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This is a viral infection of the lips and mouth which is caused by the herpes simplex virus a€“ termed HSV. Herpes doesna€™t always develop symptoms a€“ it does not always cause any outward, visible signs. Kissing or touching and any sexual contact with the area that is infected spreads oral herpes.
Many individuals have symptoms of itching, burning, and tingling proceeding the outbreak of blisters or sores. The most concentrated pain from these sores occurs at the onset and can make drinking or eating hard.
If a child with cold sores is less than 6 weeks old, the babya€™s physician needs to be notified if oral blisters or sores appear. Individuals with weakened immunity systems should also notify their primary care physician if sores or blisters appear. A physician will make a tentative diagnosis on data provided by the patient and on the physician exam. Topical anesthetic such as lidocaine (xylocaine, Nervocaine, Dilocaine, Zilactin-L) can be approved for pain relieve of oral blisters and lesions.
Oral or IV drugs exist for HSV but only for individuals with weakened immune systems, infants younger than 6 weeks or those with severe disease. Topical Denavir (penciclovir) creams can shorten attacks of recurrent HSV-if it is applied early, normally before lesions develop.
These medications may stop viral reproduction in the skin but do not eradicate HSV from the body or stop later outbreaks.
This website is for informational purposes only and Is not a substitute for medical advice, diagnosis or treatment.
Expression of concern regarding paper by Park et al, published on 25 June 2015: “Epidemiological investigation of MERS-CoV spread in a single hospital in South Korea, May to June 2015”, Euro Surveill.
It has been brought to our attention that some of the authors may not have been informed about the content of the above paper. Citation style for this article: Domeika M, Bashmakova M, Savicheva A, Kolomiec N, Sokolovskiy E, Hallen A, Unemo M, Ballard RC, Eastern European Network for Sexual and Reproductive Health (EE SRH Network). These guidelines aim to provide comprehensive information about sexually transmitted herpes simplex virus (HSV) infection and its laboratory diagnosis in eastern European countries.
During the past 20 years, genital herpes has emerged as one of the most prevalent sexually transmitted infections (STIs). The clinical differentiation of genital HSV infection from other infectious and non-infectious aetiologies of genital ulceration is difficult and laboratory confirmation of the infection should always be sought [5,9]. The guidelines presented here represent the first attempt to introduce an evidence-based approach to the laboratory diagnosis of genital herpes infections in eastern Europe.
Laboratory confirmation of the clinical diagnosis is necessary for estimating the potential infectivity during episodes of lesions, identifying persons at risk of transmitting infection subclinically, selecting women at future risk of transmitting the infection to the neonate and confirming the clinical diagnosis in those for whom antiviral therapy for HIV infection should be prescribed [8]. Methods used for the diagnosis of HSV could be divided into direct detection of virus in material from lesions and serological diagnosis. The recommended sampling sites and type of sample and methods to be used for the diagnosis of genital herpes infection are presented in Table 4.
The recommendations for sample transportation for testing using microscopy, culture and NAATs are presented in Table 5.
The recommended sites and methods to be used for the diagnosis of genital herpes infection are presented in Table 6. Microscopic examination of lesion materials using Romanovsky staining is used by a number of laboratories in Eastern Europe [17].
Viral antigen from swab specimens can be detected using either direct immunofluorescence (DIF) or enzyme immunoassay (EIA).
DIF could be classified as a rapid diagnostic test allowing type differentiation of genital herpes viruses [19,20].
The sensitivity of commercially available EIAs, when compared with that of viral isolation, is greater than or equal to 95% and with specificities ranging from 62% to 100% for symptomatic patients [22-27]. Virus isolation in cell culture has been the cornerstone of HSV diagnosis over the past two decades in laboratories of western Europe [28,29] and the United States [30]. Virus isolation in tissue culture roller tubes is slow and labour intensive, but has the advantage of demonstrating active infection within a clinical lesion and also allows virus typing and antiviral sensitivity testing [32]. Typing of HSV using cell culture can be performed directly on infected cell cultures using fluorescein isothiocyanate (FITC)- or immunoperoxidase-labelled type-specific monoclonal antibodies by DIF or by testing the cell supernatant by nucleic acid amplification tests (NAATs), with specifically designed primers. HSV detection using polymerase chain reaction (PCR) has been shown to be the test of choice in patients with genital herpes ulcers. As in western Europe and the United States, there are no comprehensively validated and approved commercial NAATs available for detection of HSV in many eastern European countries. In each DNA extraction and subsequent analysis, an internal positive control – allowing detection of amplification-inhibited samples and controlling the quality of sample preparation – and a negative control are necessary.
