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Herpes are a group of viruses spreading from skin to skin through contact; the term herpes also refers to the viral disease they cause. They appear on any part of the body and cause blisters and awfully painful sores.
A variety of diseases caused by viruses in the Herpesveridae family fall under the name herpes. Different types of herpes affect both animals and humans. In humans, Herpesveridae cause oral and genital herpes, chickenpox and shingles, cytomegalovirus, infectious mononucleosis, and Kaposi's sarcoma and other cancers. Eight herpes viruses can cause disease in humans. All produce life-long infections, though they may produce symptoms only sporadically or be asymptomatic.
Herpes simplex virus (HSV) I and II are responsible for oral and genital herpes, with HSV-I more likely to cause orofacial symptoms and HSV-II more likely to cause genital symptoms. Both viruses infect the nervous system. If symptomatic, they produce small painful blisters on the affected area that become scabs as they heal. Both types of HSV are transmitted through skin-to-skin contact with an infected person.
Varicella zoster virus (VZV) causes chickenpox and shingles, and also called herpes zoster. Chickenpox begins as a rash, which is followed by the formation of small, itchy blisters on the body and scalp. It is contagious and remains in the nervous system for life, though it rarely has serious complications. VZV infection is typically more serious in adults than in children, and it may progress to shingles, which is characterized by headache, malaise, fever, and pain in addition to blisters. In severe cases, the patient may develop postherpetic neuralgia, characterized by long-lasting, severe pain that is often difficult to manage.
Epstein-Barr virus (EBV) is extremely common, but usually asymptomatic. It most often causes infectious mononucleosis or mono, which presents as sore throat, fever, and fatigue. Infectious mononucleosis is spread via saliva, and is self-limiting, meaning it can usually be resolved without treatment. Rare and potentially fatal complications occur in 5% of all cases. EBV and Kaposi's sarcoma-associated herpesvirus (KSHV), which causes Kaposi's sarcoma and other tumors, both affect the immune system and remain in the B-cells while latent.
Cytomegalovirus (CMV) causes symptoms similar to infectious mononucleosis, and is spread through bodily fluids. CMV is treated with an immunoglobulin injection, sometimes in combination with an antiviral. Roseolovirus, also spread through bodily fluids, is the cause of the childhood disease roseola, characterized by rash, high fever, respiratory symptoms, irritability, and decreased appetite. Roseola usually resolves on its own. Both CMV and roseolovirus reside in the T-cells of the immune system when latent, and both can be life-threatening in infants and patients with compromised immune systems.
Symptoms vary depending on whether the outbreak is initial or recurrent. The first (primary) outbreak is usually worse than recurrent outbreaks. However, most cases of new herpes simplex virus infections do not produce symptoms. In fact, studies indicate that 10 - 25% of people infected with HSV-2 are unaware that they have genital herpes. Even if infected people have mild or no symptoms, they can still transmit the herpes virus.
Primary Genital Herpes Outbreak. For patients who do experience symptoms, the first outbreak usually occurs in or around the genital area within 1 - 2 weeks after sexual exposure to the virus. The first signs are a tingling sensation in the affected areas, (genitalia, buttocks, thighs), and groups of small red bumps that develop into blisters. Over the next 2 - 3 weeks, more blisters can appear and rupture into painful open sores. The lesions eventually dry out and develop a crust, and then heal rapidly without leaving a scar. Blisters in moist areas heal more slowly than others. The lesions may sometimes itch, but itching decreases as they heal.
About 40% of men and 70% of women develop other symptoms during initial outbreaks of genital herpes, such as flu-like discomfort, headache, muscle aches, fever, and swollen glands. (Glands can become swollen in the groin area as well as the neck.) Some patients may have difficulty urinating, and women may experience vaginal discharge.
Recurrent Genital Herpes Outbreak. In general, recurrences are much milder than the initial outbreak. The virus sheds for a much shorter period of time (about 3 days) compared to an initial outbreak of 3 weeks. Women may have only minor itching, and the symptoms may be even milder in men.
On average, people have about four recurrences during the first year, although this varies widely. Over time, recurrences decrease in frequency. There are some differences in frequency of recurrence depending on whether HSV-2 or HSV-1 causes genital herpes. HSV-2 genital infection is more likely to cause recurrences than HSV-1.
