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Herpes Simplex Infections

Herpes Simplex Infections

Alternate Names

  • fever blister
  • cold sore
  • Cold sore
  • Genital sores (female)


Herpes simplex infections are caused by one of two types of the herpes simplex virus. This virus is most likely to attack the skin and nervous system.

What is going on in the body?

Humans are the only known source of herpes simplex viruses. The infection is spread by close physical contact and can be passed from mother to infant during pregnancy or childbirth.
The infection is chronic and can reactivate throughout life. Herpes simplex viruses are of two types:
  • Herpes simplex virus-1 (HSV-1) tends to appear on the face, most often around the nose and mouth.
  • Herpes simplex virus-2 (HSV-2) is most often found in the genital region and is usually spread through sexual activity.
Symptoms of infection with HSV include burning, itching, tingling, and pain at the site of infection, along with blisters filled with fluid. The affected individual may also have a low fever and enlarged lymph nodes in the neck.
Most people first get HSV-1 during childhood. It causes blisters around the mouth and nose. Although the infection clears up within 2 to 3 weeks, the inactive virus remains in the body for life. Reactivation of HSV-1 later in life often causes cold sores in the same areas.
Adolescents and adults generally contract HSV-2 through sexual activity. HSV-2 causes painful ulcers in the genital region. Sometimes HSV-2 infection results in a mild case of meningitis, an inflammation of the brain and spinal cord.
For both HSV-1 and HSV-2, reactivation takes the form of a single ulcer at the site of the original infection. HSV infections of varying severity can also occur in the eyes. A person should be treated for herpes of the eye as soon as possible to avoid complications.
An HSV infection known as herpetic whitlow can also occur on the finger. It often results from touching an ulcer at some other site. Infants can acquire HSV-1 or HSV-2 from their mothers during pregnancy or childbirth, generally when the mother has HSV for the first time.
HSV infection in newborn babies is very serious and can result in the death of the infant or brain damage even when the infant is treated appropriately. For this reason, an outbreak of herpes in a mother about to deliver is a sufficient reason for a Caesarian birth.
Infection in someone with a weakened or damaged immune system can also be severe and may require prolonged treatment.
Many outbreaks occur without any obvious reason. However, the following factors may trigger a recurrence:
  • dental work
  • emotional stress
  • exposure to sunlight
  • fatigue
  • an upper respiratory infection, such as a cold or flu


What are the causes and risks of the infection?

Causes of this infection include:
  • being born to a mother who has a first-time HSV infection
  • close contact with an infected person
People in the following categories may be more at risk for herpes simplex infection:
  • people undergoing radiation therapy or chemotherapy
  • people with cancer or other debilitating diseases
  • people with HIV or other immunodeficiency disorders


What can be done to prevent the infection?

The herpes simplex virus can be passed from person to person. Someone with oral herpes should not share lipstick, utensils, or drinks with others. Touching and kissing can also spread the virus. Male latex condoms can reduce, but not eliminate, the risk of transmitting herpes during sexual activity.
A person with an immune deficiency or who has frequent recurrences often needs antiviral drugs, such as acyclovir (i.e., Zovirax), famciclovir (i.e., Famvir) and valacyclovir (i.e., Valtrex), to help prevent reactivation. A healthcare professional who specializes in the condition should monitor a pregnancy complicated by HSV infection.
People with frequent recurrences of HSV often benefit from taking acyclovir, famciclovir or valacyclovir as a preventive measure at the initiation of symptoms.


How is the infection diagnosed?

A healthcare professional can take a swab of the infected secretions from the mouth, nose, or genital sores and send it to a lab where it is tested for HSV. This is called viral isolation.
HSV can be detected rapidly in infected specimens by using special stains. The healthcare professional will also evaluate the person's symptoms and ask about recent exposure to someone who has or had a herpes simplex infection.

Long Term Effects

What are the long-term effects of the infection?

Most infections clear up in 3 weeks or less. But the infection is chronic because the virus stays in the body forever. So, it may come back over and over throughout the rest of the individual's life. Infection in newborn babies and people whose immune systems are not working well can result in brain damage or death.

Other Risks

What are the risks to others?

Herpes infections are highly contagious and can be passed from one person to another much like a cold or the flu. Good hand washing, wearing gloves, and avoiding direct contact can all help prevent the spread to others.


What are the treatments for the infection?

In most cases, herpes simplex blisters on the face or genitals are self-limiting. They will usually crust over and go away in about 2 weeks. If they last longer, a healthcare professional should be consulted.
Treatment for oral herpes includes the following:
  • diluted, or 1 1/2%, hydrogen peroxide mouth rinse
  • lip balm to soothe sores on the lips
  • topical penciclovir cream (i.e., Denavir)
  • prescription oral antiviral medicines, such as acyclovir (i.e., Zovirax), famciclovir (i.e., Famvir) and valacyclovir (i.e., Valtrex)
  • salt-water rinse, with 1/2 teaspoon salt in 8 ounces of warm water
  • sunblock cream for lip protection
Acyclovir is used to treat HSV in newborn babies and people with genital herpes who have faulty immune systems. Acyclovir or its relatives, valacyclovir or famciclovir, can also be used to treat HSV in otherwise healthy people. Other treatment is aimed at preventing secondary infection and relieving symptoms.

Side Effects

What are the side effects of the treatments?

Antiviral medicines may cause nausea, vomiting, diarrhea, and allergic reactions. Creams and ointments may cause an allergic reaction in some individuals.

After Treatment

What happens after treatment for the infection?

Some people will have frequent recurrences of HSV. They often benefit from taking acyclovir, famciclovir or valacyclovir as a preventive measure at the initiation of symptoms.


How is the condition monitored?

Any new or worsening symptoms should be reported to a healthcare professional.

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