Certified and registered reference panels comprising coded control specimens should ideally be used for intra- and inter-laboratory quality control. Serological tests detect antibodies to HSV in blood, which are indicative of ongoing latent infection. General criteria for the validation of diagnostic tests have been published by the TDR diagnostics evaluation expert panel (TDR is a Special Programme for Research and Training in Tropical Diseases, sponsored by the United Nations Children's Fund (UNICEF), the United Nations Development Programme (UNDP), the World Bank and WHO [44].
Older, classical tests can display cross-reactivity between HSV-1 and HSV-2 and even with varicella-zoster virus. Where viral culture facilities exist, they should be maintained in order to detect the causative virus directly from skin and mucous membrane lesions. These guidelines were written on behalf of the STI Diagnostic Group of the EE SRH Network, which is supported by grants from the East Europe Committee of the Swedish Health Care Community, Swedish International Development Cooperation Agency (SIDA).
Domeika M, Savicheva A, Sokolovskiy E, Ballard R, Unemo M; Eastern European Network for Sexual and Reproductive Health (EE SRH Network).
Disclaimer: The opinions expressed by authors contributing to Eurosurveillance do not necessarily reflect the opinions of the European Centre for Disease Prevention and Control (ECDC) or the editorial team or the institutions with which the authors are affiliated. Martin, MD, MPH, ABIM Board Certified in Internal Medicine and Hospice and Palliative Medicine, Atlanta, GA. They are primarily intended for professionals testing specimens from patients at a sexual healthcare clinic but may also be helpful for community-based screening programmes. However, data on morbidity due to genital herpes infections in eastern European countries is scarce and their reliability doubtful owing to the lack of validation studies for the diagnostic tests used. In general, infections caused by HSV-1 manifest above the neck and are acquired as a result of close contact with infected persons, usually in childhood.
The recurrences arise with different frequency: from once every few years to several times per month.
Neonatal herpes (including neonatal encephalitis) and increased risk for acquiring and shedding human immunodeficiency virus (HIV) are the most serious consequences of genital herpes infection [8,9].
Accordingly, exclusive reliance on clinical diagnosis could lead both to false positive and false negative diagnosis of the condition [6,9]. It is recognised that national adjustments to these guidelines may be needed in some eastern European countries to meet local laws and health strategies and according to the availability of kits and reagents. Both virological detection and type-specific serological tests for HSV should be available in clinical settings that provide care for patients with STIs or those at risk for STIs. This method, however, as well as cytological examination using Tzanckand Papanicolaou smears, have been found to have low sensitivity and specificity, and therefore should not be relied upon for diagnosis [5,9,18].
Commercial diagnostic tests produced in eastern European countries for the detection of herpes-specific virus antigen have not been validated against any international standard test; therefore the data presented below reflect characteristics of tests produced in western countries.
It can be valuable when testing high-prevalence populations [21], but when testing asymptomatic patients, the sensitivity may drop to less than 50% when compared with culture [19,21]. The sensitivity of antigen capture EIAs may be higher than that of virus culture for typical presentations, but lower for cervical and urethral swabs [22-24,27].
Although HSV can be isolated from over 90% of vesicular or pustular lesions, the isolation rate from ulcerative lesions is only 70% and falls to 27% at the crusting stage [4].
More rapid culture of HSV can be achieved by using shell vials [33] or multiwell plates [34] and centrifuging the specimen onto cell monolayers on coverslips. The detection rates of the PCR assays were shown to be 11–71% superior to virus culture [30,31,37-39].
However, some NAATs for HSV detection have been developed and are available in eastern Europe, but have not been validated against their internationally acknowledged analogues. Both type- and non-type-specific antibodies to HSV develop during the first several weeks after infection and persist indefinitely. During the past 20 years, a number of type-specific tests have been developed, the sensitivity and specificity of which have been evaluated to be approximately 97% and 98%, respectively [46].
Where culture is not available, consideration should be given to the introduction of a NAAT for HSV. An estimate of the global prevalence and incidence of herpes simplex virus type 2 infection. Genital herpes simplex virus infections: clinical manifestations, course, and complications. Genital herpes simplex virus infections: current concepts in diagnosis, therapy, and prevention. Reactivation of genital herpes simplex virus type 2 infection in asymptomatic seropositive persons. Risk of human immunodeficiency virus infection in herpes simplex virus type 2-seropositive persons: a meta-analysis. Guidelines for laboratory diagnosis of Neisseria gonorrhoeae infections in Eastern European countries--results of an international collaboration. Quality enhancements and quality assurance of laboratory diagnosis of sexually transmitted infections in Eastern Europe.
