Herpes Simplex Virus: Definition, Symptoms, Types, Cause and Treatment

Herpes Simplex Virus Overview

Herpes simplex virus (HSV) is a viral infection resulting in painful ulcers and blisters on various body parts. It spreads from one person to the other by exchanging body fluids and secretions, sexual intercourse, and skin-to-skin contact. There are many distinct types of HSV, but two common types are; HSV-1 (or type-1), which causes cold sores or oral Herpes and only occasionally causes genital Herpes, and HSV-2 (or type 2), which causes genital Herpes. HSV-1 is transmitted through contact with the mouth surfaces or the saliva of an infected person; It is transmitted to the genital region by oro-genital contact and results in genital Herpes. There is a small risk of transmission from otherwise normal-looking skin surfaces because the virus is shed even without clinical signs. The HSV-2 spreads through sexual intercourse as a person comes into contact with the fluids, sores, and anal or genital surfaces of the patient. It is sometimes transmitted in the absence of any symptoms. Both types have a lower risk of transmission from the mother to the child, resulting in neonatal Herpes. 

It often causes no symptoms or just mild and easily manageable symptoms. The most important symptom is recurrent and painful ulcers or blisters. Concurrent secondary infections cause swollen lymph nodes, body aches, headaches, sore throat, and fever. The symptoms start from a tingling, burning, and itching sensation near the sites of coming sores. The blisters open up, ooze out the contents and become ulcers that develop crusts. Repeated infections occur after the primary infection; however, they are less severe than the primary one. 

Different medicines are prescribed for both recurrent and primary infections, and the treatments done within 48 hours of the start of the symptoms are most effective. The most effective treatments are anti-viral medications like valacyclovir, famciclovir, and acyclovir (World Health Organisation, 2023). The anti-viral drugs lower the intensity of the symptoms and the risk and rate of transmission to others. The pain killers like ibuprofen, naproxen, and paracetamol are given to manage the pain, and local anaesthetics like lidocaine and benzocaine are used to numb the painful area. 

Preventive measures like avoiding the triggers that worsen the symptoms, e.g., sunlight, wearing loose-fitting clothes, using a warm water bath, drinking cold drinks, avoiding sharing items that are contaminated with the body secretions, using safe sex precautions, e.g., male condoms, informing the partner in case of infection and avoiding the sex in severe cases are very effective. If signs develop in pregnancy, the woman must consult the healthcare provider to avoid the risk of neonatal herpes. The prepuce harbours the virus, so medical male circumcision provides some protection, particularly against type-2 (National Institute of Health, News Release, 2009). The symptomatic patients must be tested for HIV and other sexually transmitted infections. 

What is Herpes Simplex Virus?

The herpes viruses, the cause of Herpes simplex disease, are members of a family of viruses known as the Herpesviridae. It has over 100 herpes viruses, but 8, including HSV-1 and HSV-2, are commonly associated with human diseases. All of the herpes viruses cause a latent infection in which there are no symptoms. Both type 1 and type 2 are contagious. The herpes simplex virus lives as a latent virus in the sensory nerve ganglia in the body without causing symptoms. The symptoms appear once the triggers, like a local injury, activate the dormant virus. 

Genital Herpes caused by HSV-2 is among the most common sexually transmitted infections, and 13% of the people in the age group 15-49 have gotten at least one episode of genital Herpes at some stage in life. HSV-1, the cause of oral Herpes, is highly common, and 67% of the global population under 50 gets the infection (World Health Organisation, 2023).

How is Herpes Simplex Virus Transmitted?

The mechanism of transmission for both types is different. HSV-1 is transmitted as a person comes into contact with the viruses present on the mouth's outside and inside surfaces, the patient's body secretions, and sores. The virus multiplies at the site of infection and travels in the nervous tissues to reach the dorsal root ganglion (DRG), where it becomes latent. In the latent phase, it remains hidden from the immune system and inactivated for a variable time. Some triggers like hormonal treatment, UV radiation, and hyperthermic stress trigger the latent virus.

Some common examples of direct dangerous direct contact are skin-to-skin contact, oral sex, and kissing. Some other transmission methods are shared eating utensils, drinkware, lip balm, and razors. However, the spread by these methods is rare as the virus has low survival outside of the body (BMC Infectious Diseases, 2006). HSV-2 is transmitted by direct contact with the secretions of the infected person who is shedding the virus. Some direct contacts that risk transmitting HSV-2 are skin-to-skin contact at the site of infection, penetrative sex, sharing sex toys, oral sex, and kissing. 

What are the Symptoms of Herpes Simplex Virus?

The symptoms develop from a few days to weeks after initial exposure to the virus. The first or primary infection symptoms are more pronounced than the second one. A primary infection starts from flu-like symptoms like pain at the site, poor appetite, fatigue, tiredness, headaches, body aches, swelling of lymph nodes, and fever. An itching, burning, and tingling sensation occurs at the local site, and then painful blisters form. One or more small-sized blisters or sores develop around the mouth, lips, tongue, anal area, and genitals. The blisters burst, develop crusts and ultimately heal. The blisters developing in the primary infections take 5-7 weeks to heal and are a potent source of virus transmission. 

