Herpes simplex

Herpes simplex is a common viral infection presenting as a cold sore or fever blister. Most instances of oral herpes are caused by herpes simplex virus type 1 (HSV-1), while genital herpes is caused by herpes simplex virus type 2 (HSV-2), but the sores can appear almost anywhere on the skin.

Many herpes infections are asymptomatic with up to 50% of Americans testing positive to HSV-1 antibodies, many of whom never report an outbreak. If symptoms occur, a person may experience:

  • Tingling/itching/burning – before the blisters appear the skin may tingle, itch or burn for a day or two.

  • Sores – one or more painful, fluid-filled blister may appear. The blisters open, ooze fluid and form a crust before healing fully.

    • Oral herpes (HSV-1) – blisters around the lips or mouth, sometimes on the face or tongue.

    • Genital herpes (HSV-2) – sores on the penis, vagina, buttocks or anus.

  • Flu-like symptoms – fever, muscle aches or swollen glands in the neck or groin.

  • Urinary – genital herpes may cause trouble urinating or cause a burning feeling while urinating, this is most often found in women.

  • Eye infection (herpes keratitis) – the virus can spread to one or both eyes causing pain, light sensitivity, discharge, and a dry feeling in the eye. Prompt treatment is necessary to avoid scarring of the eye, which can cause loss of vision.

Herpes simplex viruses spread from person to person through close contact. While you can get the virus from touching a sore, many people get it from an infected person who does not have active lesions, called asymptomatic viral shedding. Most people get HSV-1 (herpes simplex type 1) as an infant or child. This virus can spread with skin-to-skin contact by an adult who carries the virus – the adult does not have to have active sores in order to spread the virus. Cases of HSV-2 (herpes simplex type 2) are passed most commonly through sexual contact; however, there are cases of HSV-2 affecting the oral area and HSV-1 affecting the genital region. About 20% of sexually active adults in the United States carry HSV-2. Oral herpes typically last 2 to 3 weeks and genital herpes 2 to 6 weeks (the first outbreak).

Once a person becomes infected with a herpes simplex virus, the virus never leaves the body. After the first outbreak, the virus moves from the skin cells to nerve cells. The virus stays in the nerve cells forever in a latent state and can become active again by a trigger like stress, illness, fever, sun exposure, menstruation, or surgery.

During an outbreak, a Dermatologist can diagnose herpes simplex by looking at the sores. To confirm, the doctor may swab the sore and send to a laboratory. When the sores are not present, blood tests can be run to detect antibodies to herpes simplex virus. Sores often clear without treatment – however many people choose to treat outbreaks to relieve symptoms and shorten the duration of the outbreak. The most common treatment is an antiviral medication taken orally or intravenously. Acyclovir, famciclovir and valacyclovir are the medications most commonly used.

Complications from herpes simplex virus are rare, however mothers can give the virus to their baby during childbirth, If the baby is born during an active episode of genital herpes, the baby may face severe complications, and thus, a caesarean is indicated if active lesions are present to avoid birth through the vaginal canal. Patients with a weakened immune system from conditions like cancer or HIV/AIDS need to seek medical help right away if the signs or symptoms of a herpes infection emerge as they are at risk for disseminated infections. Patients with atopic dermatitis (eczema) or other skin conditions that cause an impaired epidermal barrier are at risk of disseminated herpes infections of the skin (eczema herpeticum) that requires immediate treatment as well.