Guidelines for the laboratory diagnosis of Chlamydia trachomatis infections in East European countries. Comparison of viral isolation, direct immunofluorescence, and indirect immunoperoxidase techniques for detection of genital herpes simplex virus infection. Antibody and interferon act synergistically to inhibit enterovirus, adenovirus, and herpes simplex virus infection. Diagnosis of herpes simplex virus by direct immunofluorescence and viral isolation from samples of external genital lesions in a high-prevalence population. Evaluation of a commercial enzyme-linked immunosorbent assay for detection of herpes simplex virus antigen. A comparison of PCR with virus isolation and direct antigen detection for diagnosis and typing of genital herpes.
Comparison of Light-Cycler PCR, enzyme immunoassay, and tissue culture for detection of herpes simplex virus. Detection and subtyping of Herpes simplex virus in clinical samples by LightCycler PCR, enzyme immunoassay and cell culture. Rapid detection, culture-amplification and typing of herpes simplex viruses by enzyme immunoassay in clinical samples. Comparison of two enzyme-linked immunosorbent assays for detection of herpes simplex virus antigen. Herpes simplex virus detection from genital lesions: a comparative study using antigen detection (HerpChek) and culture. British Co-operative Clinical Group national survey on diagnostic issues surrounding genital herpes.
Using the evidence base on genital herpes: optimising the use of diagnostic tests and information provision.
Rapid detection of herpes simplex virus in clinical specimens by centrifugation and immunoperoxidase staining. Herpes simplex virus detection by macroscopic reading after overnight incubation and immunoperoxidase staining.
Polymerase chain reaction for diagnosis of genital herpes in a genitourinary medicine clinic.
Increasing proportion of herpes simplex virus type 1 as a cause of genital herpes infection in college students. Neither ECDC nor any person acting on behalf of ECDC is responsible for the use that might be made of the information in this journal.
HSV-1 can also cause genital herpes. Herpes simplex virus 2 (HSV-2) is the most common cause of genital herpes, but it can also cause oral herpes. Depending on the biotypes of the above mentioned bacteria the severity of the disease varies. The World Health Organization (WHO) has estimated a prevalence of herpes simplex virus type 2 (HSV-2) infection of 29 million cases in men and 12.3 million cases in women in eastern Europe and central Asia in 2003 [1].
In contrast, the lesions of infections caused by HSV-2 are usually located below the waist and are usually acquired as a result of sexual contact with infected persons later in life.
The main clinical symptoms, manifestations and complications of genital herpes infections are summarized in Table 2. HSV is the most common cause of sexually acquired genital ulceration, however, the role of causative agents of other STIs, such as Treponema pallidum and Haemophilus ducreyi should not be forgotten. They are a consensus document of the Eastern European Sexual and Reproductive Health (EE SRH) Network [11,12] and comprise one element of a series of guidelines aimed at optimising, standardising and providing guidance on quality assurance of laboratory testing for reproductive tract infections [13-16].
The disadvantages of DIF are that it is time consuming, labour intensive and, compared to NAATs, has a suboptimal sensitivity. Delayed transport of samples to the laboratory and lack of refrigeration during transportation substantially affect the outcome of the testing [31].


Commonly used cells include primary human fibroblasts and cell lines such as MRC-5, Vero cells, baby hamster kidney and rabbit kidney cells [35,36]. Furthermore, compared with traditional PCR, real-time PCR allows detection and typing of HSV in a single reaction tube, is faster (takes approximately two hours to perform), allows simplified conditions of performance and lowers the risk of cross-contamination [37]. These act as indicators of sensitivity, specificity and reproducibility, which are independent of the test systems used. However, directly after infection there is a ‘window’ in which testing for antibodies will give a negative result.
However, the minimum requirements for the validation of a new or modified test have also been published [45].
Although the benefits of the serological assays (such as type-specific EISAs) include the possibility of automation and therefore simultaneous processing of a large number of samples at relatively low cost, they have a number of disadvantages that considerably limit their use in the diagnosis of genital herpes. If NAATs are not available, antigen detection, namely DIF or EIA, could be employed, if high performance of those tests can be assured. In: International statistical classification of diseases and related health problems, 10th revision, version for 2007. Part 2: culture, non-culture methods, determination of antibiotic resistance, and quality assurance.