The sores are very itchy, and the genital sores developing in HSV-2 result in painful urination. In the case of recurrent episodes, the symptoms improve much more rapidly, and the frequency of episodes decreases as the body starts developing immunity. The blisters developing in the recurrent episodes recover within a few days and are less painful and include tingling, burning, itching, and pain. 

How Does Herpes Simplex Virus is diagnosed?

Diagnosis of herpes simplex virus infection is based on clinical signs, laboratory tests to detect the infection biomarkers, and imaging techniques like MRI to diagnose HSV encephalitis. It must be differentially diagnosed from related issues like varicella-zoster virus, Kaposi's Sarcoma herpesvirus, human herpesvirus 6, human herpesvirus 7, Epstein-Barr virus, and cytomegalovirus. The laboratory confirmation using microscopic techniques is useful in case of a severe infection with atypical symptoms and if the patient is immunocompromised or pregnant. The scrapings from the ruptured vesicles are used for microscopic analysis, and changes in the virus-infected cells are observed after staining (HSV Infections, MSD Manual). The blood tests like complete blood counts help healthcare providers to detect the presence of any infections in the body.

The diagnosis is confirmed by tests like serotyping, viral cultures, PCR, and MRI in case of HSV-caused encephalitis. The samples for the culture and PCR are obtained from the base of ulcerated lesions and vesicles. In case of high recurrence frequency and if the symptoms are not resolving and are not responding to the anti-viral treatments, HIV infection is suspected (HSV Infections, MSD Manual). The doctors often recommend testing for other sexually transmitted infections like HIV and Chlamydia in case of a higher HSV frequency, and both partners are tested. 

What are the Different Types of Herpes Simplex Virus?

Different types of herpes viruses are Human alphaherpesvirus 1 (herpes simplex virus-1 or HSV-1 or type 1), Human alphaherpesvirus 2 (HSV-2 or type 2), varicella-zoster virus (HSV-3), Epstein-Barr virus (Human herpesvirus 4 or HHV-4), human herpesvirus 6 (HHV-6), human herpesvirus 7 (HHV-7), Kaposi's Sarcoma herpesvirus (HHV-8), and cytomegalovirus (CMV). 

The classification is based on the genetic differences and the major sites of infection, although they are able to infect different body parts. HSV-1 primarily causes infections in the eyes, throat, face, mouth and central nervous system, while HSV-2 is primarily associated with infections of the anal and genital regions.

HSV-1

Herpes simplex type 1 (HSV-1) is responsible for the primary and recurrent eruptions at the mouth, lips and genital region. It is highly common, and it is estimated that two-thirds of the global population develops Herpes at some point (WHO). Besides the sores at the mouth and lips, it causes herpes encephalitis (the leading cause of death due to Herpes, with a mortality rate of 70% if left untreated) and ocular infection (cause of blindness). After initial replication at the site of infection, the virus reaches the dorsal root ganglia and becomes dormant. 

The infection is asymptomatic in the majority of the patients. In the case of primary infection, the symptoms occur between 3 days to 1 week after virus exposure. The initial symptoms include tingling and burning sensation before skin lesions start, tenderness, localized pain, fever, lack of appetite and generalized weakness. The vesicles erupt, form crusts, and the symptoms resolve in 2-6 weeks. The recurrent infections cause the same symptoms but are milder than the primary infection. The infections become more severe and chronic in case the patient is immunocompromised. 

For diagnosis, different tests are used. For example, blood tests are used to detect the antibodies against the viruses and polymerase chain reaction (PCR) test is used to detect viral genes with high sensitivity and specificity. The other methods are fluorescent antibody assay and the viral culture. The treatment involves using anti-virals like valacyclovir which is used at the dose rate of 2g twice daily for just one day. The healthcare providers decide the frequency and dosage based on recurrence frequency and the presence or absence of immunosuppression. Th lesions of the mouth resolve easily. However, the diseases occur in the form of cycles of dormancy and reactivation. 

For prevention, it is necessary to avoid physical contact with someone having cold sore or other symptoms, use male condoms and consult the doctor for preventive anti-viral therapy in case of suspected exposure. 

HSV-2

The herpes simplex virus 2 or HSV-2 is the cause of genital herpes, which is among the most common genital infections and sexually transmitted infections, affecting 13% of the global population, according to WHO (2023). Although HSV-1 and HSV-2 are involved in genital infections, HSV-2 has a major role. The virus spreads as a person comes into contact with the skin or the body secretions of the symptomatic or asymptomatic patient during sexual intercourse. It is transferred through other means like sharing of utensils, but they are less important. 

After the initial infection and the resolution of initial symptoms in 10-14 days, the virus becomes dormant in the sensory nerves and activates in later life in response to different stresses. Once activated, the virus again reaches the skin sites where it replicates, causing local skin eruptions. The primary infection causes symptoms like difficult and painful urination, swelling of the lymph nodes and the formation of sores, ulcers and, ultimately, the crusts. The genital lesions are particularly painful and cause painful urination, burning pain and swelling of the vulva in females. The other general symptoms noted are weakness, headache and fever which are noted in up to 24% of patients in a study by Johnston and colleagues in 2008.

For diagnosis, PCR and serotyping are used. Many symptoms resemble urinary tract infections; a urinalysis is required to rule out the cause. Testing for other sexually transmitted infections (STIs) like chlamydia, gonorrhoea and HIV is recommended.

