Herpes simplex viruses - more commonly known as herpes - are categorized into two types: herpes type 1 (HSV-1, or oral herpes) and herpes type 2 (HSV-2, or genital herpes). Most commonly, herpes type 1 causes sores around the mouth and lips (sometimes called fever blisters or cold sores).
HSV-1 can cause genital herpes, but most cases of genital herpes are caused by herpes type 2. In HSV-2, the infected person may have sores around the genitals or rectum. Although HSV-2 sores may occur in other locations, these sores usually are found below the waist.
Herpes viruses cycle between periods of active disease - presenting as blisters containing infectious virus particles - that last 2–21 days, followed by a remission period. Genital herpes, however, is often asymptomatic, though viral shedding may still occur. After initial infection, the viruses are transported along sensory nerves to the sensory nerve cell bodies, where they become latent and reside life-long.
Causes of recurrence are uncertain, though some potential triggers have been identified, including immunosuppressant drugs. The previously latent virus then multiplies new virus particles in the nerve cell and these are transported along the axon of each neuron to the nerve terminals in the skin, where they are released. Over time, episodes of active disease reduce in frequency and severity.
Herpes symptoms can vary. Many infected individuals have few, if any, noticeable symptoms. In people who do have symptoms, the symptoms start 2 to 20 days after the person was exposed to someone with HSV infection. Symptoms may last for several weeks.
The first episode of herpes is usually worse than outbreaks that come later. The predominant symptom of herpes is the outbreak of painful, itching blisters filled with fluid on and around the external sexual organs or, for oral herpes, on or very near the lip. Females may have a vaginal discharge.
Symptoms vaguely similar to those of flu may accompany these outbreaks, including fever, headache, muscle aches and fatigue. There may be painful urination, and swollen and tender lymph glands in the groin.
Usually the blisters will disappear without treatment in two to 10 days, but the virus will remain in the body, lying dormant among clusters of nerve cells until another outbreak is triggered.
Many patients are able to anticipate an outbreak when they notice a warning sign (a tingling sensation, called a prodrome) of the approaching illness. It is when they feel signs that an outbreak is about to start that they are particularly contagious, even though the skin still appears normal.
Sores typically come back near the site of the first infection. Usually, as the outbreaks recur, there are fewer sores and they heal faster and are less painful.
Herpes simplex type 1, which is transmitted through oral secretions or sores on the skin, can be spread through kissing or sharing objects such as toothbrushes or eating utensils. In general, a person can only get herpes type 2 infection during sexual contact with someone who has a genital HSV-2 infection. It is important to know that both HSV-1 and HSV-2 can be spread even if sores are not present.
Pregnant women with genital herpes should talk to their doctor as genital herpes can be passed on to the baby during childbirth.
For many people with the herpes virus, attacks (or outbreaks) of herpes can be brought on by the following conditions:
- Physical stress.
- Poor emotional coping style.
- Persistent stressors for greater than 1 week.
- Exposure to ultraviolet light.
- Nerve damage.
- Tissue damage.
- A suppressed immune system.
- Other infections.
Unlike other sexually transmitted diseases, herpes cannot be cured because medication that will attack the virus while it lies dormant in the nerve cells will also damage the nerve cells.
However, there is treatment available for acute outbreaks that involves the use of anti-viral drugs. To be effective, therapy must be started immediately after the first sores appear. Every sexual partner of the infected person needs to be examined, and if necessary, treated.
Long-term drug therapy ('suppressive treatment') may be helpful for individuals who suffer frequent recurrent outbreaks. Suppressive treatment will reduce outbreaks by 85 percent and reduces viral shedding by more than 90 percent.
During an outbreak of genital herpes, a number of measures can be taken to make the patient more comfortable:
- Wear loose clothing.
- Avoid excessive heat or sunlight.
- Keep the sore area clean and dry.
- Do not use perfumed soaps, sprays, feminine deodorants, or douches.
- Avoid touching sores.
- Wash hands if you do touch the sores.
Topical antibiotic ointments also may be applied to prevent secondary bacterial infections.