Herpes is a viral infection that causes no symptoms in most people, while in some it causes recurrent painful blisters on the lips, skin or mucous membranes. The virus remains in the body permanently, so episodes can recur for years.
What herpes and herpetic infection are
Herpes simplex is a viral disease with a characteristic eruption of grouped blisters on the skin and mucous membranes. Herpes is not a fungus and not a cold in the sense of an acute respiratory viral infection: it is caused by two neurotropic viruses, HSV-1 and HSV-2, which affect nerve cells.
It is transmitted through direct contact with damaged tissues, saliva or biological fluids of a carrier — including through skin that appears normal. The infection is treatable but not curable. According to WHO estimates, 3.8 billion people under 50 are infected with HSV-1 — 64% of the world's population; HSV-2 — 520 million people aged 15–49, or 13%.
Types of herpes: types of herpesviruses and their manifestations
HSV-1 usually affects the mouth, neck, face, eyes and CNS; the most common variant is the labial, lip form, commonly called a "cold sore". HSV-2 is characterized by anogenital lesions. Both types can cause lesions at both locations: after orogenital contact, HSV-1 causes genital herpes.
Other forms have also been described: herpetic whitlow, ocular herpes (keratitis), herpetic encephalitis and meningitis, neonatal herpes. In 95% of cases of recurrent genital herpes, HSV-2 is detected.
Herpes type 6 and other types of the family
Herpes type 6 belongs to the herpesvirus family, but the data in this article relate only to HSV-1 and HSV-2.
How herpes manifests: rash, eruptions and other signs
Most infected people have no symptoms or mild ones: the person is unaware of the virus and transmits it to others. If symptoms appear, they often begin with tingling, itching or burning at the site of future eruptions.
Herpes looks like grouped blisters or open erosions: in the oral form — around the lips and in the mouth, in the genital form — around the genitals and anus. The blisters are painful, rupture, ooze and become covered with a crust. The first episode is often accompanied by fever, body aches, headache and enlarged lymph nodes; recurrences are shorter and milder.
According to WHO estimates, in 2020 at least one symptomatic episode of genital herpes was experienced by 205 million people aged 15–49 — 5.3%; in 92% of them the symptoms are associated with HSV-2, which causes recurrences more often than genital HSV-1.
Why the virus stays in the body and how the chronic form proceeds
After infection, the virus enters nerve endings in the skin and travels along them to a sensory neuron in a ganglion, where it enters a latent stage and integrates into the genome of the host cell. The immune system does not eliminate it: herpes is a lifelong infection with alternating inactive and active phases.
Reactivation is triggered by illness or fever, sun, menstruation, trauma, emotional stress, surgery. Chronic herpes consists of recurrent episodes: over time they become less frequent, and after several years they may be asymptomatic, although the person remains contagious.
In immunodeficiencies — HIV, tumors, after transplantation — the course is more severe. HSV-2 increases the risk of HIV acquisition approximately threefold; rare complications include meningoencephalitis and disseminated infection; neonatal herpes is possible in newborns.
Diagnosis and when to see a doctor
Oral herpes is recognized by its external manifestations — blisters and erosions. Without eruptions, the diagnosis is confirmed by laboratory testing. The doctor may prescribe:
- viral culture (culture) of discharge from the affected area;
- a blood test for antibodies to herpes simplex virus;
- an HSV test.
Reasons to see a doctor are pregnancy (there is a risk of transmitting the virus to the child), weakened immunity, ocular forms of herpes. You can also consult a doctor if blisters or ulcers appear.
Herpes itself is not a reason to call an ambulance. 103/112 — for a life-threatening condition, including if the condition of a newborn or a person with weakened immunity is rapidly deteriorating.
The material is for reference and does not replace a doctor's consultation: the diagnosis and scope of examinations are determined by the doctor.
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This content is for reference and does not replace a doctor's consultation. Medical disclaimer