The primary infections resolve within three weeks, even without treatments. Anti-viral agents like acyclovir, valacyclovir etc., are used, and the treatment dosage, frequency and duration are decided by the healthcare providers based on the purpose of treatment, i.e., for the treatment of primary or recurrent infections or prophylaxis. The primary infections need prolonged treatments at higher doses. The essential oils, e.g., peppermint oil, eucalyptus oil and Australian tea tree oil, have anti-viral properties and are effective for skin lesions, according to Paul Schnitzler (University of Heidelberg, Germany). 

The prevention needs avoidance of physical contact with someone having sores in the genital and anal region, using male condoms and consulting the doctor for preventive anti-viral therapy in case of suspected exposure. 

What is the Treatment for Herpes Simplex Virus?

For the treatment of oral and genital herpes, medications and home remedies are effective. The medications are used to treat both primary and recurrent infections. The medicines like anti-virals and painkillers lower the symptoms' frequency, severity and duration but do not cure them. In the case of recurrent infections, the treatments are highly effective when started within 48 hours of symptoms. Several anti-viral drugs like valacyclovir, acyclovir and famciclovir are used for treatment. The secondary symptoms are treated as they arise. 

Medications: No drug that completely cures the disease is available. The treatment is focused on relieving the symptoms and providing comfort to the patient as long as the virus completes its cycle and the body recovers itself. The doctors prescribe anti-viral drugs like acyclovir, famciclovir and valaciclovir. Novel anti-viral drugs like cidofovir and foscarnet are recommended if the virus resists the common anti-viral drugs. The anti-viral drugs prevent viral replication, help manage symptoms and lower the risk of viral shedding. The creams and ointments containing local numbing agents like tetracaine (Viractin®, Pontocaine® and Ametop Gel), benzocaine (Lanacane® and Dermoplast®) and lidocaine (LidoRx® and Lidoderm®) are available over the counter and, help manage the symptoms like pain, itchiness, burning, and tingling. 

For better efficacy and result, the treatment must be initiated as soon as (or within 24 hours) the signs like tingling and burning start. The use of anti-viral drugs causes the symptoms to resolve 1-2 days earlier than if no such drugs are used, and the drugs reduce the severity of symptoms. Various anti-viral drugs used for the treatment of HSV are;

Acyclovir (Zovirax®) is a prescription drug available as oral pills and topical preparations. It improves healing and lowers the severity of pain and other symptoms of genital herpes. In immunocompromised people, it lowers the spread of the virus to the other body parts and thus lowers the risk of complications. An IV preparation containing acyclovir is injected in severe cases for better response. 

Denavir (Penciclover®) is a topical cream that helps treat the recurrent cold sores of oral herpes. It is considered to be safe for adults above 12 years of age. Although some healthcare agencies like CDC discourage topical preparations for genital herpes, it is still prescribed. 

Docosanol (Abreva®) treats recurrent and severe herpes simplex labialis, the common recurrent infection of the perioral tissues and lips caused by HSV-1. Various studies prove its safety and effectiveness for HSL. However, limited clinical data is available. 

Valaciclovir (Valtrex®) is available as oral pills and is prescribed to treat primary infections and flare-ups of genital and oral herpes. The people experiencing a high frequency of flare-ups are asked to take it daily as a part of suppressive therapy. It decreases the risk of transmission to the sexual partner and lowers the risk of further infections. It is safe in pregnancy as animal studies have found that the risk of pregnancy complications is very low. 

Famciclovir (Famvir®) is prescribed for genital and oral herpes and is available as oral tablets. It is recommended for people to have good immunity. The safety data in pregnancy is limited and not prescribed during pregnancy. The animal studies' data show that pregnancy complication risk is low. It is prescribed for recurrent and first infections, although it is not a drug of choice for primary infections. 

These anti-viral drugs are approved for HSV. However, some risks and side effects like confusion, sleepiness, nausea, and headaches must be known to the patients. Valaciclovir and acyclovir have similar working mechanisms and cause kidney dysfunction and are prescribed at lower doses or avoided in kidney patients. Some anti-viral drugs cause dangerous interactions with other drugs, and the patients are advised to consult the pharmacist for drug-drug interactions. 

Another useful thing to consider during the treatment is the number of recurrences each year. If a person experiences less than six annual recurrences, the doctors often recommend anti-viral therapy for each recurrence (intermittent treatment). If, however, the recurrence frequency is very high, it is often recommended to take anti-viral drugs for an extended period, like 6-12 months (suppressive treatment). It doesn't eliminate the risk of disease. However, the severity of symptoms and the risk of transmission to other people are significantly reduced. The commonly recommended treatment plans for that herpes are;

Initial treatment: A short course of anti-viral drugs for 7-10 days is prescribed in case of signs or symptoms or a confirmatory diagnosis. It helps prevent the symptoms and prevent dangerous complications. The duration is prolonged if the symptoms don't improve in that time. After an initial treatment, the healthcare providers provide further treatment guidelines based on the frequency of flare-ups and severity of the clinical signs. 

Intermittent treatment: In case the symptoms disappear after the initial treatment, intermittent treatment is recommended. The herpes virus stays in the body and causes many recurrent infections. During intermittent treatment, the anti-viral drugs are only used to handle a flare-up. The choice of intermittent treatment depends upon the healthcare providers, as some recommend its use while others don't prescribe it.