MSSVD Special Interest Group on Genital Herpes and the British Co-operative Clinical Group. Trends in HSV Types and Genital HerpesGenital herpes can be caused by either HSV-2 or HSV-1. Since this disease is infectious it can spread by respiratory droplets or by contact with the infected person.
The international classification of diseases caused by herpes virus (anogenital) [2] is presented in Table 1. Unfortunately, the differentiation of HSV-1 from HSV-2 based on anatomical site of infection is not absolute, since genital herpes may frequently be caused by HSV-1 as a result of oro-genital sexual practices and vice versa. This episode resolves spontaneously, but recurrences may occur as a result of reactivation of the infection that has become latent but persists in the cervical ganglia. Both oral and genital herpes are manifested by acute recurrences followed by varying periods of latency, when the virus remains in a non-multiplying episomal form in the nuclei of the neurons in the ganglia.
They are primarily intended for professionals testing specimens from patients at sexual healthcare clinics but may also be helpful for community-based screening programmes.
The characteristic cytopathic effect of HSV in tissue culture generally appears within 24–72 hours, but may take up to five days.
Use of NAATs for diagnosis of HSV also allows less strict sample transportation conditions, compared with those required for diagnosis by culture.
Serodiagnosis is useful for documenting newly acquired infections and for diagnosis in persons who present without lesions or with atypical lesions.
Similarly, if an individual has not been exposed to HSV-1 in childhood, he or she may develop severe genital lesions following sexual exposure to HSV-2 later in life. Classically, each episode or recurrence is characterised by a patch of redness at the site of the recurrence, followed by a localised papular then vesicular rash. Testing for HSV type-specific antibodies can also be used to diagnose HSV-2 infection in asymptomatic individuals [31,40], and other persons with undiagnosed HSV-2 infection. Unfortunately, serological tests alone cannot inform the aetiology of a presenting genital lesion with any degree of certainty. Type-specific serology should be used for detecting asymptomatic individuals, testing pregnant women at risk of acquiring HSV infection close to delivery, men who have sex with men, and people who are HIV positive. Except where otherwise stated, all manuscripts published after 1 January 2016 will be published under the Creative Commons Attribution (CC BY) licence. In recent years, HSV-1 has become a significant cause in developed countries, including the United States. Symptoms of respiratory diphtheria include fever, difficulty in breathing and swallowing and further spread of the disease can cause heart and neurological problems such as paralysis. However, because HSV-2 is almost always associated with genital disease, whereas HSV-1 is associated with both oro-pharyngeal and genital disease, there is often considerable stigma associated with HSV-2 infection. As with HSV-1 infections, primary HSV-2 infections resolve spontaneously but recurrences are likely to occur as a result of reactivation of latent infection that has been established in the sacral ganglia. The vesicles contain a clear fluid that contains many thousands of infectious viral particles.
Non-infectious causes of genital ulceration, such as inflammatory bowel disease (Crohn disease), mucosal ulcerations associated with Behcet syndrome or fixed drug eruption, may also be confused with genital herpes [9].
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After the diagnosis of the infected patient, proper treatment should be taken including diphtheria antitoxin which reduces the progression of the disease and later antibiotics like penicillin and erythromycin should be applied to eradicate it completely. Acquisition of HSV-1 usually results in lesions of the oro-pharynx and around the mouth and on the lips and chin. These vesicles burst, forming shallow ulcers or erosions that eventually crust and heal spontaneously without leaving scars.
The types of persons who are recommended to be tested for genital herpes infections are listed in Table 3. Up to 50% of first-episode cases of genital herpes are caused by HSV-1 [41], but recurrences and subclinical viral shedding are much less frequent for genital HSV-1 infection than genital HSV-2 infection [42,43].
It is recommended that any non-validated diagnostic tests should be validated against a recommended, approved gold standard test.
Vaccination and immunization of infants at the age of 2,4 ,6 months is the finest way to prevent this disease.
These episodes usually last less than 10 days, but may be prolonged as a result of secondary bacterial infection or immunosuppression. The risk of infection is highest during outbreak periods when there are visible sores and lesions.
Sexual transmission of HSV most often produces infection of the genital mucosa, genital skin (penile and labial) and the perigenital region. In most cases of genital herpes (80–90%) the disease progresses subclinically, but may become symptomatic at any time [5,6].
Virus from genital secretions can also infect other areas, including the eyes and oro-pharynx and rectal mucosa [3,4].
The incubation period of both HSV-1 and HSV-2 is usually from two to 10 days (up to four weeks).
