|Herpes Simplex Virus
|Also Listed As:
Herpes simplex virus (HSV) infections are very common worldwide. HSV-1 (often
called oral-facial herpes) is transmitted through kissing or sharing drinking
utensils, and HSV-2 (often called genital herpes) through sexual contact. Both
HSV-1 and HSV-2 can cause infections around the face, mouth, and genitals. The
infection may not show symptoms for a long time, and then become activated by
exposure to the sun, fever, menstruation, emotional stress, a weakened immune
system, or acute illness.
Once you have herpes, it is likely to recur. In between herpes outbreaks, the
virus lies dormant (like it is hibernating or sleeping) in nerve cells.
Recurrent HSV-1 infections on the lip are often mild and are commonly referred
to as cold sores or fever blisters. HSV-2 lesions tend to recur more often and
to be more severe than HSV-1 infections.
Herpes infections in infants and in people who have weak immune systems or
herpes infections that affect the eyes are serious and potentially
|Signs and Symptoms|
- Small grouped blisters in the infected area like the genitals (namely,
penis scrotum, vagina, cervix, or labia), around the genitals (such as anus or
inner thighs) mouth, lips, tongue, gums, or throat; the blisters can then become
ulcers (raw sores) and later crust over
- Burning, itching, pain, or tingling sensations often precedes the
appearance of the blisters
- Enlarged lymph nodes near the infected area
- Fever, headache, and flu-like symptoms (such as muscle aches and
malaise [generally feeling bad]), particularly when you first contract the virus
- Vaginal or penile discharge
- Pain with urination
HSV-1 is transmitted through saliva; therefore, kissing someone with HSV-1,
drinking from the same instrument, or participating in oral-genital sex with
someone who has HSV-1 can cause you to contract the virus.
HSV-2 is a sexually transmitted disease meaning that it is transferred from
one sexual partner to another through genital secretions.
Herpes simplex may be transmitted even if the infected person does not have
active symptoms or visible lesions.
Also, a mother can pass the infection to her baby during vaginal birth,
especially if there are active lesions around the vagina at the time of
Everyone is at risk for oral herpes from HSV-1, including children many of
whom are already infected by age three. In fact, studies suggest that by
adolescence 62% of Americans are infected with HSV-1 and by the time one is in
the 40's, 90% have been infected.
All sexually active people are at risk for acquiring genital herpes. Having
multiple sexual partners puts you at even greater risk. Estimates of how many
Americans are infected range from 20% to 30%.
Immunosuppressed individuals (see
Special Populations) are at
increased risk for severe cases of herpes.
In many instances, your doctor is able to make the diagnosis of herpes from
physical appearance of the lesions and no tests are required. If your doctor is
not 100% certain, however, then fluid from the blisters can be removed and
tested for the herpes simplex virus. This can be done through viral cultures
which is very accurate but generally takes 2 to 3 days to get the results and
make an official diagnosis. Another more immediate, but less accurate, approach
is to do a Tzanck test of the skin lesions. This involves taking a sample of
fluid from the blisters, staining the fluid with a dye, and examining the
stained fluid under the microscope looking for a characteristic appearance of
the virus. Finally, there is a blood test that may be helpful for making a
diagnosis, especially if herpes simplex is suspected but no symptoms are present
or if a distinction between HSV-1 and HSV-2 is needed.
Prevention of spread from one person to the next is quite difficult since the
virus can be transmitted even when there are no visible lesions. Some measures
that may help, however, are described below.
If you do not have herpes:
- Avoid direct contact with cold sores or genital herpes lesions on
other people. For example, avoid sexual intercourse altogether when your partner
has active lesions. At other times, use latex condoms, which can help avoid but
not eliminate sexual transmission of genital herpes.
- Wash items that may have saliva or other bodily fluid from someone
with oral herpes in boiling water before you use (like razor blades, drinking
cups or glasses, etc.)
- Do not share certain items (like a toothbrush, razor, etc.) with an
infected person, especially when herpes lesions are active.
If you do have herpes:
- Avoid precipitating causes like sun exposure and try to reduce your
stress level. (See
- Avoid performing oral sex when you have active herpes lesions on or
near your mouth.