Suppressive treatment: It involves taking lower doses of anti-viral drugs daily for a long time. Healthcare professionals recommend it in case of a high frequency of recurrences. It is a preventive measure and results in a significant decrease in the number of recurrences and severity of symptoms. It lowers the risk of transmission to other people. The research is undergoing to explore new treatment options like gene editing and vaccination. Animal trials for both have provided reasonable results. However, the application to humans is yet a far cry. 

Home remedies: Home remedies must be tried only after consulting the doctor. The evidence supporting home remedies is anecdotal, and more scientific evidence is needed. Nevertheless, some remedies help relieve symptoms of herpes simplex virus. These include the use of over-the-counter or prescription painkillers like ibuprofen and acetaminophen, bathing or soaking in salty and lightly warm water, pouring lukewarm water on the blisters to ease the pain during urination, application of aloe Vera gel to the skin sores, using loose-fitting clothes for better comfort and avoiding irritation, applying a lotion or a cream containing a local anaesthetic like lidocaine or benzocaine on the urethra immediately before urinating and using ice packs to soothe the sores. The ice must not be applied directly on the sores and must be wrapped in a cloth. 

What are the Risk Factors Associated with Herpes Simplex Virus?   

The risk of infections is not the same for all people, and the people having poor immunity, advanced HIV infections, primary immunodeficiency (a type of genetic immunosuppression), receiving immunosuppressive drugs, e.g., corticosteroids, anti-cancer drugs etc., and patients undergoing medical procedures like organ transplants are at higher risk. Demographic parameters like gender, age, ethnicities, obesity, smoking, etc., have a role.

An earlier study published in the European Journal of Epidemiology in 2001 noted various risk factors for HSV-1. The data was collected using a questionnaire from 596 students aged 17-41 from two regions. The following risk factors were identified (an odd ratio means an association between exposure and risk, and a high odd ratio means higher risk);

1. History of oral lesions: The virus was latent in the people having the infection in the past. The infection rate of HSV-1 for both regions was as high as 55.3% in the people who had experienced oral lesions in the past 12 months.
2. Sexual history: Sexual intercourse serves as a mode of disease transfer, and the students having sexual intercourse in the past months have a higher risk of HSV-1 infection (odd ratio: 1.88). 
3. High-stress: People exposed to higher stress levels have poor immunity and show high risk (odd ratio: 1.79).
4. Seropositivity for HSV-1: Seropositivity for HSV-1 is very high, and most people are positive for the virus without clinical signs. The seropositive people have a higher risk of developing disease (odd ratio: 6.90). 

Likewise, the risk factors of HSV-2 infection were reported by another study published in the Sexually Transmitted Infections in 2001. The study used data from 3306 women. Various risk factors of HSV-2 seropositivity identified were;

1. Having Chlamydia infection in the past: People having a Chlamydia infection in the past have a higher risk. 
2. Age at first sex: Having sex at an early age increases the risk of genital herpes. Women having their first sexual intercourse at age 15 or less are 70% more likely to have antibodies for HSV-2.
3. History of other sexually transmitted infections: People with a history of other STIs, e.g., human papillomavirus infection and syphilis, have a higher risk. 
4. Number of sexual partners: Women who have had more than one sexual partner for a long time have a double risk of HSV-2.
5. Asian origin: Patients born in North Asian or South East Asian countries have a higher risk.
6. Miscellaneous factors: Some other factors associated with a higher risk of genital herpes are the number of live birth, number of pregnancies, the presence of genital herpes in the sexual partner, having a herpes infection in the past, lower level of education, and advanced age.  

What are the Complications of Herpes Simplex Virus if Not Treated?

Both types of herpes infections are highly contagious and spread from one person to the other quickly and cause severe complications in some patients. The complications of different types of herpes are;

Complications of HSV-1 (oral herpes): It is a mild infection for most people, and the symptoms continue without complications. The complications occur in advanced-age people with different chronic illnesses and weakened immune systems. The complications include dehydration due to restricted water intake in case of severe oral blisters and encephalitis. In encephalitis, the virus reaches the brain, causing inflammation. It is not deadly in most cases and only causes flu-like symptoms. Other complications are skin infections, herpes whitlow (an abscess in the soft tissues), and blisters on the fingers if the child sucks fingers. The virus spreading to the eyes causes inflammation and swelling of the eyes and corneal infection, leading to blindness.

Complications of HSV-2 (Genital herpes): Genital herpes is mild to harmless, but there is still a danger of complications. Minor complications include inflammation around the rectum and bladder area that causes pain and swelling. It prevents emptying of the bladder, and a catheter is often needed to empty it. Meningitis is a rare complication that develops when the virus reaches and causes inflammation of the membranes surrounding the brain and spinal cord. Viral meningitis is, however, a mild condition and typically resolves itself. An even rare complication is the encephalitis.

