What you need to know about Herpes Simplex Virus (HSV)!

Have you ever had small watery blisters on your lips or genitals that itch and hurt? Or have you heard of a friend or relative who has had this happen to them? The cause of this could be the Herpes Simplex Virus. Don't worry, this is something that happens to many people. Today, we'll talk about this in detail and in a very simple way.

What is Herpes Simplex Virus?

Simply put, herpes simplex virus, or HSV for short, is a virus that can affect many different parts of your body. But it's most commonly seen in the area around your mouth (oral herpes) and genitals (genital herpes) .

When you get infected with HSV, that is, when the virus enters your body, small, water-filled blisters (bubbles) form. These blisters then break open and form a crust on top. This is what we call a "herpes outbreak." But sometimes you can be infected with this virus without having any symptoms. That means you may not even know you have the virus.

The most important thing is that this HSV virus is very contagious . It is spread from person to person through skin-to-skin contact. The virus enters your body through your skin and mucous membranes (mucosa). The virus then uses your cells to make copies of itself. This is called replication .

Once you get infected with this virus, it stays in your body for the rest of your life. Most of the time, it's dormant , meaning it's asleep. But sometimes it can "wake up," meaning it's reactivated , and those blisters can appear. How HSV affects you depends on many factors, including the type of virus and your overall health.

There is no permanent cure for this yet . But don't worry, there are treatments. These treatments can help control herpes outbreaks and reduce the chance of you passing the virus on to someone else.

What are the types of herpes simplex viruses?

There are two main types of herpes simplex virus:

• Herpes simplex virus type 1 (HSV-1)
• Herpes simplex virus type 2 (HSV-2)

Both types, HSV-1 and HSV-2, can cause infections in your mouth (oral herpes) and genitals (genital herpes). Both types can also cause infections in other parts of the body.

How exactly does the HSV virus affect our body?

The herpes simplex virus can cause infections in the following places on your body:

Regarding the mouth and face

Oral herpes causes blisters (sometimes called "fever blisters") to form on and around your lips and mouth. Some people may also develop blisters and other symptoms inside their mouth when they are first infected. This is called herpetic gingivostomatitis . Very rarely, blisters can also appear on or inside the nose. This is called nasal herpes .

In the genital area

Genital herpes causes blisters to form in your genital area. These can appear in places you can see (for example, the vulva in women, the penis in men) or in places you can't see (for example, the cervix).

On other skin areas of the body

HSV can also infect your fingers, which is called herpetic whitlow . Or it can cause skin infections anywhere on your body, which is called herpes gladiatorum . People with atopic dermatitis (a condition similar to eczema) can sometimes develop a widespread skin infection called eczema herpeticum if they get infected with HSV.

For the eyes

HSV can cause a serious eye infection called herpes keratitis (a type of eye herpes called ocular herpes ). This can even affect vision, so prompt treatment is necessary.

To the brain and spinal cord

Imagine, this HSV virus can infect your brain! It's called herpes simplex encephalitis . Or it can infect the protective membranes that surround the brain and spinal cord. It's called herpes meningitis . Sometimes, if both the brain and these protective membranes are infected, a life-threatening condition called herpes meningoencephalitis can occur. These are serious conditions.

To other internal organs

The HSV virus can affect one or more organs in your chest and abdomen. For example, it can affect the esophagus (herpes esophagitis ), the lungs ( HSV pneumonia) , and the liver ( HSV hepatitis ). These infections are most common in people who have a weakened immune system .

What are the symptoms of a herpes simplex infection?

The symptoms of an HSV infection vary depending on the type of infection. Let's take a look at how these symptoms mainly manifest themselves:

• Oral herpes: Blisters on the lips or around the mouth. The skin may feel numb, itchy, or burning for about 48 hours before the blisters appear.
• Genital herpes: Blisters on and around the genitals. Symptoms may include fever, headache, swollen lymph nodes , or what we call genital warts, and itching or numbness in the genital area, up to 48 hours before the blisters appear.
• Herpes gladiatorum: Blisters anywhere on the skin, especially on the hands, face, ears, or chest.
• Herpetic whitlow: Blisters on the fingers, discoloration of the skin around the nail, swelling of the finger.
• Herpes keratitis (eye herpes): Eye pain or inflammation, feeling like something is in the eye, sensitivity to light, blisters on the eyelid or around the eye.
• HSV encephalitis: Headache, fever, focal seizures , changes in speech or behavior.
• Herpes meningitis: Headache, fever, sensitivity to light.

How do we get an HSV infection?

You can get HSV through direct contact with someone who has HSV. This means that part of your body has to come into contact with the following:

• Herpes blisters (in the mouth or genital area).
• Skin or mucosal surfaces (such as the mouth, vagina, or rectum) – these can be contagious whether or not there are visible blisters.
• Saliva , semen, or vaginal discharge – these can be contagious whether or not there are signs of infection.