- Use latex condoms even when lesions are not present and avoid sexual
intercourse altogether when you have active lesions.
Herpes cannot be cured, so the goals of treatment include reducing the number
of recurrences and lessening your symptoms when you have an outbreak.
Even without any intervention, oral herpes lesions generally subside in no
more than 1 to 2 weeks. Using
medications may shorten the course and
decrease the discomfort.
Some cases of genital herpes may be quite mild and not need any treatment. In
severe or prolonged cases, however, as well as herpes infections if you are
Special Populations) or if you
have frequent recurrences,
medications that fight the virus may be
In addition to physical relief of symptoms and reducing frequency of
outbreaks, coping with the emotional and social aspects of having genital herpes
is part of treatment. See
Taking lukewarm baths or applying ice to herpes lesions may help reduce pain,
burning, or other discomfort. It is important to cleanse the infected area with
soap and water, which may help avoid local spread of herpes from the active
blisters to surrounding areas on your skin. After bathing or washing, it is
important to completely dry the affected area.
Wear cotton underwear and avoid tight fitting clothes as they can restrict
air circulation and slow the healing of lesions.
Coping with the emotional and social aspects of having genital herpes can be
Mind/Body Medicine for further
Antiviral medicines may help shorten the duration of a herpes outbreak. If
you have 6 or more recurrences of genital herpes per year, your doctor may
recommend use of antiviral medicines at all times to prevent such frequent
Medications that your doctor may prescribe include:
For maximum benefit during recurrences, medication should be started as soon
as you experience the tingling, burning, itching, or other sensations that often
precede the appearance of the herpes lesions.
Acyclovir given intravenously (through a vein) in the hospital is sometimes
needed if you have an infection involving the brain, eyes, or lungs or if you
are in a group at high risk for complications (see
Foscarnet, another antiviral agent that is quite powerful and also delivered
intravenously, may be nececessary if your herpes lesions are resistent to
acyclovir or the other medications listed.
|Nutrition and Dietary Supplements|
Because supplements may have side effects or interact with medications, they
should be taken only under the supervision of a knowledgeable healthcare
Although the research to date is not entirely conclusive, lysine supplements
have been used to help treat or prevent mouth and genital lesions caused by
herpes. Taking lysine supplements or increasing lysine in your diet (from foods
like fish, chicken, eggs, and potatoes) may speed recovery time and reduce the
chance of recurrent breakouts of the herpes infection. If you have high
cholesterol, heart disease, or high triglycerides (type of fatty material in the
blood, generally measured when you have your cholesterol checked), it is best,
at this point, not to use lysine because animal studies suggest that this
supplement may raise cholesterol and triglyceride levels.
Propolis, a resin from tree bark and leaves, is loaded with flavonoids
(antioxidants that help fight infection and boost immune function). A study of a
small number of people with genital herpes compared an ointment made from
propolis to acyclovir ointment (a medication commonly used for herpes). In this
research trial, the lesions of those using the propolis healed more quickly than
those using acyclovir. Research on larger numbers of people would be helpful. In
the interim, it may be worth trying propolis ointment for genital herpes lesions
if your doctor approves.
Test tube studies suggest that spirulina, also known as blue green algae, has
activity against certain viruses including herpes. Whether this laboratory
finding will prove beneficial for people in treating herpes infections is not
known. More research is needed before a recommendation can be made.
Topical preparations of zinc have shown benefit in
relieving symptoms and preventing recurrences of oral herpes
The use of herbs is a time-honored approach to strengthen the body and treat
disease. Herbs, however, contain active substances that can trigger side effects
and interact with other herbs, supplements, or medications. For these reasons,
herbs should be taken with care and only under the supervision of a practitioner
knowledgeable in the field of herbal medicine.
Aloe (Aloe vera)
Preliminary evidence suggests that aloe gel used topically may improve the
symptoms of genital herpes. Whether this same use of aloe will apply to oral
herpes lesions is not known, but it may be worth trying in order to reduce the
length and severity of your symptoms. Talk to your doctor about the possibility
of using topical aloe vera for herpes lesions.
