Herpes Infections

Melinda Gooderham, MD, FRCPC

Herpes infections occur in two major areas of the body: around the mouth and around the genitals. These common infections are caused by the herpes simplex virus (HSV). When the infection occurs in the mouth area, it causes cold sores, which are also known as fever blisters, oral herpes or herpes labialis (Latin for herpes of the lips). Genital herpes is a common sexually transmitted infection, which is usually simply called herpes (herpes genitalis).

This article discusses how herpes infections are transmitted, what the symptoms are and how the infections are treated.


How is the herpes virus transmitted?

There are two types of the herpes virus: type 1 (HSV-1) and type 2 (HSV-2). Infections of the mouth area are usually caused by HSV-1, while most cases of genital herpes (about 60% of the cases in Canada) are caused by HSV-2. That being said, there can be cross-over and both types can infect either area.

People get herpes infections by coming into direct contact with the skin of someone who is already infected with the virus. Cold sores, for example, can be contracted by kissing someone with a herpes infection in that area. Genital herpes is transmitted during sexual contact with someone who has a genital herpes infection. While people are more likely to acquire the virus to from someone with a visible sore, it can also be transmitted from an infected person who does not have a visible sore and may not know that he or she is infected.


What are the symptoms of herpes infections?

The symptoms vary from person to person. In fact, about three-quarters of people who have the herpes virus may not even be aware of the infection. For those who do experience symptoms, the infection causes a rash on the exposed skin, with bumps and/or blisters. For oral herpes, the infection usually occurs on the lips, but can also develop on other parts of the face. For people with genital herpes infection, the rash can either appear on the skin of the genitals or on the buttocks. Although a doctor can usually diagnose herpes just by looking at an active rash, there are other conditions that can look similar to herpes infections. So if your doctor thinks that you have herpes, he or she will take a sample from your skin using a swab and send it to a laboratory to find out if it is caused by the herpes virus or by something else. The results usually come back within five days.

When the virus is first contracted, the rash is usually the most severe it's ever going to be. For people with genital herpes infections, they may also feel very unwell with fever, headaches, muscle aches and pain or difficulty urinating with the first infection.

While the symptoms are most severe with the first episode, it usually heals within two to four weeks. After it heals, symptoms can come back many more times over the course of a person's life. When these symptoms return, the person can usually feel tingling and pain in the area before they can see the skin change. The skin then becomes red and small bumps form. These can get worse and form small blisters, ulcers and crusts (scabs). When the symptoms return after the initial infection, these are called "outbreaks".

The severity of the initial infection and outbreaks vary from person to person, and can be more severe in people with a weak immune system.


How do I get rid of a herpes infection?

There is no cure for herpes; once a person is infected with HSV-1 or HSV-2, he or she will have the virus for life. But that doesn't mean he or she will always have sores. Most infections heal by themselves within two to four weeks. Once the initial infection starts to heal, the virus travels down the nerve where it stays alive but inactive in the nerve root outside the spinal cord.

Initial herpes infections and outbreaks can also be treated with medication, either applied directly to the skin in a cream or ointment (topical medication) or taken in pill form (oral medication). These treatments, called antivirals, are available only by prescription. Some of the brands that are available in Canada are Zovirax® (acyclovir) and Abreva® (docosonal). The best time to use these treatments is as soon as the person feels an outbreak coming on, to reduce the duration and pain of the outbreak. Oral herpes is most often treated topically, while people with genital herpes are usually prescribed oral antiviral medication.

In addition to the antiviral treatment, some people find that pain relievers like acetaminophen or ibuprofen can ease pain and discomfort. For genital herpes, sitz baths (where you soak only the hips and buttocks in warm water or saline solution) can also be soothing.


How can I prevent outbreaks?

Outbreaks usually occur during periods of stress or illness, when the virus travels back down the nerve to the skin (either mouth or genitals) and causes the symptoms. This is the time when the virus is most likely to be transmitted to someone else. Avoiding stressful situations or practicing stress management techniques may help prevent outbreaks.

There are also some common triggers for outbreaks of oral or facial herpes, including sun exposure, the common cold, fever, or menstruation. Although these triggers are largely unavoidable, some outbreaks or oral herpes can be prevented with sunscreen if one is expecting exposure to the sun.

Herpes is a lifelong condition caused by infection by a virus. It can affect skin in the mouth or genital area. It is spread by direct, skin-to-skin contact. Some people may not experience any symptoms, while others develop a skin rash with clusters of red bumps, blisters or ulcers. Herpes can be easily diagnosed by a doctor and confirmed by a simple laboratory test. Oral antiviral medication is usually used for the treatment of genital herpes, while herpes of the mouth and face can be treated with cream or ointment in many cases. The goal of treatment for herpes infections is to reduce the severity of the skin rash and the duration of outbreaks.

Dr. Melinda Gooderham is the Medical Director at the SKiN Centre for Dermatology in Peterborough, Ontario. The centre includes a state-of-the-art Phototherapy and Psoriasis Treatment Centre, Patch Test Clinic, Laser Clinic, and Dermatology Research Centre. To learn more about Dr. Gooderham's clinical research and ongoing studies visit: ResearchTrials.org - SKiN Centre for Dermatology

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