Herpes Simplex Virus Infections

Herpes simplex virus infection is asymptomatic most of the time; however, in some cases, the following signs and symptoms may be noticed.

• Burning, itching, or tingling: If you have herpes, your skin may itch or burn for a few days before the appearance of blisters.
• Sores: Painful fluid-filled blisters or sores may appear. These sores usually develop 2-20 days after close contact with an infected person. They may form a crust prior to healing. The location of sores differs according to the type of HSV infection:
  • Oral herpes (HSV-1): Blisters usually appear on and around the lips (herpes labialis). Oral infection may involve the inside of the cheeks, tongue, gums, and roof of the mouth (herpetic gingivostomatitis).
  • Genital herpes (HSV-2): Sores mostly appear on genital organs such as the vagina, vulva, labia, and cervix in women, and the penis and testicles in men. In some cases, the buttocks, anal region, and inner thighs may also be involved.
• Flu-like symptoms: You may observe typical flu-like symptoms such as fever, sore throat, swollen lymph nodes in the neck (oral herpes) or groin (genital herpes), and muscle aches.
• Urinary problems: Individuals, mostly women, suffering from genital herpes may experience a burning sensation while urinating or have trouble urinating.
• Herpes keratitis: Sometimes the herpes simplex virus may spread to one or both eyes, leading to sensitivity to light, discharge from the eyes, pain, and a gritty feeling in the eye.

Note: Herpes can occur in other areas such as fingers (known as herpetic whitlow) and the brain (known as herpes encephalitis).

Herpes simplex virus (HSV) infections are common viral infections caused by the Herpes simplex virus. While most people have asymptomatic HSV, meaning they do not show any signs or symptoms when infected, some may experience sporadic episodes of small, fluid-filled blisters or sores.

HSV can spread through close contact with an infected person. The herpes simplex virus is primarily transmitted when a person touches the sore. However, even individuals without visible sores can spread the virus, a phenomenon known as asymptomatic viral shedding.

Once infected, the virus enters the cells and begins replication. It also travels to the nerve cells, where it remains in an inactive (dormant) state. This means that although the virus is present in the body, it neither replicates nor shows any symptoms. However, the virus can be activated later, leading to recurrence of the infection. These recurrences are often triggered by:

• Stress or anxiety
• Any infection, injury, or febrile illness
• Hormonal changes, such as during menstruation
• Exposure to extreme cold or hot conditions

The following risk factors increase the susceptibility to herpes simplex virus infections:

• Gender: Women are more prone to HSV infection compared to men.
• Close contact with an infected person: The virus can spread through prolonged skin-to-skin contact, kissing, and sharing items such as brushes, cups, or towels.
• Multiple sexual partners: Having multiple sexual partners increases the risk of herpes infection due to a higher likelihood of coming into contact with an infected individual or an asymptomatic carrier.
• Unprotected sexual contact: HSV-2 is primarily sexually transmitted through vaginal, anal, or oral sex. Individuals who do not use protective measures like condoms or dental dams are at a greater risk of contracting herpes.
• Low immunity: Individuals with low immunity or those suffering from immunocompromised conditions, such as human immunodeficiency virus (HIV) infection, autoimmune diseases, cancer, or immunoglobulin A (IgA) deficiency, are at a higher risk. Additionally, those on immunosuppressive drugs, such as chemotherapy or steroids, or who have undergone organ transplants, face increased risk.

During an outbreak, a doctor or clinician can diagnose HSV infections by examining the sores or blisters. They might also inquire about other symptoms, including:

• Flu-like symptoms
• Early signs, such as tingling or burning

To confirm the diagnosis, a swab or fluid sample may be taken from the sores or blisters and sent to a laboratory for culture or PCR testing.

When sores have healed or are not present, blood tests to check for HSV-1 and HSV-2 antibodies, which indicate exposure to the virus, are recommended. These tests include:

• Herpes simplex virus 1 & 2, IgM
• Herpes simplex virus 1 & 2, IgG

While the blood test does not indicate an active infection, especially in the absence of open sores or lesions, it provides information about past exposure to the herpes virus. In cases of a first infection, the test is likely to be negative, as there may not have been sufficient time for the body to develop antibodies. In such instances, the HSV-1 and HSV-2 antibody test may be repeated in eight to 12 weeks.

To prevent contracting or spreading of HSV-1 infection or oral herpes:

• Do not share your personal items such as towels and brushes with anyone.
• Avoid sharing your drinks.
• Do not let anyone come in close contact with you or touch your sore in case of an active infection.
• Avoid triggers such as stress, sunlight, and extreme cold weather, which can lead to recurrence of the infection.

To prevent contracting and spreading HSV-2 infection or genital herpes:

• Practice safe sex. The consistent and correct use of barrier contraceptives like condoms can reduce the risk of infection even if your partner is asymptomatic. Condoms can also protect against other sexually transmitted diseases. The use of condoms or dental dams while giving or receiving oral sex is equally important.
• Avoid intercourse as soon as either partner suspects or is diagnosed with an HSV infection.
• Get an antibody test to know if you have herpes or any other sexually transmitted disease that you may transmit to your partner.
• Take antiviral medication as advised by your doctor. This reduces the chances of others contracting the disease.

Once you have the herpes virus, it remains in your body for life. Herpes sores typically improve on their own within one to two weeks without medical treatment. However, in cases of severe or frequent outbreaks, a doctor can prescribe antiviral medications to suppress the infection, manage symptoms, and prevent recurrence. Your doctor may recommend an antiviral cream or ointment to alleviate symptoms such as burning, itching, or tingling. In some cases, antiviral oral medications or injections may also be prescribed.