SymptomsWhen genital herpes symptoms do appear, they are usually worse during the first outbreak than during recurring attacks. Herpes, Pregnancy, and Newborn InfantsHerpes can pose serious risks for a pregnant woman and her baby. The risk is greatest for mothers with a first-time infection, because the virus can be transmitted to the infant during childbirth.
Guidelines from the American Academy of Pediatrics recommend using specific diagnostic tests for women in labor to determine the risk of transmission. Babies born to mothers infected with genital herpes are often treated with the antiviral drug acyclovir, which can help suppress the virus. Herpes viruses include human herpes virus 8 (the cause of Kaposi sarcoma) and varicella-zoster virus (also known as herpes zoster, the virus responsible for shingles and chickenpox).
The word "herpes" comes from the Greek word "herpein," meaning "to creep." This refers to the unique characteristic pattern of all herpes viruses to creep along local nerve pathways to the nerve clusters at the end, where they remain in an inactive (dormant) state for variable periods of time. The usual cause of oral herpes (herpes labialis), which are commonly called cold sores or fever blisters. HSV-1 can also cause genital herpes, which is a sexually transmitted disease (STD). Herpes simplex virus 2 (HSV-2). Until recently, the general rule was to assume that HSV-1 caused oral herpes and HSV-2 caused genital herpes. It is now clear, however, that either type of herpes virus can be found in the genital or oral areas (or other sites).
In fact, HSV-1 is now responsible for more than half of all new cases of genital herpes in developed countries. The Disease ProcessHerpes is transmitted through close skin-to-skin contact. To infect people, the herpes simplex viruses (both HSV-1 and HSV-2) must get into the body through tiny injuries in the skin or through a mucous membrane, such as inside the mouth or on the genital or anal areas.
The risk for infection is highest with direct contact of blisters or sores during an outbreak. But the infection can also develop from contact with an infected partner who does not have visible sores or other symptoms. Once the virus has contact with the mucous membranes or skin wounds, it enters the nuclei of skin tissue cells and begins to replicate. The virus is then transported from the nerve endings of the skin to clusters of nerve cells (ganglia) where it remains inactive (latent) for some period of time. However, at some point, the virus wakes up and travels along nerve pathways to the surface the skin where it begins to multiply again. During this time, the virus can infect other people if it is passed along in body fluids or secretions.
Viral shedding may be accompanied by noticeable symptoms (outbreak) but it can also occur without causing symptoms (asymptomatic shedding).
In either case, a person is infectious during periods of viral shedding. Symptoms may appear as multiple small red bumps or patches that develop blisters.
Certain triggers can wake up the virus from its dormant state and cause it to become active again.
In general, recurrent episodes of herpes cause less severe symptoms than the primary outbreak.
HSV-1 is the most prevalent form of herpes simplex virus, and infection is most likely to occur during preschool years. In addition, because HSV-1 can be passed in saliva, people should also avoid sharing toothbrushes or eating utensils. Transmission of Genital Herpes Genital herpes is transmitted through sexual activity.
People can get HSV-2 through genital contact or HSV-1 through mouth-to-genital contact with an infected partner. People with active symptoms of genital herpes are at very high risk for transmitting the infection. Unfortunately, most cases of genital herpes infections occur when the virus is shedding but producing no symptoms. Most people either have no symptoms or do not recognize them when they appear. In the past, genital herpes was mostly caused by HSV-2, but HSV-1 genital infection is increasing. There is also evidence that children today are less likely to get cold sores and become exposed to HSV-1 during childhood. Centers for Disease Control and Prevention (CDC), about 1 in 6 Americans ages 14 to 49 years have genital herpes.
While HSV-2 remains the main cause of genital herpes, HSV-1 has significantly increased as a cause, most likely because of oral-genital sex. African-American women are at particularly high risk. People with compromised immune systems, such as those who have HIV, are at very high risk for genital herpes. Drugs that suppress the immune system, and organ transplantation, can also weaken the immune system and increase the risk for contracting genital herpes. It is almost impossible to defend against the transmission of oral herpes, because it can be transmitted by very casual contact, including kissing. Still, you can help reduce the risk of transmitting oral herpes by not sharing objects that touch the mouth, such as eating and drinking utensils, toothbrushes, and towels. It is best to refrain from any type of sex (vaginal, anal, or oral) during periods of active outbreak. However, herpes can also be transmitted when symptoms are not present (asymptomatic shedding). Although condoms may not provide 100% protection, they are proven to significantly reduce the risk of sexual disease transmission, including herpes. Natural condoms made from animal skin do NOT protect against HSV infection because herpes viruses can pass through them. Use a water-based lubricant. Lubricants can help prevent friction during sex, which can irritate the skin and increase the risk for outbreaks.