Lemon Balm (Melissa officianalis)
Some studies suggest
that topical ointments containing lemon balm may help heal herpes cold sores. In
one study of 116 people with HSV, for example, those who applied lemon balm
cream to their lip sores experienced significant improvement in redness and
swelling after only two days. Although other symptoms (such as pain and
scabbing) did not improve, both the participants and their physicians reported
that the lemon balm ointment was highly effective. Several animal studies also
support the value of topical lemon balm for oral herpes lesions.
Peppermint Oil (Mentha x piperita)
In test tubes,
peppermint oil has exhibited antiviral properties against a number of infectious
agents, including herpes. Whether this would translate into help for relieving
herpes lesions is not known at this point.
In one Swiss study, a cream made from sage (Salvia officinialis) and
rhubarb (Rheum palmatum) lessened the length of time that herpes lesions
were present to the same extent as the medication acyclovir. More research on
this topic would be helpful.
Siberian Ginseng (Eleutherococcus senticosus/Acanthopanax
Although not all studies agree, one 6-month study of 93 people with HSV-2
(which, again, generally causes genital herpes lesions) found that Siberian
ginseng reduced the frequency, severity, and duration of outbreaks. This herb
should not be given to children and should not be taken if you have high blood
pressure, obstructive sleep apnea (repeated, prolonged periods when breathing
stops while sleeping), narcolepsy (frequent day time sleeping), are pregnant or
Tea Tree Oil (Melaleuca alternifolia)
Use of tea tree oil, applied topically in gel form, has some popularity for
herpes lesions on the lips. Although more research is needed before definitive
conclusions can be drawn, there is some scientific basis for this use. First, in
test tubes, tea tree oil has the ability to fight both strains of herpes viruses
(HSV 1 and HSV 2). Secondly, there has been one small study comparing use of tea
tree oil gel to placebo in those with recurrent oral herpes. The herpes lesions
of those who used the tea tree oil healed more quickly than those who used
placebo. Studies of larger numbers of people are necessary, however, along with
studies that compare tea tree oil to medications used for herpes.
Additional herbs that may be recommended by an herbal specialist for the
treatment of either oral or genital herpes include:
- Pau d'Arco (Tabebuia
Although Echinacea (coneflower) has gained some popularity for the
prevention of herpes, there is no scientific evidence that it works for this
purpose. In fact, despite test tube studies suggesting that Echinacea has the
ability to fight the herpes virus, one study of people with herpes did not show
any reduction in the number of their outbreaks.
To try to prevent herpes outbreaks, herbalists may also consider remedies
that help strengthen your immune system or act as adaptogens (substances that
help relieve stress).
Case reports in the scientific literature suggest that acupuncture may help
reduce the length of time of a herpes outbreak and decrease your chances for
recurrent lesions. Additional research would be helpful.
|Massage and Physical Therapy|
Regular massage can help alleviate chronic stress; therefore, in theory,
receiving massage on a regular basis may help avoid recurrent outbreaks.
Aromatherapy, a massage method using essential oils, is one that has been
evaluated for these purposes and results thus far suggest that this is a useful
Although few studies have examined the effectiveness of specific homeopathic
therapies, professional homeopaths may consider the remedies described below for
the treatment of herpes based on their knowledge and experience. One study of 53
people with genital herpes did show that the majority experienced improvement in
their symptoms and were less likely to have recurrent outbreaks when treated
with homeopathy. Participants in this study were followed for up to 4 years.