Some of the antiviral medications used to treat both HSV-1 and HSV-2 infections include:

• Acyclovir
• Ganciclovir
• Famciclovir
• Valacyclovir

Click here to learn more about the medicines for herpes simplex virus infections. Click Now!

There are few things you can do at home to help manage herpes sores.

1. To relieve pain and discomfort

• For painful blisters and sores, you can apply medicine such as benzocaine and L-lysine.
• You can also put ice on the blisters to reduce pain and itching.
• Keep away from triggers such as stress and sunburn to prevent future outbreaks.

2. To prevent the spread of HSV infection

• Prevent the spread of this virus to other parts of your body by washing your hands after touching a blister or open sore.
• Do not apply ointment with your fingertips to open sores; instead, use a cotton tip applicator.

3. To prevent the spread to an uninfected person

• If you have sores or symptoms of herpes simplex virus, avoid having sex with your partner.
• People with active symptoms of oral herpes should avoid oral contact with others and sharing objects that have contact with saliva, such as utensils.
• Even if you do not have any symptoms, use a latex condom to lower the risk of spreading the virus.
• If you are pregnant and your partner has herpes, inform your doctor. You may need to take medication towards the end of your pregnancy to prevent passing the virus to your newborn.

1. Finger or thumb infection: Also known as herpetic whitlow, this infection may cause your finger or thumb to become red or swollen before the appearance of blisters. It is usually accompanied by burning pain.
2. Esophagus infection: Herpes esophagitis is a viral infection of the esophagus that can be very painful and interfere with swallowing. It is typically seen in immunocompromised patients, including those post-chemotherapy and HIV patients.
3. Eye infection: If left untreated, herpes may cause herpes keratitis, leading to redness in one or both eyes, swollen eyelids, conjunctivitis with opacity, superficial ulceration of the cornea, pain in the periorbital region, or impaired vision.
4. Other sexually transmitted infections: Genital herpes can increase the risk of transmitting or contracting other sexually transmitted infections, including HIV.
5. Bladder complications: In some cases, genital herpes can cause inflammation of the urethra, which is the tube that carries urine from the bladder to outside. The swelling can close the urethra for several days, requiring the insertion of a catheter to drain the bladder.
6. Rectal inflammation (proctitis): Genital herpes can also lead to inflammation of the lining of the rectum.
7. Nervous system involvement: Cranial or facial nerves can become infected by HSV, resulting in temporary paralysis of the affected muscles. Rarely, in Maurice syndrome, neuralgic pain may precede each recurrence of herpes by 1 or 2 days. If left untreated, herpes can lead to meningitis or encephalitis, which is the inflammation of the membranes and cerebrospinal fluid surrounding the brain and spinal cord.
8. Eczema herpeticum: In patients with a history of atopic dermatitis or Darier disease, herpes simplex may result in a widespread condition called eczema herpeticum. Numerous blisters can erupt on the face or body, along with swollen lymph glands and fever.
9. Erythema multiforme: A single or recurrent episode of erythema multiforme can occur rarely with HSV infection. The rash presents as symmetrical plaques on the hands, arms, feet, and legs, marked by target lesions that sometimes have central sores.

Some home remedies might help in alleviating the symptoms associated with sores and blisters. Do consult your doctor before trying any of them.

• Tea tree oil: Tea tree oil is a great remedy for numerous health issues. To heal herpes sores, the oil must be diluted with a carrier oil before applying it to a cold sore or genital herpes.
• Aloe vera: Aloe vera has wound-accelerating and soothing properties. Aloe vera gel extracted from the plant can be applied directly to the body without dilution. It is effective in alleviating itching and redness caused by sores.
• Echinacea: Echinacea is a medicinal plant with anti-viral properties. It is known for enhancing the immune system and easing the symptoms of this viral infection. All parts of the Echinacea plant—flowers, leaves, and roots—can be used for healing herpes.
• Lemon balm: Lemon balm is one of the most effective herbal remedies that may cure and reduce the risk of herpes transmission. It contains flavonoids, phenolic acid, and rosmarinic acid, which help in healing sores and blisters.
• Baking soda: Baking soda is an effective treatment for quickly alleviating herpes symptoms. It provides relief from itchy and painful sores.
• Epsom salt: Bathing in Epsom salt water is a great remedy for soothing itching and pain associated with herpes. This remedy helps to dry the sores, thereby reducing itching.
• Oregano oil: Oregano oil possesses anti-viral properties that can help alleviate the symptoms of the herpes simplex virus and promote the speedy recovery of herpes blisters.
• Ice pack: The simplest method to relieve herpetic lesions, particularly for genital herpes, is the application of ice. However, it is important to note that prolonged exposure to ice on genital areas can damage tissues.

Herpes can be managed well with medications and other preventive measures. It usually doesn't cause any serious troubles in healthy adults. However, there are a few things that should be kept in mind if you or your partner are living with a herpes infection.

• If you or your partner have an active herpes infection, do not engage in any form of sexual activity.
• It is advised to use condoms during sexual intercourse. However, remember that condoms only protect against genital exposure to the virus and do not prevent skin-to-skin contact with open sores.
• In the case of genital herpes, avoid touching the affected areas during an outbreak and wash your hands frequently to prevent transferring the infection to other parts of the body.
• Herpes, like other sexually transmitted diseases, carries some social stigma and can impact sexual relationships. If you're feeling distressed about your condition, it is advisable to talk with your doctor, therapist, or counselor.