Only water-based lubricants (K-Y Jelly, Astroglide, AquaLube, and glycerin) should be used. However, it is best not to use condoms pre-lubricated with spermicides. Do not use spermicides for protection against herpes. Nonoxynol-9 can cause irritation around the genital areas, which makes it easier for herpes and other STDs to be transmitted. Use a dental dam or condom for oral sex. If you have any symptoms of oral herpes, it is best not to perform oral sex on a partner until any visible sores or blisters have healed. Limit the number of sexual partners. The more sexual partners you have, the greater your chances of becoming infected or infecting others. It is very unlikely to transmit or contract genital herpes from a toilet seat or bath towel. Studies suggest that male circumcision may help reduce the risk of HSV-2, as well as human papillomavirus (HPV) and HIV infections. However, herpes can cause significant and widespread complications in people who don't have a fully functioning immune system.
The CDC recommends that all people diagnosed with herpes simplex virus 2 (HSV-2) get tested for HIV. Most people with HIV are co-infected with HSV-2 and are particularly vulnerable to its complications. HSV-2 infection increases HIV levels in the genital tract, which makes it easier for the HIV virus to be spread to sexual partners. Herpes and PregnancyPregnant women who have genital herpes due to either HSV-2 or HSV-1 have an increased risk for miscarriage, premature labor, inhibited fetal growth, or transmission of the herpes infection to the infant in the uterus or at the time of delivery. Herpes in newborn babies (herpes neonatalis) can be a very serious condition. Fortunately, neonatal herpes is rare. Although about 25 to 30% of pregnant women have genital herpes, less than 0.1% of babies are born with neonatal herpes.


The baby is at greatest risk during a vaginal delivery, especially if the mother has an asymptomatic infection that was first introduced late in the pregnancy. The risk for transmission also increases if infants with infected mothers are born prematurely, there is invasive monitoring, or instruments are used during vaginal delivery. Transmission can occur if the amniotic membrane of an infected woman ruptures prematurely, or as the infant passes through an infected birth canal.
This risk is increased if the woman is having or has recently had an active herpes outbreak in the genital area. Very rarely, the virus is transmitted across the placenta, a form of the infection known as congenital herpes. Also rarely, newborns may contract herpes during the first weeks of life from being kissed by someone with a herpes cold sore. Infants may get congenital herpes from a mother with an active herpes infection at the time of birth. Aggressive treatment with antiviral medication is required. Most infected pregnant women do not have a history of symptoms, so herpes infection is often not suspected or detected at the time of delivery. Fortunately, if a woman does have genital lesions, rapid diagnostic blood tests can quickly determine her chances of transmitting the virus to her baby during delivery. Some women with new or recurrent herpes may also be prescribed antiviral medication during pregnancy. A woman with herpes can usually safely breastfeed her baby, as long as she does not have a lesion on her breast or nipple. Neonatal herpes can spread to the brain and central nervous system, causing encephalitis and meningitis. Herpes can also spread to internal organs, such as the liver and lungs. Infants infected with herpes are treated with acyclovir, an antiviral drug. They usually receive several weeks of intravenous acyclovir treatment, often followed by several months of oral acyclovir.
It is important to treat babies quickly, before the infection spreads to the brain and other organs. Fortunately, rapid diagnostic tests and treatment with acyclovir have significantly improved survival rates and reduced complication rates. Nearly all who recover have some impairment, ranging from very mild neurological changes to paralysis.
Like encephalitis, meningitis symptoms include headache, fever, stiff neck, vomiting, and sensitivity to light.
Fortunately, herpes meningitis usually resolves after about a week without complications, although symptoms can recur. Herpes Eye ComplicationsOcular herpes is a recurrent infection that affects the eyes.
Ocular herpes is usually a simple infection that clears up in a few days, but in its more serious forms, and in severe cases, it can cause blindness. It only affects the upper layer (epithelium) of the cornea and heals with scarring. Stromal Keratitis. Iridocyclitis is another serious complication of ocular herpes, in which the iris and the area around it become inflamed. Herpes Skin ComplicationsEczema Herpeticum A rare form of herpes infection called eczema herpeticum, also known as Kaposi varicelliform eruption, can affect people with skin disorders and those with a weakened immune system. Untreated, this condition can be extremely serious and possibly fatal. Gingivostomatiti Oral herpes can cause multiple painful ulcers on the gums and mucus membranes of the mouth, a condition called gingivostomatitis.
