Brief overview
- Symptoms: Itching, burning, pain, feeling of tension in the affected area of the body, then typical blister formation with fluid accumulation, later crust formation, also possible with general signs of illness such as fever in the case of initial infection
- Causes and risk factors: Mostly smear infection with herpes simplex virus type 1 and type 2, often first infection as a child within the family, infection also possible through sexual intercourse, repeated herpes outbreaks often due to a weakened immune system
- Diagnosis: Depending on the part of the body affected, based on a visual diagnosis of the typical symptoms and laboratory tests
- Treatment: Can be treated with virus-inhibiting medication (antivirals), shortened duration of illness, use of certain household remedies also possible with a simple course of illness
- Prognosis: Not curable, usually harmless course without scarring, duration of illness often shorter due to antivirals, severe courses are possible in immunodeficiency or in newborns, some of which are life-threatening
- Prevention: initial infection: possible to a limited extent through hygiene measures (no shared cutlery, food, etc.) in the event of an acute herpes outbreak, limit close physical contact, reactivation: strong immune system important (healthy diet, exercise, sufficient sleep), no vaccination possible to date
What is herpes?
In principle, there are different herpes viruses, which sometimes trigger very different diseases in humans. However, “herpes” usually refers to the typical symptoms triggered by the herpes simplex virus (HSV). Doctors subdivide the viruses of the genus herpes simplex into type 1 and type 2, i.e. HSV-1 and HSV-2.
Other herpes viruses cause diseases such as chickenpox and shingles, mononucleosis or three-day fever.
In Germany, over 90 percent of adults are infected with the herpes simplex virus type 1. With HSV-2, the rate is significantly lower at between 10 and 30 percent.
HSV-2 usually causes genital herpes and is mainly transmitted via sexual intercourse. Herpes simplex virus 1, on the other hand, is far more common and usually spreads within the family as early as infancy or early childhood.
How does herpes progress at the respective sites?
Herpes always follows the same pattern, regardless of the area of the body: first there is itching and pain at the affected area, sometimes accompanied by general symptoms such as tiredness or malaise. This is followed by the formation and opening of blisters and the formation of a crust. Once this falls off, the herpes outbreak is healed.
The herpes infection is usually most severe during the first infection, with subsequent outbreaks being milder. Herpes in the genital area in particular is sometimes very unpleasant and painful during the initial infection, especially in women.
How contagious is herpes?
Herpes is an extremely contagious disease and is particularly infectious when viruses are shed and fresh blisters are visible. The greatest risk of herpes infection comes from the fluid in the blisters, which contains a large number of viruses.
As soon as all the blisters have crusted over and no more new ones appear, the risk of infection is already significantly lower. Nevertheless, it is still possible for the body to excrete small amounts of virus at this point for some time after the herpes crust has fallen off.
How does a herpes infection occur?
Herpes is first and foremost a viral infection. The initial infection with herpes occurs from person to person, mainly through smear infection. This means that the herpes virus spreads from the site of infection or from the saliva of an infected person to the mucous membranes of a healthy person – for example during kissing or sexual intercourse.
In general, the risk of herpes transmission increases with close physical contact, so that children sometimes also become infected while playing, for example.
In addition, infection is also possible through objects such as used glasses. However, herpes requires moisture. If the herpes viruses dry out, they die. According to recent studies, it is probably possible for herpes viruses to survive outside the body for up to 48 hours.
As the saliva is also infected with viruses and infectious in the case of active herpes disease on the lips and mouth, the herpes viruses can even be transmitted by droplet infection when in physical proximity. When speaking, tiny droplets of saliva are produced which travel short distances through the air and thus reach the mucous membranes of other people.
The time between the first infection and the onset of symptoms is around two to seven days (incubation period); several weeks are also possible.
How does herpes reactivation occur?
Once infected with the herpes virus, the virus remains in the body for life and can be reactivated at any time (reactivation).
The herpes simplex virus cannot be completely destroyed by the immune system, but can only be put into a kind of dormant state. Within certain cells, it remains inactive most of the time and does not cause any damage. Under certain circumstances, however, the herpes disease reactivates.
Herpes viruses mainly accumulate in so-called nerve ganglia, i.e. collections of nerve cell bodies. If the immune system is temporarily or permanently weakened, individual herpes viruses migrate from the ganglia back to the epithelial cells on the surface of the skin. There they multiply again and cause the typical symptoms once more.