The presence of HSV increases the risk of various other sexually transmitted infections. Breaks in the skin facilitate the entry of germs into the body, causing local and systemic infections. Perhaps the most serious complication of genital herpes is the neonatal herpes. The infection passes to the child during childbirth or pregnancy and causes blindness, brain damage and even the baby's death. Besides HSV-1 and HSV-2, various other types of herpes cause different complications, e.g., 

Varicella zoster virus (HSV-3): It causes shingles and chickenpox. The infection is normally mild; however, in some cases, it causes severe complications leading to toxic shock syndrome, chronic pain, zoster paresis (motor weakness of a group of muscles), diseases of blood vessels and eyes, meningoencephalitis, cerebellitis (inflammation of muscles), myelopathies (injuries of the spinal cord) and pneumonia. The risk of complications is higher in people with poor immunity (Maria A. Nagel, MD). 

Epstein Barr virus (HSV-4): It is the cause of infectious mononucleosis that is rarely serious. It rarely causes any complications and is often unnoticed. The complications are the inflammation of heart muscles, encephalitis and lymphoma (cancers of lymph nodes). 

Cytomegalovirus (HSV-5): It causes infections like mononucleosis and hepatitis. The infection is uncomplicated in people with good immunity. People with poor immunity have a risk of pneumonia and encephalitis. The virus sometimes passes to newborn babies during delivery and pregnancy and causes complications like premature birth, poor liver functions, pneumonia, cerebral palsy, delays in neurodevelopment, sensorineural hearing loss and seizures.

How Does Herpes Simplex Virus Affect Women During Pregnancy and Giving Birth?

Herpes infections cause life-threatening complications for newborn babies if acquired during pregnancy or childbirth. The impact on pregnancy and birth depends upon the timing of the infection. 

Women infected before pregnancy or in the first trimester of pregnancy: The risk of passing infections to newborn babies is very low if the women become infected before pregnancy or in the first trimester of pregnancy, and one study noted that just 1% of babies born to the mothers infected in the last trimester of pregnancy are infected during the birth. Pregnant women must look for signs of infection before birth and consult the doctor if there are signs. If there are no signs, there is no risk to the pregnancy, and a normal birth occurs. However, if there are signs or a confirmed diagnosis of HSV, the caesarian section is recommended as it greatly lowers the risk of transmission to the newborn baby. 

It is estimated that 13% of pregnant women having HSV experience an outbreak at the time of delivery, and the risk of an outbreak is lowered by a preventive use of anti-viral drugs daily starting from 35 weeks of pregnancy and continuing throughout the birth. The treatment increases the chances of having a normal birth as it is noted that only 4% of women who have received anti-viral drugs needed a caesarian section as compared to 13% of the infected women who didn't receive treatment. 

Women infected in the later stages of pregnancy: The risk of passing the infection to the baby significantly increases as the pregnancy advances, and it is noted that the risk becomes 30-50% if the woman is infected in the third trimester. Therefore, women acquiring infection in the last trimester are recommended caesarian section. To prevent infection in the last trimester, it is necessary to avoid sex (both oral and genital) with the patients or suspected patients. The initial outbreaks in pregnant women cause more severe signs and are treated with anti-viral drugs like aciclovir, and if the signs are very severe, the drugs are given through the intravenous route. The further outbreaks are not serious, and anti-viral drugs are not normally used. The medications are used only in complicated cases or in cases of severe symptoms. 

HSV infection and newborn baby's health: The transmission of infection to newborn babies causes neonatal herpes. It results in severe signs like seizures, damage to vital organs like the heart, lungs and liver; recurrent and severe sores on the mouth, genitals, eyes and skin; complicated infections like viral meningitis; deafness and blindness. 

How to Prevent Herpes Simplex Virus?

The herpes simplex viruses are acquired through intimate relationships (not necessarily sexual), and family members are among the most common sources. No licensed vaccine is available to prevent HSV. However, some strategies help lower the transmission of viruses. These include;

Avoiding contact: In an active oral outbreak, the patients must avoid contact, like sharing lip balm, towels, water bottles, glasses and other utensils and kissing. Such measures, however, don't eliminate the risk as the transmission occurs from asymptomatic patients too. 

Role of healthcare providers: To prevent the risk, healthcare workers must be vigilant as they carry infectious agents from one person to the otters. Healthcare professionals must use gloves to examine patients with active or suspected infections. Risky procedures like bronchoscopy and suctioning must be performed with proper mouth and eye protection. 

Patient education: Patients with oral and genital sores must be educated about the risks they pose to their intimate partners and the transmission and prevention of infection during pregnancy, which is dangerous for the baby. 

Precautions during sexual activities: To lower the risk of transmission, the barriers to oral and vaginal sex must be used. For example, condoms lower the risk of transmission when the patient is shedding the virus. 

Precautions for athletes: The risk of cutaneous herpes viruses is higher in athletes, e.g., wrestlers. The athletes with the signs must only participate in contact sports once the lesions have dried and entered the crust stage. The use of preventive anti-viral drugs reduces the risk of outbreak in patients that have or don't have a history of herpes virus by lowering the transmission. So, some experts recommend that Athletes, regardless of the history of the herpes virus, must take 1g valaciclovir daily while at the summer camp, and it was noted that it reduced the risk of the outbreak by 87%. 

Precautions during pregnancy: To lower the risk and transmission in pregnancy, the HSV status of both parents is determined using laboratory tests, and the high-risk women must be asked to lower the oro-genital contact, particularly near the term. The recommendations vary from state to state. However, the caesarian section lowers the risk of neonatal transmission for women who are shedding the viruses close to the term. The studies are undergoing to understand the benefits and risks of prophylactic anti-viral treatment. If necessary, healthcare professionals must recommend it only after weighing the potential benefits and risks. 