Children with gingivostomatitis commonly develop herpetic whitlow (herpes of the fingers). Herpetic Whitlow A herpetic whitlow is an infection of the herpes virus involving the finger, often around the fingernail.
In children, this is often caused by thumb sucking or finger sucking while they have a cold sore.
It can also occur in adult health care workers, such as dentists, because of increased exposure to the herpes virus. The use of latex or polyurethane gloves prevents herpes whitlow in health care workers. SymptomsHerpes symptoms vary depending on whether the outbreak is initial or recurrent.
The primary outbreak is usually worse than recurrent outbreaks, with more severe and prolonged symptoms.
In fact, studies indicate that 10 to 25% of people infected with HSV-2 are unaware that they have genital herpes. The first signs are a tingling sensation in the affected areas (genitalia, buttocks, and thighs) and groups of small red bumps that develop into blisters. The sores may sometimes itch, but itching decreases as they heal. About 40% of men and 70% of women develop other symptoms during initial outbreaks of genital herpes, such as flu-like discomfort, headache, muscle aches, and fever. Some women may have difficulty urinating and may, occasionally, require a urinary catheter. Women may also experience vaginal discharge. Recurrent Genital Herpes Outbreak In general, recurrences are much milder than the initial outbreak.
The virus sheds for a much shorter period of time (about 3 days) compared to an initial outbreak of 3 weeks. Women may have only minor itching, and the symptoms may be even milder in men. On average, people have about four recurrences during the first year, although this varies widely. There are some differences in frequency of recurrence depending on whether HSV-2 or HSV-1 caused genital herpes.
HSV-2 genital infection is more likely to cause recurrences than HSV-1. Symptoms of Oral HerpesOral herpes (herpes labialis) is most often caused by HSV-1, but it can also be caused by HSV-2. It usually affects the lips and, in some primary attacks, the mucus membranes in the mouth.
A herpes infection may occur on the cheeks or in the nose, but facial herpes is very uncommon. Primary Oral Herpes Infection If the primary (initial) oral infection causes symptoms, they can be very painful, particularly in children. The sores last 10 to 14 days and can be very uncomfortable. Blisters that may be preceded or accompanied by sore throat, fever, swollen glands, and painful swallowing.
Recurrent Oral Herpes Infection A recurrent oral herpes infection is much milder than the primary outbreak.
It usually manifests as a single sore, commonly called a cold sore or fever blister (because it may arise during a bout of cold or flu).
The sore usually shows up on the outer edge of the lips and rarely affects the gums or throat. Recurrences of genital herpes are more likely with HSV-2 infection than with HSV-1 infection. The outbreak of infection is often preceded by a prodrome, an early group of symptoms that may include itchy skin, pain, or an abnormal tingling sensation at the site of infection. Recurrent outbreaks feature most of the same symptoms at the same sites as the primary attack, but they tend to be milder and briefer. Occasionally, the symptoms may not resemble those of the primary episode, but appear as fissures and scrapes in the skin or as general inflammation around the affected area. They include sunlight, wind, fever, physical injury, surgery, menstruation, suppression of the immune system, and emotional stress. Oral herpes can be triggered within about 3 days of intense dental work, particularly root canal or tooth extraction. Timing of Recurrences Recurrent outbreaks may occur at intervals of days, weeks, or years.
For most people, outbreaks recur with more frequency during the first year after an initial attack. The good news is that in most healthy people, recurring infections tend to become progressively less frequent, and less severe, over time.
However, other conditions can resemble herpes, and doctors cannot base a herpes diagnosis on visual inspection alone. These tests include: Virologic tests (viral culture of the lesion) Serologic tests (blood tests that detect antibodies) The CDC recommends that both virologic and serologic tests be used for diagnosing genital herpes. People diagnosed with genital herpes should also be tested for other sexually transmitted diseases. At this time, experts do not recommend screening for HSV-1 or HSV-2 in the general population. Genital herpes can be caused by either HSV-1 or HSV-2. It is important to determine which virus is involved, as the type of herpes infection influences prognosis and treatment recommendations.
Recurrences of genital herpes, and viral shedding without overt symptoms, are much less frequent with HSV-1 infection than with HSV-2. False-negative (testing negative when herpes infection is actually present) or false-positive (testing positive when herpes infection is not actually present) results can occur. Your health care provider may recommend that you have a test repeated. Virologic TestsViral culture tests are made by taking a fluid sample, or culture, from the lesions as early as possible, ideally within the first 48 hours of the outbreak. PCR tests are much faster and more accurate than viral cultures, and the CDC recommends PCR for detecting herpes in spinal fluid when diagnosing herpes encephalitis. PCR can make many copies of the virus' DNA, so that even small amounts of DNA in the sample can be detected.