Before prescribing a remedy, homeopaths take into account a person's
constitutional type. A constitutional type is defined as a person's physical,
emotional, and psychological makeup. An experienced homeopath assesses all of
these factors when determining the most appropriate remedy for each
For lesions around the lips and mouth:
- Natrum Muriaticum -- for eruptions at the corners of the mouth
that occur during periods of emotional stress and tend to worsen in the daytime
- Rhus toxicodendron -- for eruptions consisting of many small
blisters that itch intensely at night
- Mercurius -- for children who drool and may have a fever
- Sepia -- for outbreaks that do not improve with other
homeopathic remedies; this remedy is most appropriate for individuals who tend
to have a lack of energy and don't tolerate cold weather
For genital lesions:
- Graphites -- for large, itchy lesions in individuals who are
- Natrum Muriaticum -- for eruptions that occur during periods of
emotional stress and symptoms that tend to worsen in the daytime
- Petroleum -- for lesions that spread to anus and thighs;
symptoms tend to worsen in winter and improve in summer
- Sepia -- for outbreaks that do not improve with other
homeopathic remedies; this remedy is most appropriate for individuals who tend
to have a lack of energy and don't tolerate cold weather
Having genital herpes can impact your social and emotional life and many find
it quite difficult to cope with this. In fact, if you have herpes, it is quite
common to feel depressed, angry, and even guilty. Worrying about possible
rejection by someone with whom you are hoping to become intimate is also
typical. Joining a support group in which members share common experiences and
problems can help alleviate these stresses associated with having genital
herpes. Seeing a couples' therapist with a committed partner may also be helpful
for working through some of these issues.
Using relaxation techniques, such as yoga, guided imagery, and meditation, on
a daily basis may help you feel better overall and cope with your stresses
related to having herpes.
In a 6-week training program to learn how to hypnotize oneself using guided
imagery, participants with frequently recurring genital herpes were able to
reduce their outbreaks by nearly 50% and improve their mood, including reducing
feelings of depression and anxiety.
Individual therapy with a psychiatrist, psychologist, or social worker as
well as biofeedback are other therapeutic approaches that can help reduce
symptoms associated with herpes and reduce one's tendency to withdraw from
social situations if you have genital herpes.
|Traditional Chinese Medicine|
A traditional Chinese physician would likely prescribe topical herbal
remedies consisting of a combination of herbal extracts to treat oral or genital
Herpes viruses can be transmitted to a newborn during vaginal delivery in
mothers infected with herpes viruses, especially if the mother has active
lesions in the vagina at the time of delivery. If you do have active lesions at
that time, delivery by cesarean section (often called C-section) will be
recommended to avoid infecting your baby.
Newborn baby - herpes infections contracted during
delivery from the mother can lead to meningitis, herpes infection in the blood,
chronic skin infection, and may even be fatal.
If your immune system is suppressed (from, for example, human
immunodeficiency virus [HIV], receipt of chemotherapy for cancer, long term use
of high doses of steroids, or use of medications that intentionally suppress the
immune system such as following organ transplant) are more likely to suffer from
complications of herpes and
are more likely to have severe, frequent outbreaks.
|Warnings and Precautions|
If you are diagnosed with genital herpes, you should be tested for other
sexually transmitted diseases like chlamydia and gonorrhea.
|Prognosis and Complications|
Herpes is a chronic, recurrent infection. The initial symptoms usually appear
within 1 to 3 weeks of exposure to the virus and last 7 to 10 days (for oral
lesions), 7 to 14 days (for genital lesions). Usually the number of outbreaks is
greatest in the first year and higher for HSV-2 genital lesions than HSV-1 oral
lesions. Each year after that, the number of outbreaks typically diminishes and
they become progressively less severe. But, you can never completely get rid of
Complications of herpes include:
- Herpetic keratitis - herpes infection of the
eye leading to scaring within the cornea and possible blindness
- Persistent herpes infection, without lesion-free periods
- Herpes infection in the esophagus
- Herpes infection of the liver which can lead to cirrhosis (liver
- Encephalitis and/or meningitis - serious
- Lung infection
- Eczema herpetiform - widespread herpes across
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|Review Date: June 2003|
|Reviewed By: Participants in the review process include: Shiva Barton, ND, Wellspace,
Cambridge, MA; Jacqueline A. Hart, MD, Department of Internal Medicine,
Newton-Wellesley Hospital, Boston, Ma and Senior Medical Editor A.D.A.M., Inc.;
Dahlia Hirsch, MD, Center for Holistic Healing, BelAir, MD; Richard A. Lippin,
MD, President, The Lippin Group, Southampton, PA; Sherif H. Osman, MD,
President, Medical Staff Harford Memorial Hospital, Falston General Hospital,
Bel Air, MD.|
Copyright © 2004 A.D.A.M., Inc
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