Definition

Herpes simplex is a common viral infection characterized by the formation of localized blisters in specific areas of the body. While this condition can affect individuals from all backgrounds, many may not display noticeable symptoms. According to the World Health Organization (WHO), projections from 2016 suggested that approximately 3.7 billion people under the age of 50 (about 67% of the population) were infected with HSV-1. Additionally, 491 million individuals aged 15 to 49 (constituting 13% of the population) were found to be infected with HSV-2. Other research indicates that nearly 90% of individuals aged 50 possess antibodies to HSV-1.

Causes

Herpes simplex is caused by the herpes simplex virus (HSV), a virus with a double-stranded DNA structure. There are two primary types: HSV-1 and HSV-2.

• HSV type 1 infection, often known as oral herpes, typically results in infections on the face and the inside and surrounding mouth. This virus is mostly transmitted by direct contact with viruses found in wounds, saliva, mucous membranes, or seemingly healthy skin surfaces. Nevertheless, the likelihood of transmission is greatest when there is an open injury. While less prevalent, HSV-1 can also induce genital herpes when the mouth or skin comes into contact with the genitals.
• HSV type 2 infection typically results in anogenital herpes, which refers to infections of the genitals and anus. This type of herpes is transmitted by sexual contact and is classified as a sexually transmitted infection (STI). HSV-2 is primarily spread during sexual intercourse by coming into contact with the surfaces, skin, wounds, or bodily fluids of the vagina or anal of infected individuals. Although asymptomatic, this virus is frequently contagious and can be transmitted through seemingly normal-looking skin.

Nevertheless, both categories can potentially infect any region of the skin or mucous membranes without being limited to the mouth and genitals. It is crucial to keep in mind that both types of HSV can be spread via the mouth or genitals. HSV-1 and HSV-2 have the ability to cause both oral and genital herpes. People with HSV-1 often develop genital herpes, as oral-genital contact could easily spread this virus. Meanwhile, HSV-2 is less likely to induce symptoms in the mouth.

While uncommon, both HSV-1 and HSV-2 can be transmitted vertically from a mother to her baby during childbirth, resulting in the development of neonatal herpes. The global incidence of neonatal herpes is 10 per 100,000 births. The risk of neonatal herpes is greatest when a new mother acquires herpes for the first time during the later stages of pregnancy.

Risk factor

Herpes simplex can affect individuals of all age groups. If you come into contact with HSV, it is quite probable that you may contract the infection. If you possess the following characteristics, your susceptibility to infection is higher:

• Engage in a sexual relationship with a partner who has HSV
• Have a compromised immune system
• Participate in sexual intercourse without using a condom, diaphragm, or other contraceptive devices
• Children, HSV-1 infection or oral herpes is typically contracted in childhood 
• HSV-2 infects nearly twice as many women as men due to the more effective sexual transmission of HSV-2 from men to women

Symptoms

An individual who has contracted HSV will harbor the virus in a latent state for a very long time. HSV will reside in the spinal nerves that control cutaneous sensation following the initial infection. Recurrence might manifest years following the first infection. Recurrence occurs because the virus follows along the nerves and multiplies in the skin or mucous membranes. The proliferation of HSV on the skin or mucous membranes will result in the formation of blisters. The lesions could also appear in other areas of the skin. The frequency of symptom recurrence varies among individuals. Recurrence, in many cases, is commonly triggered by fever. For instance, if an individual has flu accompanied by fever, the recurrence likelihood of herpes simplex will be elevated. 

Most herpes cases are asymptomatic, unless the virus reactivates and multiplies, excruciating skin blisters or recurrent sores could occur. The severity of these symptoms might range from mild to severe.

• Oral herpes results in the appearance of painful blisters or sores surrounding the mouth. Before the appearance of blisters, these symptoms are sometimes preceded by a sensation of tingling, stinging, or burning in the mouth.
• The symptoms of genital herpes can manifest as the presence of one or more blisters or lesions on the genitals, buttocks, anus, and inner thighs. Common symptoms of a new infection may include elevated body temperature, muscles or joints pain, and enlargement of lymph nodes. Recurrent episodes of genital herpes caused by HSV-1 infection are uncommon. Nevertheless, anogenital herpes frequently results in the recurrence of symptoms. The recurrent symptoms of anogenital herpes are often less severe than the initial episode and tend to occur less frequently over time.

While symptoms typically manifest on the genitals or mouth and lips, they may also manifest on other body areas, including the hands and fingers.

Diagnosis

Typically, the diagnosis of HSV is established through anamnesis and the inspection of the blisters. In addition, the doctor will inquire about other symptoms such as runny nose (which could be one of the signs of viral infection) and a tingling and burning sensation. In order to verify the diagnosis, a culture test is necessary, which involves obtaining a fluid sample from the wound using a swab and submitting it to the laboratory.

For people with increased risks of herpes but currently asymptomatic, blood tests to detect HSV antibodies are available. However, it is important to note that these tests may not yield accurate results until 12 weeks after infection.

Management

Certain medications can lessen the intensity of symptoms and the frequency of recurrence, but they cannot eradicate the infection or eliminate the virus within the nerves. Acyclovir, famciclovir, and valacyclovir are the most effective antiviral medications for herpes.

At home, you can alleviate the pain and discomfort caused by blisters by applying:

• Warm or cold compress 
• Aloe vera
• Mixture of minced garlic and olive oil
• Mixture of baking soda or cornstarch with water

Complications

• HSV-2 infection triples the risk of HIV infection. Individuals who have contracted both HIV and HSV-2 have a higher likelihood of transmitting HIV to other individuals. Herpes simplex is a commonly observed disease in HIV patients.
• Individuals with a compromised immune system, such as those with advanced HIV disease, may experience worsened symptoms and more frequent recurrences of herpes. Uncommon complications that may arise include infection of the brain and brain membranes and systemic infection. Additionally, HSV-1 can potentially infect the eye's cornea, resulting in keratitis. 
• Herpes can result in permanent neurological disorders and even death in infants.

Prevention

• Individuals experiencing symptoms of oral herpes should refrain from engaging in mouth-to-mouth contact with others, including oral sex, and should avoid sharing items that come into frequent contact with saliva, such as spoons or toothbrushes. Meanwhile, those with genital herpes should refrain from engaging in sexual activity when they are symptomatic. HSV-1 and HSV-2 are highly transmissible when there are open wounds, but can still spread even in the absence of visible symptoms.
• Sexually active individuals can prevent genital herpes and other infectious diseases by using condoms properly. Nonetheless, HSV can still be transmitted by direct contact with genital or anal regions not covered by condom.
• Circumcision can provide protection to men against HSV-2, HIV, and HPV infections.

When to see a doctor?

It is advisable to seek medical attention from a physician if you have contracted HSV so you can be tested to identify other sexually transmitted infections you might have. There is no reason to feel ashamed about visiting healthcare facilities, as this viral infection is actually quite prevalent.

Pregnant women experiencing symptoms of genital herpes should seek medical advice to prevent the transmission of the virus to the baby.

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