A person with HSV does not shed the virus from all parts of their body. The virus is shed only from the infected area . Usually, that is, from the site where HSV first entered the body.

For example, if someone has genital herpes, the virus can only be transmitted through the skin, mucous membranes, and bodily fluids of their genital area. HSV cannot be transmitted through their saliva – but if they also have oral herpes, that's a different story (we'll talk about that later).

Also, imagine that your partner has oral herpes but not genital herpes. Then you don't have to worry about contracting HSV from touching their genitals. You are only at risk of contracting HSV from touching their mouth or saliva.

But if your partner has both oral herpes and genital herpes, you can get HSV from their mouth and genitals. But how the virus affects you depends on which part of your body was touched. This is something to look into a little more deeply.

How long is the incubation period of the herpes simplex virus?

The incubation period for herpes simplex infections, the time between the virus entering the body and the appearance of symptoms, can range from one to 26 days. However, it is usually about six to eight days.

Some people, even if they are infected, do not show symptoms right away. Instead, symptoms may not appear for months, or even years, until the virus reactivates.

What are the triggers for herpes simplex virus outbreaks?

Here are some triggers that can trigger an outbreak of oral herpes or genital herpes:

• Fever .
• Stress .
• Weakened immune system (due to medications or other underlying medical conditions).
• Hormonal changes (for example, during menstruation).

Possible causes specific to oral herpes:

• Sun exposure .
• An upper respiratory infection (like a cold).
• Any injury to the oral area .

Sometimes herpes can flare up for no apparent reason.

What are the stages of a herpes simplex infection?

There are three main stages of an HSV infection:

1. Primary infection

2. Latency

3. Reactivation

HSV Primary Infection

"Primary infection" is what happens after the HSV virus enters your body. The virus travels to nearby nerve cells and begins to replicate there. If HSV enters your mouth, it usually infects your trigeminal nerves . If it enters your genitals, it usually infects your sacral plexus, a network of nerves in your pelvic area.

Then HSV travels along your nerves to the skin or mucous membranes nearby. By this time, your immune system recognizes that there is an invader and starts sending out immune cells. This causes inflammation and blisters to form on the skin. You may also notice swollen lymph nodes in that area (for example, under the armpits or in the groin).

Some people don't experience any symptoms during the initial infection, so they don't even know they have HSV.

HSV Latency

Within a few weeks, your immune system will control the initial infection. But the HSV virus will remain in the nerve cells it first infected. Doctors call this a latent period . This means that the virus is in your nerve cells, but is inactive (“sleeping”) most of the time.

During dormancy, most of the infected cells are dormant, but a few can be awake at any given time. This usually doesn't cause a herpes outbreak. But sometimes the infected cells "wake up" and cause enough trouble for the immune system to notice. This is called HSV reactivation.

HSV Reactivation

Reactivation is when infected cells wake up and mount an immune response. There are several things that can happen at this point:

• Control within the nervous system: HSV activity occurs for a short time, starting and ending in the nerve cells. Your immune system controls the virus before it can reach the skin or mucous membranes. This is something that happens to people with HSV all the time – the virus wakes up, shows little activity for about two to six hours, and that’s it. You don’t shed the virus, you don’t have symptoms, and you don’t spread HSV to others.
• Asymptomatic viral shedding: Some infected cells reach the outermost layer of your skin (epidermis). Even if there is not enough viral activity to cause symptoms, the virus can still be "shed." This means that the virus can leave your skin and infect someone else through direct contact. HSV is most commonly spread from person to person during this shedding period.
• Symptomatic herpes outbreak: Infected cells multiply on your skin to the point where they cause symptoms. That's when you start to see blisters on your skin. This is what most people think of when they think of a herpes outbreak. At this point, the virus can easily be spread to others through direct contact.

How do doctors diagnose HSV infections?

Doctors diagnose HSV infections by doing a physical exam and running tests. During the exam, your doctor will look for signs of infection (such as blisters). He or she may take a sample of the blisters and send it to a lab for testing. If the doctor suspects encephalitis and/or meningitis , he or she may do a spinal tap .

If you don't have blisters, your doctor can do a blood test to check for antibodies to HSV-1 or HSV-2. Antibodies are a sign that you've been infected with the virus before. The test results can help your doctor plan treatment.

What are the treatments for herpes simplex infection?

Antiviral medications prescribed by a doctor are the main treatment for HSV infections. These come in different forms:

• The pills you swallow.
• You are applying a cream or ointment to your skin.
• A medicine that your doctor gives into a vein (intravenously - IV) .
• The drops you put in your eyes (for ocular herpes).

Your doctor will tell you which type(s) of medication is best for you. This will depend on the following factors:

• The type of infection you have.
• The seriousness of it.
• How well your immune system is working.

They will also tell you the correct dosage and how long you need to take the medicine.