Oral herpes (herpes labialis) is most often caused by herpes simplex virus 1 (HSV-1) but can also be caused by herpes simplex virus 2 (HSV-2). It usually affects the lips and, in some primary attacks, the mucous membranes in the mouth. A herpes infection may occur on the cheeks or in the nose, but facial herpes is very uncommon.
Primary Oral Herpes Infection. If the primary (initial) oral infection causes symptoms, they can be very painful, particularly in small children.
Blisters form on the lips but may also erupt on the tongue.
The blisters eventually rupture as painful open sores, develop a yellowish membrane before healing, and disappear within 3 - 14 days.
Increased salivation and foul breath may be present.
Rarely, the infection may be accompanied by difficulty in swallowing, chills, muscle pain, or hearing loss.
In children, the infection usually occurs in the mouth. In adolescents, the primary infection is more apt to appear in the upper part of the throat and cause soreness.
Recurrent Oral Herpes Infection. Most patients have only a couple of outbreaks a year, although a small percentage of patients experience more frequent recurrences. HSV-2 oral infections tend to recur less frequently than HSV-1. Recurrences are usually much milder than primary infections and are known commonly as cold sores or fever blisters (because they may arise during a bout of cold or flu). They usually show up on the outer edge of the lips and rarely affect the gums or throat. (Cold sores are commonly mistaken for the crater-like mouth lesions known as canker sores, which are not associated with herpes simplex virus.)
Treatment for genital herpes will depend on whether:
you have the infection for the first time (a primary infection) or you have an infection that keeps coming back (a recurrent infection)
you are being treated by your GP
In most instances, a primary infection of genital herpes will develop some time after you have been exposed to the herpes simplex virus (HSV). This can be months or even years after the exposure, or it may be after four to seven days.
If you have a primary genital herpes infection your GP may treat you for the condition. They may prescribe antiviral tablets, called aciclovir, which you will need to take five times a day.
Aciclovir works by preventing HSV from multiplying. However, it does not clear the virus from your body completely and does not have any effect once you stop taking it.
You will need to take a course of aciclovir for at least five days, or longer if you still have new blisters and ulcers (open sores) forming on your genital area when your treatment begins.
Aciclovir can cause some side effects, including:
feeling sick
being sick
headaches
For more information, see the patient information leaflet that comes with your medicine.
There are also several self-help measures that you may be able to follow to ease your genital herpes symptoms.
You should visit your GP if you have been diagnosed with genital herpes before and you are experiencing a recurrent infection.
If the symptoms of your recurrent infection are mild, your GP may suggest some self-help measures to help ease your symptoms without the need for treatment. If your symptoms are more severe, you may be prescribed antiviral tablets (aciclovir), which you will need to take five times a day for five days.
If you have fewer than six recurrent infections of genital herpes in a year, your GP may prescribe a five-day course of aciclovir each time you experience symptoms. This is known as episodic treatment.
If you have more than six recurrent attacks of genital herpes in a year, or if your symptoms are particularly severe and causing you distress, you may need to take aciclovir every day as part of a long-term treatment plan.
This is known as suppressive treatment and it aims to prevent further recurrent infections from developing. In this instance, it is likely that you will need to take aciclovir twice a day for 6 to 12 months.
After you have been taking aciclovir for 12 months, your GP will usually stop your suppressive treatment. You may continue to experience further recurrent infections of genital herpes after your treatment has been stopped.
As long as recurrent genital herpes infections are infrequent and mild, you will only need to take a five-day course of aciclovir as and when it is needed. Episodes of recurrent genital herpes usually become less frequent and less severe after around two years.
Suppressive treatment may be restarted if you have further genital herpes infections after the treatment has been stopped, or if you have severe recurrent infections. Your GP may refer you for specialist treatment if you continue to have recurrent infections of genital herpes while you are having suppressive treatment.
If you are experiencing recurrent attacks of genital herpes you should consider being tested for HIV. Recurrent attacks may be a sign of a weakened immune system (the body’s natural defence against infection and illness), which may indicate that you have HIV.