Herpes simplex: symptoms, causes & treatment

Herpes simplex is an infection caused by the herpes simplex virus, which belongs to the family of herpes viruses. There are two main variants that can affect different parts of your body. The herpes simplex virus type 1, abbreviated HSV-1, mainly causes infections of the mouth and lips, known as cold sores or herpes labialis. The herpes simplex virus type 2, abbreviated HSV-2, is responsible for genital herpes, with genital lesions.

What makes this infection special is the behavior of the virus after the first infection. After an initial infection, the virus does not disappear from your body. It settles in the nerve nodes where it remains dormant without causing any inconvenience. You then become a carrier of the virus, even if you have no symptoms. This means that the infection may flare up again at a later time.

It's important to know that herpes is contagious. The virus spreads through direct contact with infected skin lesions or body fluids. When having oral sex with an infected person, HSV-1 can also cause genital herpes, which means that the traditional separation between the two types is less strict than previously thought.

Estimates assume that 50 to 60 percent of adults are carriers of the herpes virus. However, most carriers never develop symptoms and do not even know they are carrying the virus. Only a few actually experience visible blisters.

The first infection with the herpes simplex virus usually occurs through direct contact with someone who carries the virus. This can be done via kissing, oral contact or sexual contact. During the initial infection, the virus multiplies in the skin cells, leading to the characteristic vesicles. At the same time, part of the virus travels via the nerves to the nerve nodes where it settles permanently.

After the first infection, your skin heals, but the virus remains in the nerve ganglia, the collection sites of nerve cells, for life. There, the virus lies dormant waiting. For most carriers, the virus stays calm and never causes problems again. In others, however, the virus can reactivate, leading to a new outbreak of skin lesions.

Various factors can trigger an upsurge. Fever is a well-known trigger, hence the name cold sores. A weakened immune system due to illness, stress, or fatigue makes you more vulnerable to reactivation. Cold and flu can trigger the virus. Also sunlight, especially sunburn, is a known trigger for cold sores. In women, menstruation can play a role in triggering flare-ups.

The mechanism behind this reactivation has to do with your immune system. When your immune system is temporarily weakened, the virus gets the chance to travel from the nerve nodes back to the skin, where it causes injuries again. Other skin lesions in the same area can also wake the virus up. Even malnutrition or extreme exhaustion can upset the balance.

In people with a severely weakened immune system, for example due to HIV or cancer, the outbreaks can be more extensive and last longer. The lesions can also spread over larger parts of the body. This often requires more intensive treatment with stronger antiviral medications.

An upsurge typically starts with a warning phase. You experience pain and a burning, tingling sensation in the area where the lesions will appear. This can take a few hours to a day. These warning signs are valuable because treatment is currently most effective. Some people recognize this feeling and can then start treatment immediately.

Then a red, spotty and well-defined rash appears at the affected site. Within this red zone, groups of small blisters are formed, filled with clear fluid. The blisters are painful and sensitive. They can coalesce into larger blisters. The contagiousness is now highest because the moisture contains many virus particles.

After a few days, the blisters open and a superficial erosion occurs that looks like an abrasion. This can become purulent or bloody and is often the most painful stage. The area may feel tight and hurt when moving. After that, the healing process begins with crusting. The scabs fall off after a few days and temporarily leave a pink spot. The entire process usually takes one to two weeks, sometimes a little longer the first time.

Bee labial herpes lesions appear on the lips, around the mouth and sometimes on the cheeks. The lesions often occur at the edge of the lip where the skin merges into mucous membrane. Eating and drinking can be painful during a flare-up. Bee genital herpes injuries occur on the genitals, the pubic area, around the anus and on the buttocks. Urination can be painful when urine runs over the lesions.

The hands and fingers can also be affected, especially in healthcare providers who have professional contact with body fluids. This is called herpetic whitlow and can be extremely painful. Infections near the eyes require particular attention because the virus can affect the eye and threaten vision.

The first infection is usually more severe than later outbreaks. You may have a fever, feel generally ill, and develop swollen lymph nodes in the neck or groin. The lesions are more extensive and the healing process takes longer, sometimes two to three weeks. Later outbreaks are usually milder and short-term.

Herpes simplex has clear preferred sites depending on where the first infection occurred and which type of virus is involved. The virus usually stays true to the original site of infection.

Bee HSV-1 infections the area around the mouth is most affected. The lips are the classic location for cold sores, often on the outer edge. The lesions can occur on the outside of the lips but also inside the mouth, on the gums, tongue or palate. Sometimes the rash spreads to the skin around the lips, cheeks, nose, or even forehead.

Bee genital herpes the lesions concentrate on the genitals. In men, blisters often form on the penis, glans, scrotum, or inner thighs. In women, the vulva, the labia, the vagina, and the area around the vaginal opening may be affected. The area around the anus and buttocks may also be affected, especially after anal sex.

The hands and fingers can develop herpes in healthcare providers, but also in children who suck their thumbs while they have cold sores. The blisters often occur around the nails or fingertips and can be extremely painful, which can cause functional restrictions.

It face may be more widely affected in people with a weakened immune system. Injuries can spread over larger areas of the face and even the neck. In case of infections near the eye, injuries on the eyelid, the corner of the eye, or around the eye should be assessed directly by a doctor because of the risk of eye damage.

