itself in 1 to 2 weeks. However, it may come back.

Herpes infection may be severe and dangerous if:

• It occurs in or near the eye
• You have a weakened immune system due to certain diseases and medications

HSV-2: GENITAL HERPES

Once you are infected, the virus stays in your body for the rest of your life. Some people never have another episode. Others have frequent outbreaks that can be triggered by fatigue, illness, menstruation, or stress.