How often such reactivations occur varies greatly from person to person. In some people, herpes occurs several times a year, while others are rarely or never affected after the primary infection. Genital herpes caused by HSV-2 tends to reactivate more frequently than cold sores caused by HSV-1.
When is herpes contagious?
Herpes is only contagious during primary infection or reactivation. This is when viruses are shed. However, the classic symptoms are not always present.
In so-called latent infections, those affected excrete viruses but show no symptoms. If appropriate precautions are not taken, the risk of herpes transmission increases.
While the virus is in a dormant state, herpes infection is not possible.
What symptoms does herpes cause?
Herpes symptoms during the initial infection
Initially, unspecific symptoms (prodromal symptoms) often occur, followed later by the typical symptoms on the skin. The first symptoms follow directly after the incubation period and sometimes occur up to two days before the actual herpes infection. Typical prodromal symptoms of herpes are
- General malaise
- fatigue
- headache
- fever
- Nausea
During this phase, there is often itching or tingling in the areas where the blisters eventually develop, and slight pain is also possible.
The actual herpes outbreak is then accompanied by fluid-filled blisters on reddened skin, swelling and skin damage. The term “herpes stages” can only be used to a limited extent, as the transitions are fluid. Even after blisters have burst and crusted over, it is possible for new blisters to form again.
Herpes symptoms during reactivation
In contrast to the initial infection, the initial stage of herpes in a reactivated outbreak is usually much weaker and only lasts a few hours.
Those affected often have no symptoms at all before the actual signs of herpes appear. Although the outbreak is often less severe than the initial herpes infection, the course and type of symptoms are the same.
How long does herpes last?
How long the disease lasts also depends on the stage of the disease. In the case of an initial infection, the symptoms are often somewhat more persistent; in the case of reactivation, the body’s defenses are already familiar with the herpes virus and get the infection under control more quickly.
If the herpes symptoms persist for an unusually long time, there may be a so-called superinfection in addition to an immune deficiency. This is an additional bacterial infection of the affected skin areas. This is because the damaged skin is an ideal entry point for bacteria if the body’s defenses are weakened.
Herpes in children
The first occurrence of herpes in children is often more severe than in adults. Children often feel very miserable, with a high temperature, similar to a severe cold or flu. The classic herpes symptoms do not necessarily occur. Herpes in infants and children is therefore sometimes not so easy to recognize.
A special form of herpes in children is gingivostomatitis herpetica, in which there is a pronounced infection in the mouth. Occasionally, adults are also affected.
You can find out more about this in the article Herpes in the mouth.
Special forms of herpes and complications
Herpes on the skin
The herpes simplex virus can be transmitted from the actual site of infection – for example by scratching – to other areas of the skin. This occurs preferentially on injured or very thin areas of skin. For example, herpes on the eyelid and herpes on the back are just as common as herpes on the arm or herpes on the finger.
A special case is eczema herpeticatum. This is a more extensive herpes infection with rapidly bursting blisters in patients who also suffer from skin diseases such as neurodermatitis or psoriasis. A pronounced feeling of illness is typical.
Herpes on the eye
Herpes on the eye is a special case. The viruses can infect various areas, such as the eyelid or cornea, but also the retina. There is then a risk of blindness in the affected eye. You can find out how to recognize ocular herpes and how doctors treat it in our article Herpes on the eye.
Herpes encephalitis
Herpes encephalitis (inflammation of the brain) can also be caused by the virus, usually HSV-1. If herpes is located in the brain, it can lead to life-threatening complications.
Generalized herpes simplex
Another complication is the generalized form of the disease. In this case, the viruses enter the bloodstream and multiply excessively (viremia). Doctors also refer to severe forms as herpes simplex sepsis, i.e. blood poisoning with herpes viruses.
Generalized forms usually only occur in high-risk patients with a severely weakened immune system – for example after chemotherapy or organ transplants.
Cold sores
You can find more details on the most common variant of herpes in the text Cold sores.
Genital herpes
Herpes in the genital area is particularly troublesome and usually associated with a high level of shame. You can read the most important information on this topic under Genital herpes.
Herpes in the mouth
First-time herpes in children sometimes leads to an extensive infection in the mouth. More on this under Herpes in the mouth.
Herpes during pregnancy
There are a few things to bear in mind regarding herpes during pregnancy. You can find more detailed information on this under Herpes during pregnancy.
How does a herpes infection occur?