Treatment depends on the severity of the infection, frequency of outbreaks and your general health. Treatment cannot remove the virus from your body, but it can alleviate symptoms and shorten the duration of an outbreak.

Bee limited injuries who do not recur frequently and for people with a normal immune system, treatment is not always necessary. The rash heals on its own within one to two weeks. If you still want to do something, a local cream with an antiviral agent may do the trick. You apply it every two to four hours for five to ten days.

The most important thing in local treatment is timing. Start lubricating as soon as you experience the first tingling, even before the blisters are visible. The sooner you start, the more effective the treatment. Once the blisters are fully developed, local treatment has less effect.

Bee people with a weakened immune system more intensive treatment is recommended. Then, antiviral tablets are prescribed that deal with the virus from within. These tablets are taken several times a day for five days. In severe cases, the lesions may be so extensive that hospitalization is necessary for injections of antiviral medications. The duration of treatment is then seven to ten days.

Bee frequent recurrent flare-ups, for example six or more per year, preventive treatment may be useful. You then take a low dose of antiviral medication daily for a longer period of time, for example six to twelve months. This significantly reduces the number of outbreaks, sometimes by 70 to 80 percent. After stopping the preventive treatment, the flares may recur, but often to a lesser extent.

During a flare-up, it is important to take care of the injuries clean and dry to keep. Wash your hands regularly, especially after touching the lesions. For cold sores, avoid kissing or oral contact. In the case of genital herpes, it is wise not to have sex during a flare-up, even with a condom, because the virus can spread through skin contact.

Pain Management can help reduce discomfort. Common pain relievers such as acetaminophen or ibuprofen take away the pain and any fever. In genital herpes, urinating can be made less painful by first pouring some water over the lesions or sitting in a warm bath.

The use of alcohol, toothpaste, or other home remedies It has no proven effect on lesions and can irritate the skin additionally. These products dry out the skin but do not fight the virus. They can even slow down the healing process by dealing extra damage.

Antibiotics have no effect on herpes because it is a viral infection. They only work against bacteria and are therefore pointless in the case of uncomplicated herpes. They are only prescribed if a secondary bacterial infection develops, which is recognizable by increasing redness, warmth and suppuration.

The constant covering the injuries with bandages is not necessary. The injuries heal better when they can get to the air. Covering can be useful to avoid contact with others or for aesthetic reasons, but use breathable patches that you change regularly.

Vaccination There is no such thing as herpes simplex for general use. Vaccines are being researched, but they are not available yet. Preventive antiviral medication is currently the only way to reduce the number of flare-ups.

It discontinue antiviral treatment once the symptoms disappear is not wise. Even if the vesicles have already begun to heal, you should complete the full course. This is usually five days before topical treatment. Too short a treatment can cause the virus to become active again and the outbreak to return.

It squeezing out vesicles does not accelerate the healing process. In fact, it increases the risk of spreading the virus to other parts of your body and can lead to scarring. Leave the blisters intact and allow them to burst open and heal naturally.

Is herpes simplex curable?

No, herpes simplex has no cure. Once infected, the virus stays in your body for life. It settles in the nerve nodes where it remains dormant. However, treatment can alleviate symptoms, shorten flares and reduce the frequency of recurrence. However, most wearers never or rarely suffer from flare-ups.

How Contagious Is Herpes?

Herpes is most contagious during an active flare-up when blisters are present. The virus spreads through direct contact with the lesions or fluid from the blisters. You can transmit the virus even without visible symptoms, although the chance is much smaller. Condom use reduces the risk of genital herpes but does not provide complete protection because the virus can spread through skin contact.

How often do flares recur?

This varies greatly from person to person. Some people never have a flare-up after the first infection. Others experience a return several times a year. On average, the outbreaks decrease in frequency and severity as the years go by. Stress, illness, sunlight and menstruation in women can trigger flare-ups.

Can Herpes Be Dangerous?

For most people, herpes is an annoying but harmless condition. In people with a severely weakened immune system, more serious complications can occur with extensive injuries that are difficult to heal. Herpes in newborns can be dangerous and cause damage to organs. Infections near the eyes also require urgent attention because the virus can damage the eye and cause blindness. When in doubt, you always seek medical advice.

When should I see a doctor?

See your doctor the first time you see suspected herpes lesions to confirm the diagnosis. Medical advice is also important in case of serious or extensive injuries, infections near the eyes, frequent recurrent flare-ups or if you have a weakened immune system. Pregnant women with herpes should report this to their obstetrician or gynecologist to prevent transmission to the baby during delivery.

Can I prevent herpes?

Complete prevention is difficult because many people are carriers without knowing it. Avoid kissing or intimate contact with someone who has active cold sores. In genital herpes, condom use reduces the risk but does not provide complete protection. If you are a carrier yourself, avoid contact during bursts. Protect your lips from intense sun with high-SPF lip balm to prevent blemishes. Wash your hands regularly and touch the injuries as little as possible.

1. Skindr dermatologists
2. Health and Science: Herpes simplex skin infection
3. Ebpnet: Evidence-based guidelines for the general practitioner
4. RIVM: Guidelines for herpes simplex virus infections
5. NHG: Cold Sore Treatment Guidelines