Treatments for oral and genital herpes fall into two main categories: episodic therapy and chronic suppressive therapy .

What is Episodic Therapy?

This is a short-term treatment aimed at a single episode (outbreak). It involves taking antiviral medication at the first sign of a herpes outbreak (such as skin rash, itching). The sooner you start taking the medication, the better it works . Doctors use episodic therapy for both primary HSV infections and recurrent outbreaks.

Episodic therapy can do the following:

• Make symptoms less severe.
• Help the pain go away quickly.
• Help blisters heal quickly.
• Reduce the amount of virus that comes out of your skin.

Important: Treating one flare-up does not affect future flare-ups. Episodic therapy cannot prevent future flare-ups or affect their severity. For that, you need chronic suppressive therapy.

What is Chronic Suppressive Therapy?

This means you'll need to take antiviral medication for a long time. Doctors recommend this method for people with genital herpes who:

• Those who experience frequent or severe outbreaks.
• Immunocompromised people.
• People who have multiple sexual partners or partners who do not have genital herpes.

Doctors also recommend chronic therapy for people who have severe oral herpes outbreaks and/or who have outbreaks at least six times a year.

Specific medications your doctor may prescribe include:

• Acyclovir
• Valacyclovir
• Famciclovir

Doctors usually use chronic suppressive therapy for people with genital HSV-2. It is not often recommended for genital HSV-1, because this type causes fewer outbreaks.

Chronic suppressive therapy can do the following:

• Reduce the number of urges you have by between 70% and 80%.
• Make symptoms less severe.
• Reduce viral shedding when you are asymptomatic. This can help protect your sexual partners.

Can HSV infections be prevented?

HSV is a very common virus that spreads easily between people. So, it's a little difficult to prevent. But you can do these things to reduce your risk:

• Avoid close contact with people who have an HSV outbreak. For example, don't kiss someone who has cold sores or have sex with someone who has genital sores.
• Ask your partners to get tested for sexually transmitted infections (STIs) , including herpes. You can get HSV from someone who is asymptomatic. Knowing that a partner has HSV can help you take protective measures.
• Use a barrier method (such as condoms or dental dams) during every sexual act. These do not protect you 100%, but they can reduce the risk of spreading HSV to your partner. Barrier methods do not cover all areas where HSV can be transmitted. But they do cover some areas. In addition, they can help protect you from other STIs.

If you have oral herpes or genital herpes, talk openly with your sexual partners about their risks. Both types of HSV can be spread through various sexual activities. Make sure you and your partner are on the same page about safety measures and testing.

Is herpes completely curable?

No, herpes simplex is a lifelong infection . The virus can reactivate from time to time and cause outbreaks. How often this happens varies greatly from person to person.

Most people with oral herpes experience fewer outbreaks as they age, especially after age 35. Similarly, the frequency of genital herpes outbreaks also usually decreases over time. Genital HSV-1 causes fewer outbreaks than genital HSV-2.

When should I see a doctor?

If you have symptoms of an HSV infection, or if you think you may have been exposed to HSV, see a doctor. Your doctor will tell you if you need a test or tests.

What questions should I ask my doctor?

If you have oral herpes or genital herpes, it may be helpful to ask your doctor these questions:

• What treatments do you recommend?
• How can I reduce the risk of spreading HSV to others?
• What is the chance of HSV spreading to other parts of my body?
• How do I prevent outbreaks?

Is HPV the same as herpes simplex?

No, HPV (Human Papillomavirus) and herpes simplex are two different viruses . HPV stands for Human Papillomavirus, which does not belong to the herpes virus family. However, both HPV and HSV:

• Very common.
• Very contagious.
• It spreads through skin-to-skin contact.
• It can affect your sexual organs.

Does everyone have herpes simplex?

No, but HSV is a very common virus . Researchers estimate that in 2016, about 3.7 billion people worldwide had antibodies to HSV-1 (meaning blood tests showed evidence of a previous HSV-1 infection). That same year, nearly 500 million people had antibodies to HSV-2. So you can imagine how widespread this is.

Can someone with herpes simplex donate blood?

Yes, but only if all three of these things are true:

• If you are not currently having a herpes outbreak .
• If the blisters that have recently appeared (in the mouth or genital area) are very dry and close to healing .
• If you meet the other qualifications required to donate blood.

To learn more about eligibility, talk to your doctor or the place where you plan to donate blood.

Finally, remember this (Take-Home Message)

Herpes simplex is a virus that, despite its "simple" name, has a somewhat complicated story. It's a very cunning virus that can be transmitted even when a person has no symptoms. And it can affect many other parts of the body, not just the places we often hear about.

But that doesn't mean that HSV has to complicate your life. Fortunately, antiviral medications have made living with HSV much easier than it used to be. If you think you have an HSV infection, see a doctor. They know how common this virus is and they're ready to help you live with it. Don't worry, you're not alone!

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