Children are often in close physical contact, so herpes is particularly contagious among them. The liquid contents of the blisters are the main cause of infection with herpes. For this reason, it is never advisable to lance the herpes blisters.
Risk factors for herpes reactivation
Reactivation of herpes usually occurs when the immune system is weakened or the nerve along which the virus travels is irritated. There are many reasons for this. Common causes of herpes are
- Colds and flu-like infections
- Mental and physical stress
- Certain medications, such as cortisone or chemotherapy drugs
- Excessive exposure to UV light
- Hormonal changes
- Injuries
- Immunodeficiency disease HIV
Colds weaken the immune system and encourage dormant herpes viruses from the nerve ganglia to resurface on the skin. The herpes symptoms then often occur together with a fever, which is why they are generally referred to as “cold sores”. However, fever alone does not cause blisters.
Why do you often get herpes after sunburn? Excessive UV radiation not only irritates the skin, but also nerves and herpes viruses can be activated as a result. Skin injuries also encourage reactivation.
But not everyone who complains of having “constant herpes” has an immune deficiency. Some people suffer from reactivations more often than others, without being able to find specific reasons for this. Stress in particular, whether physical or emotional, seems to favor herpes and frequent reactivations.
How is herpes diagnosed?
The doctor usually recognizes herpes easily on the basis of the patient’s medical history and symptoms. A simple visual diagnosis is often sufficient. Depending on the area of the body affected, in some cases it makes sense to identify the pathogen in the laboratory.
Examination methods for herpes
The following methods are available to rule out similar diseases or to check herpes viruses for possible resistance to medication:
Antibody determination (serology)
When the body is confronted with a pathogen, the healthy immune system produces so-called antibodies. These play an important role in the destruction of pathogens.
The detection of certain antibodies indicates a herpes infection, although the test result is not always conclusive. Especially in immunocompromised patients, sometimes no herpes antibodies are found even though the patient is infected.
Antibody determination is helpful in determining the spread of the infection in a population group.
Antigen determination
Direct virus detection with PCR
The most accurate method for reliably detecting herpes viruses is the artificial multiplication of viral DNA in the laboratory. Even with the smallest amounts of virus, the genetic material of the virus can be multiplied using this method until it is finally detectable. Doctors refer to this method as polymerase chain reaction (PCR).
Cultivation of the herpes viruses
The most complex detection method is the cultivation of herpes viruses. For this, a sample is placed in a culture medium – by adding medication, the reaction of the viruses can be tested and therapies adapted. It is also possible to differentiate between HSV-1 and -2.
How is herpes treated?
You can find out exactly how herpes is treated in the text Herpes: Treatment
Home remedies for herpes
Some sufferers use home remedies to treat herpes. You can find out what home remedies there are and which of them are useful in the text Home remedies for herpes.
Can herpes be cured?
The herpes simplex virus remains in the body for life after the initial infection, even if it rarely or never breaks out.
If the herpes symptoms last significantly longer than two weeks, it is advisable to consult a doctor to rule out complications or diseases with a similar appearance.
What should be avoided during an active herpes outbreak?
If you are acutely suffering from a herpes outbreak, it is advisable that you pay attention to a few things. In this way, it is possible to limit the duration of the illness and avoid spreading the virus unnecessarily.
- Avoid touching the infected area as much as possible.
- Wash your hands thoroughly after touching an infected area.
- If you wear contact lenses, wear glasses during a herpes outbreak. This will prevent the virus from getting into your eye via smear infection.
- Do not share glasses, napkins, towels, cutlery etc. with other people during a herpes infection.
- Use a herpes patch to cover the herpes and do not wear make-up. This is because the viruses get onto the make-up utensils and may spread further.
- Avoid direct skin contact, especially kissing, with other people.
- If you have herpes, do not scratch or prick the blisters or remove the crust.
How can herpes be prevented?
A strong immune system is the main way to prevent frequent herpes outbreaks (reactivations). To promote this, it is advisable to pay attention to the following things:
- A healthy and balanced diet
- Sufficient sleep
- Regular exercise
- Reduce stress
Good skin care is also important for cold sores. Especially in the cold season, the right lip care can prevent many reactivations, as chapped, roughened lips make infection easier. In summer, it is advisable to protect the lips from UV damage with adequate sun protection.
Is there a herpes vaccination?
An effective, regularly used vaccination against the herpes simplex virus does not yet exist. As the type 1 herpes simplex virus differs only minimally from type 2, an effective vaccine would automatically be effective against both types.