Safety tips: Besides the precautions mentioned above related to different people engaged in healthcare, there are some useful tips for patients. These are; 

• The patients must not hide the signs from partners and inform them if any. It is important to inform future partners before intimacy. 
• The patients must be aware of and alert about the symptoms. Avoid close contact with the people if the symptoms are there and continue to do so after some days of the resolution of symptoms. 
• The hands must be washed with an antiseptic solution or good-quality soap after contact with the sores, body secretions or any suspected person. 
• The patients must use latex male condoms, although they don't provide 100% protection.
• Consult the healthcare provider for suppressive therapy and take it regularly if recommended. 

Despite all measures, the virus is still transmitted and acquired from asymptomatic people, and it is important to be vigilant about the signs and symptoms.

Prevention of neonatal herpes: The precautions are needed to lower the risk of viral transmission to the newborn baby. In case of the male partner has herpes and the female partner doesn't, using male condoms reduces the risk of transmission. However, the risk is not eliminated. So, it is better to avoid sex, as there is no reason to risk a baby close to delivery. In the rare event of transmission to the baby, the baby is treated with anti-viral drugs. There is no proof that it is transmitted through the breast milk. So unless there are sores on the breasts, it is safer to breastfeed the baby. Any person having cold sores or any HSV lesions or who had so in the recent past must not be allowed to hold the baby. The parents must insist anyone intending to hold the baby wash their hands before doing so. 

During childbirth, the following precarious promise to lower the risk of viral transmission to the baby.

• Consult the midwife or gynaecologist and make sure the healthcare provider is aware of the situation
• Inform the healthcare provider about the signs that are present in the absence of visible signs, like burning and itching
• Ask the healthcare provider not to rupture the bag earlier as it protects from the viruses present there
• Monitor the baby for at least three weeks after the delivery for any signs of herpes infection like poor appetite, crankiness, skin rash and fever and inform the concerned paediatrician.

How is Herpes Simplex Virus Related to HIV?

Acquired immunodeficiency syndrome (AIDS), caused by the human immunodeficiency virus, destroys the immune system. It effectively destroys the body's ability to ward off infections. Consequently, people having HIV have a higher risk of infections, including HSV and experience more severe symptoms than people with normal immune systems. The risk of HIV acquisition in people having HSV-2 infection is three times higher than in the general population (Katherine J. Looker, PhD and colleagues, 2017). HSV is classified as a 'defining condition' for AIDS as AIDS is suspected in people who experience a higher frequency of episodes and severe signs that last more than a month and affect the oesophagus, bronchi and lungs. 

Moreover, the evidence suggests that the transmission of HIV is linked to HSV-2. The active herpes simplex virus infection increases the HIV viral shedding, that is, the release of HIV particles from mucosal tissues. So, people having undetectable HIV load in the other body fluids often have a detectable viral load in the genital secretions. Anti-viral therapy for HSV lowers the risk of symptomatic HSV infections. However, it is often ineffective to lower HIV viral shedding. 

Therefore, HIV-positive patients with an active HSV-2 infection have a 3-4 times higher risk of transmitting HIV to their sexual partners. Likewise, HIV-negative patients suffering from active HSV-2 infection have a higher risk of acquiring HIV. It is attributed to various factors, like the presence of open sores that allow easy access to HIV and the active binding of HIV to the macrophages present at the site of active infection. Such factors allow HIV to be carried across the mucosal barriers of the anus and vagina and enter the bloodstream.

How Contagious Is HSV-1 Genitally?

HSV-1, the cause of cold sores, is responsible for one-third of cases of genital herpes. It is highly contagious and is passed easily through the genital and oral route, through mouth-to-mouth contact and other contacts like mouth to genitals, genitals to mouth and genitals to genitals. It means genital herpes develops if a person engages in oral sex with a patient having cold sores. It is a serious concern as 70% of the UK’s population develop cold sores due to HSV-1. Both HSV-1 and HSV-2 are linked to genital herpes, but most of the cases are caused by HSV-2. 

However, HSV-1 is much more common than HSV-2, so there is a substantial risk of acquiring genital herpes from a patient having cold sores. The reverse occurs too, although the risk is very high. It means it is possible for a person engaging in oral sex with a person having genital herpes due to HSV-2 to develop oral sores. It is important to remember that both genital herpes and oral sores are transmitted from one person to the other, even in the absence of any symptoms (asymptomatic shedding). So, it is very hard to avoid the transmission of herpes simplex virus due to its highly contagious nature, and the preventive protocols provide a partial degree of protection.

What are Common Misconceptions about Herpes Simplex Virus?

Herpes simplex virus, particularly genital herpes, is a common disease and inspires popular imagination. Consequently, it has become the focus of many misconceptions. Here are some misconceptions attached to it and their truth. 

Herpes is a rare disease, and few people are at risk. 

Truth: Exactly the opposite is true. Herpes simplex virus is more common than many thought. About 67% of the global population under 50 develop cold sores and other lesions due to HSV-1, according to WHO. So, a person developing cold sores belongs to the majority group. Likewise, 13% of the global population has HSV-2, the major cause of genital herpes. Both statistics show that it is a highly common condition. 

