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Herpes, also called herpes simplex, is any of the diseases caused by herpes simplex virus (HSV).
There are two subtypes of the virus that can each be responsible for either cold sores or genital herpes; although human herpesvirus 1 (herpes simplex virus-type 1 or HSV-1) is the overwhelmingly common cause of cold sores, and HSV-2 is responsible for a slight majority of genital herpes cases.
Herpes simplex virus (HSV) is a member of the Herpesviridae family of viruses, a family of DNA viruses. UI: 14624112) HSV 1 and 2 correspond to HHV 1 and 2, and both are very prevalent in the human population, with as many as 30-70% of all people tested testing positive for antibodies at some point in their lifetime. HSV's genome is a double stranded linear DNA, with about 50% sequence homology between HSV-1 and HSV-2. Active replication of the virus in these cells results in the lesions of typical vesicles and shedding of the virus.
The virus is destroyed, except for virus which, through retrograde axonal transport, is sequestered in the ganglion of sensory neurons. All symptoms of infection disappear at that point and the infected person enters a period of "latent infection". Even during latent infections, when there are no symptoms or signs of illness, the virus is maintained in a repressed state in nerve cells. Herpes Simplex viruses generally cause mucocutaneous infection, that is, cells of the skin and the mucous membranes are infected. The initial infection with the virus is called the primary infection, and can be accompanied by systemic systems such as fever and muscle aches.
In general, lesions from HSV 1 are more commonly seen on the face, but also accounts for a large minority of genital infections.
Transmission can occur when sores are visible, as well as when there are no visible lesions. The diagnosis of a herpes simplex infection is ordinarily a clinical one, that is- it is made by a trained health care provider based on the patient's history and physical findings, rather than on laboratory tests.
Viral culture is an expensive laboratory test that must be carried out for 10 days in order to assume negative results.


These cell culture dishes are pictured from a laboratory performing culture of herpes simplex virus. Diagnostic tests on the immune response to the virus can determine not only the subtype of herpes simplex infection but whether the outbreak is primary or recurrent. HSV-1 and HSV-2 each have respective variations in virally produced glycoprotein G, and immunoglobulin G (IgG) produced by an infected person differs accordingly. Cold sores are most commonly caused by Human herpesvirus 1 and are ubiquitous in distribution in human populations. In population studies in the United States, both serotypes of the herpes virus are prevalent in symptomatic genital herpes infections. Although both types of herpes simplex virus can account for genital herpes, and cause a very similar appearing rash, "HSV-1 has a much lower recurrence rate. The Center for Disease Control (CDC) in the United States recommends that genital lesions be cultured in order to determine the type of HSV infection, since the severity and clinical course of the disease can be better predicted with this information. There is a relationship between genital herpes and the risk of catching (and spreading) additional venereal diseases, since the ulcers caused by herpes are more vulnerable to invasion by pathogens than intact skin or mucosa. Although herpes infection is aggravating in healthy adults, it is a lethal disease in very young babies.
However, newborns have a limited immune system for the first 3 weeks of life, and even a kiss by a well-meaning friend or relative who bears a virus-shedding cold sore on the lips can cause infection in the newborn (albeit rarely).
All the immunosuppressive drugs used to allow transplant patients to keep their transplanted organs healthy have an unfortunate side effect of reactivating latent herpes simplex infections.
Herpes has been recognized for centuries, "cold sores" (herpes febrilis) were described by the Roman physician Herodotus in the year 100 CE. The phenomenon of latent infection permits long-term persistence of the virus within the host and potential future transmissibility to others."[1] Other species of Herpes virus are also human pathogens, notably Herpes Zoster, the cause of both chicken pox (in acute infection) and shingles (chronic infection with reactivation). Many of the polypeptides produced by each type of virus are identical, and are coded by the homologous regions of DNA, but some of the expressed proteins are different and some of these distinct proteins are antigenic - that is, they give rise to an antibody response in infected hosts. During this time, special tests done in research can demonstrate single strand viral RNA in the infected nerves. In addition to the common mucocutaneous infection, HSV 1 and 2 can also cause keratitis (inflammation in the eye), encephalitis (brain infection), and severe neonatal disease if acquired during pregnancy.


However, a clinical diagnosis does not distinguish between HSV-1 and HSV-2 infection, except by probability.
Because HSV 2 is spread more commonly by sexual contact, it is easier to prevent than HSV 1. Serological testing for such antibodies is the usual means to determine the type of HSV (1 or 2) infection present in patients. Although genital lesions are a form of STD, other lesions can be contracted without sexual contact. Confirming a diagnosis and clarifying the actual virus type involve requires laboratory testing. If the individual has clear signs of a genital herpes infection, but the tests for IGG are negative, the most likely explanation is that this is a primary outbreak, and the patient has not yet begun production of that type of antibody. More than 50 million people are infected in that country, making this the most common STD in the USA. Regardless of how they were contracted, however, an infected person can spread virus to another person with mucosa to mucosa or skin to mucosa contact.
The most definitive proof of infection, the "gold standard" of diagnostic tests, is the growth of the virus in artificial culture from a specimen taken from the patient's lesions.
Confirmation of that presumed diagnosis of a primary herpes infection can be made on follow-up testing, with demonstration of anti-HSV IgG levels. Although primary ulcers have a high rate of viral shed, recurrent lesions shed virus at a much lower rate, and so culture of recurrent lesions has a high false negative rate. UI: 9674772), and reactivation of the virus from sacral nerves is the basis for recurrent genital herpes. Accordingly, in patients with typical presentations of recurrent outbreaks, failure to culture the virus in no way overturns the diagnosis.



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