However, many labs now use PCR for herpes testing because it is highly accurate. An older type of virologic testing, the Tzanck smear test, uses scrapings from herpes lesions.
The scrapings are stained and examined under a microscope for the presence of giant cells with many nuclei or distinctive particles that carry the virus (called inclusion bodies). The Tzanck test is not reliable for providing a conclusive diagnosis of herpes infection and is not recommended by the CDC. Serologic TestsSerologic (blood) tests can identify antibodies that are specific for either HSV-1 or HSV-2. When the herpes virus infects you, your body's immune system produces specific antibodies to fight off the infection.
If a blood test detects antibodies to herpes, it is evidence that you have been infected with the virus, even if the virus is in a non-active (dormant) state. The presence of antibodies to herpes also indicates that you are a carrier of the virus and might transmit it to others. Serologic tests can be especially useful for people who do not have active symptoms, but who have other risk factors for herpes (such as other STDs, multiple sex partners, or a monogamous partner who has genital herpes). Although glycoprotein (gG) type-specific tests have been available for many years, many of the older nontype-specific tests that cannot distinguish HSV-1 from HSV-2 are still on the market.
Canker sores frequently crop up singly or in groups on the inside of the mouth, or on or underneath the tongue. The drugs are used initially to treat a first attack of herpes, and then afterward to either treat recurrent outbreaks (episodic therapy) or reduce frequency of recurrences (suppressive therapy).
Drugs can, however, reduce the severity of symptoms, improve healing times, and prevent recurrences.
If people experience very severe disease or complications, they need to be hospitalized and receive an antiviral drug intravenously.
Your health care provider will prescribe one of the three antiviral medications, which you will take for 7 to 10 days.
You should begin the medication as soon as you notice any signs or symptoms of herpes, preferably during the prodrome stage that precedes the outbreak of lesions.
If taken during prodrome, episodic therapy may help prevent an outbreak from occurring or reduce its severity.
Valacyclovir is taken once a day. Suppressive treatment can reduce the frequency of outbreak recurrences by 70 to 80%.
It is generally recommended for people who have frequent recurrences (6 or more outbreaks per year). Because herpes recurrences often diminish over time, you should discuss annually with your health care provider whether you should stay with drug therapy or discontinue it. While taking any suppressive therapy for genital herpes, it is still important to regularly use latex condoms and to avoid any sexual activity during recurrences. A new form of acyclovir (Sitavig) is administered orally as an adhesive tablet; it is applied to the gum region of the mouth, where it dissolves during the course of the day.
In addition, acyclovir is available in topical form, as is the related drug penciclovir (Denavir). Topical TreatmentsThese ointments or creams can help shorten healing time and duration of symptoms. However, none are truly effective at eliminating outbreaks. Penciclovir (Denavir) heals HSV-1 sores on average about half a day faster than without treatment, stops viral shedding, and reduces the duration of pain. Ideally, you should apply the cream within the first hour of symptoms, although the medication can still help if applied later.
Apply the cream 5 times a day, beginning at the first sign of tingling or pain. Over-the-counter topical ointments may provide modest relief. They include Anbesol gel, Blistex lip ointment, Campho-phenique, Herpecin-L, Viractin, and Zilactin.
Some contain a topical anesthetic such as benzocaine, tetracaine, or phenol. Lip balm that contains sunblock, or sunscreen applied around the lips may help prevent sun-triggered outbreaks.
Herbs and SupplementsGenerally, manufacturers of herbal remedies and dietary supplements do not need FDA approval to sell their products. Just like a drug, herbs and supplements can affect the body's chemistry, and therefore have the potential to produce side effects that may be harmful.
There have been several reported cases of serious and even lethal side effects from herbal products.
Always check with your provider before using any herbal remedies or dietary supplements. Many herbal and dietary supplement products claim to help fight herpes infection by boosting the immune system. There has been little research on these products, and little evidence to show that they really work. Epidemiology, clinical presentation, and antibody response to primary infection with herpes simplex virus type 1 and type 2 in young women. Seroprevalence of herpes simplex virus type 2 among persons aged 14 - 49 years -- United States, 2005-2008.
Guidance on management of asymptomatic neonates born to women with active genital herpes lesions. Genital shedding of herpes simplex virus among symptomatic and asymptomatic persons with HSV-2 infection.



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