The presence of cold sores on the mouth reflects the presence of sexually transmitted infections.

Truth: It is not necessarily true. The cold sores develop due to HSV-1, which is not an STI. It is transmitted by oral contact and not through sexual activities. The genital herpes caused by HSV-2 is rarely associated with cold sores. 

HSV is mainly a disease of genital organs.

Truth: People think of herpes as a short form of genital herpes. Therefore, it is assumed that herpes means genital herpes. However, there are two major types of herpes, HSV-1 and HSV-2. The more common type, HSV-1, is not associated with genital disease and causes cause oral sores.

Genital herpes is a disease of promiscuous people.

Truth: Genital herpes is a very common sexually transmitted disease. Having more sexual partners increases the risk of acquiring it. However, it is unnecessary; some people catch genital herpes with just one sexual partner. The responsible virus stays in the body for a very long time and sometimes continues to be transmitted without disease. 

Male condoms eliminate the risk of genital herpes.

Truth: Although male condoms are among the prevention protocols and reduce the risk, they don't eliminate the risk, and people using condoms still get genital herpes. It happens because the condoms don't cover all the skin and sometimes rupture. Male condoms still provide a reasonable margin of safety. A study involving many researchers in 2016 noted that the use of condoms reduces the risk of male-to-female transmission through sex by 96% (Clinical Infectious Diseases, 2016). 

Genital herpes is easily identified as it always causes visible signs and symptoms.

Truth: Genital herpes is experienced differently by different people. Some people develop signs like ulcers and sores, while others don't develop any signs and remain asymptomatic. Among the symptomatic people, the majority develop signs that are not solely ascribed to genital herpes, and only a minority develop easily recognisable symptoms. 

Genital herpes is not treatable.

Truth: It is not true. Although, like other viral conditions, it is not fully treatable, it is managed using a variety of medications, and the visible symptoms eventually resolve. The intensity of recurrent infections is even low and more easily manageable. The timely treatment lessens the duration of illnesses and disease recurrence and transmission to the susceptible population. So, it is far from an untreatable scourge. 

Genital herpes is the cause of cervical cancer.

Truth: Genital herpes has no association with cervical cancer. Cervical cancer is due to another virus, the human papillomavirus (HPV). HPV is sexually transmitted and causes wart-like lesions. That's why some people misunderstood it to be genital herpes. 

A complete STI test kit detects genital herpes.

Truth: A complete STI test kit normally doesn't include genital herpes. The best and only way to diagnose the condition is to visit the doctor if there are signs. The samples are taken and dispatched to the laboratory for diagnosis. HSV is too common an infection to be a source of worry.

Only penetrative sex transmits genital herpes.

Truth: Genital herpes needs close skin-to-skin contact. So, anal or vaginal sex is unnecessary, and it is transmitted through skin-to-skin contact, genital-to-mouth contact, mouth-to-mouth contact etc. It is transmitted by oral sex if the partner has cold sores, resulting in sores in the genital area. Dental dams or condoms provide some protection against viral transmission. Still, some people develop HSV despite all measures. 

If a male is monogamous and still acquires herpes from the female partner, the female is likely to have sexual intercourse with another male. 

Truth: Although it is a possibility, it is not necessarily true. It is possible to get genital herpes from someone in the late past without knowing it. The virus remains dormant and is recently activated in response to stress. Some people have the virus in their body and continue to transmit it for a lifetime. So, blaming the female partner is inappropriate.

Genital herpes is transmitted only from active lesions.

Truth: Active blisters and ulcers facilitate the transmission. However, transmission occurs without sores and blisters. It is due to asymptomatic viral shedding in which the patients shed the virus without any symptoms. Therefore, it is good to use male condoms and dental dams when engaging in vaginal and oral sex for protection. The risk of transmission is higher in the case of active infection.

A canker sore and herpes are the same things. 

Truth: Both are often confused but are different conditions. Herpes is a contagious disease that causes ulcers around the genital organs and mouth. The ulcers and sores are pus-filled and eventually burst, causing discomfort and pain and forming crusts to heal. The canker sores are, however, non-contagious and non-viral and develop inside cheeks and lips. The canker sores are different from herpes sores as they have a whitish and soft border and are like pink craters. The canker sores are attributed to diverse causes like hormonal changes and poor immunity. 

The partners are able to identify the presence of HSV-2 easily and inform the other partner about it. 

Truth: Herpes is a very sneaky infection. It sometimes exists in the body without signs and is transmitted between partners during that period. Therefore, patients with HSV-2 are often unaware of it. It is likely that even if a person knows about it, they will likely believe the myths about the herpes simplex virus and hide the information from their partner. 

A vaccine is available for herpes virus. 

Truth: Unfortunately, no vaccines or proper cure is available for HSV. Scientists are struggling to achieve it, but the behaviour and nature of the virus are hindering the development of effective vaccines. Only the treatment with anti-viral drugs is the available treatment option. 

Living with someone with HSV is very risky.

Truth: It is not true. There is a risk of transmission. However, it is reduced using anti-viral drugs and prevention protocols, and living with the patient is not necessarily risky. Moreover, there are many other modes of acquiring the HSV besides the partner. 

Herpes is transmitted through blood.

Truth: It is not true. Although it is diagnosed through blood tests, it is not transmitted through the blood. It is safe to donate blood as soon as there are no active lesions and the cold sores have healed. In the case of anti-viral treatment, the blood transfusion must be delayed for 48 hours or more, as the doctor recommends.

Presence of herpes needs a long-term use of condoms.

Truth: Condoms are useful. However, the decision to use or not must be made after discussion with the partner. Condoms are not 100% effective, and other measures, e.g., avoiding sex during active infection and using dental dams and anti-viral drugs, are necessary.

The herpes is always transmitted to the newborn during the delivery of a baby.

Truth: It is a possibility but not a certainty. The preventive measures reduce the risk of transmission to the baby. Although 2-3% of pregnant women in the UK have herpes, neonatal herpes is diagnosed in just a fraction of babies.

Is Herpes Simplex Virus Considered an STD?

Yes, genital herpes caused by herpes simplex virus type-2 (HSV-2) and less commonly by herpes simplex type-1 (HSV-1) is considered to be among the most common sexually transmitted diseases (STDs). It is transmitted through all sexual activities like oral sex, vaginal and anal sex. Genital herpes is, however, transmitted by some non-sexual means, like sharing personal items and kissing. The use of safe sex practices is useful for the prevention of STDs, including herpes. So, it is important to seek professional help if there are any signs of genital herpes, and the partner must be informed about the condition. Sexual activities must be avoided as soon as the active sores are there. Another thing to note is that not all types of herpes viruses cause genital herpes, and sexual activities are among the other close contacts that increase the risk.

Is Herpes Contagious a Disease?

Yes, the diseases caused by the herpes virus are contagious and passed from one person to another during close contact. The diseases are passed both during the active infection and during the latent phase, but the risk is higher in the active phase. Safe behaviours are needed, and precautions must be taken to avoid or at least lower the risk of transmission. All types of diseases caused by the herpes viruses, including the most common types (type 1 and type 2), are transmitted during close contact. However, all people acquiring the disease don't necessarily develop the signs. 

The virus is spread through contact, like touching the sores and blisters, sharing personal items like towels, razors etc., and engaging in oral or vaginal sex and kissing. Due to the asymptomatic viral shedding, it is possible to get an infection from a person even without any clinical signs. Given the high prevalence of herpes simplex viruses, it is likely that a person acquires the virus yet doesn't develop any signs for a lifetime. The use of preventive measures and preventive therapy lowers the risk of transmission to the susceptible person. However, the risk is never eliminated.

Can Herpes Simplex Virus be cured?

No, currently, no cure is available for herpes simplex virus. Anti-viral drugs help manage the symptoms, reduce the severity of signs and lower the transmission rate, but they do not eliminate the virus. The patients continue to shed the virus for a long time, even after the resolution of symptoms. In case of signs of disease, the patients must consult the healthcare provider for accurate and reliable information about the treatment and prevention options. The research is undergoing to explore the treatment and develop vaccines for herpes simplex virus. 

HSV-1 causes fever blisters and cold sores in or around the mouth. It is a rare cause of genital herpes. HSV-2 is the major cause of genital herpes and causes painful blisters in the anal and genital areas. All of the diseases caused by herpes viruses are contagious. Over time, the body's immune system starts developing immunity which causes the resolution of the symptoms. Yet, the virus stays in the body, and no treatment or immune mechanisms are able to dislodge it from the body. 

Is There a Cream Made for Herpes?

Yes, various creams are available that help treat herpes lesions. The topical creams are available both over the counter and on prescription. Some common examples are; 

Zovirax® (acyclovir 5%): It is an anti-viral cream that is recommended for oral herpes and to treat the rashes caused by shingles and chickenpox. It works by inhibiting the ability of the virus to reproduce. It is well tolerated, has fewer side effects, and shortens the expected duration of an outbreak by almost half a day. It is applied to the sores at least five times per day or as the doctor recommends. 

Denavir® (Penciclovir 1%): It is a prescription anti-viral cream for herpes. It works similarly to the Zovirax. It is applied every two hours or as recommended by the doctor.

Xerese (acyclovir+ hydrocortisone): It contains 1% hydrocortisone and 5% acyclovir. It improves the healing time and lowers the recurrence frequency. 

All the anti-viral creams mentioned above are expensive and must be used as the doctor recommends.

Besides these, some other topical products used to treat herpes symptoms are;

Hydrocortisone cream: It is a topical corticosteroid available in various forms like lotions, ointments and creams. The 1% or lower strengths are available over the counter, and higher strengths are available on prescription. It reduces symptoms like pain, itchiness and redness but doesn't treat or prevent the virus. It is inexpensive and causes mild side effects like redness, itchiness and dryness.

Abreva (Docosanol): It is available OTC and influences the attachment of HSV to the body cells. It relieves the severity and pain associated with the sores and decreases the duration of the outbreak. It must be applied as soon as possible after the appearance of signs at least five times a day. It is cheaper than many other anti-viral products and causes minimal side effects. 

Lysine cream: Lysine is among the essential amino acids the body can't prepare and needs to be provided from outside. Lysine works by lowering the levels of another amino acid, arginine. The virus needs arginine to replicate itself. The resulting inhibition of viral replication lowers the frequency and severity of symptoms. However, limited efficacy and safety data are available.