Herpes (herpes simplex)

• Overview
• Causes
• Symptoms
• Diagnosis
• Treatment
• Prevention

Overview of herpes

9 of the 200 herpes viruses can cause a variety of illnesses in humans and affect people of all ages. In fact, it is estimated that more than two thirds of the population carry herpes viruses, in many cases without even knowing it. This is because these viruses remain in the body after an initial infection that usually goes unnoticed, i.e. without symptoms, and remain in a state in which they do not form new viruses.

If the immune system is weakened, the virus is reactivated, begins to multiply and eventually leads to symptoms of illness. Whether or not herpes flares up also depends on the condition of the person’s immune system. In principle, it is possible for herpes to be (re)activated without the affected person noticing. However, even in such cases, the virus multiplies and is excreted, allowing it to easily spread to other people and trigger further infections.

It is estimated that about 70% of the Swiss population carries the HSV-1 virus and about 20% carry the HSV-2 virus. Infection with the HSV-1 virus often occurs in childhood, while the HSV-2 virus is mainly transmitted through sexual contact.

People with weakened immune systems, pregnant women and people suffering from chronic stress are particularly at risk of infection with herpes viruses. Other particularly vulnerable people are patients with immunodeficiency diseases such as HIV/AIDS or people whose immune system is suppressed by medication, especially transplant patients.

Types of herpes viruses

There are many different herpes viruses. This article focuses in particular on the herpes simplex viruses and the herpes simplex infection caused by them. In addition to herpes simplex viruses, the varicella zoster virus, which causes chickenpox and shingles, also belongs to the herpes virus family, as does the Epstein-Barr virus, which causes glandular fever.

The following herpesvirus infections are known in humans, among others:

• Certain types of cancer caused by human herpesvirus 8
• Shingles, caused by varicella zoster virus
• Chickenpox, caused by the varicella zoster virus
• Glandular fever, caused by the Epstein-Barr virus or the cytomegalovirus
• Cold sores, caused by herpesvirus 1 and, more rarely, herpesvirus 2 (HSV-1 and HSV-2)
• Genital herpes, caused by herpesvirus 2 and, more rarely, herpesvirus 1 (HSV-2 and HSV-1)

Herpes simplex virus

Herpes simplex virus (HSV) is a widespread virus that can be divided into 2 types: HSV-1 and HSV-2. Herpes simplex viruses often cause infections of the skin, mouth, lips, genitals and eyes. Basically, both types of virus can cause genital herpes and cold sores (herpes genitalis and herpes labialis), as well herpes in the eyes or nose.

Severe infections caused by herpes simplex viruses include meningitis, encephalitis or neonatal herpes. Since there are no vaccines that are effective against HSV-1 or HSV-2, treatment for these types of virus focuses on alleviating symptoms.

Herpes simplex virus: HSV-1

According to estimates by the World Health Organization (WHO), around two thirds of the world’s population are infected with HSV-1, making it a widespread viral infection. Herpes simplex virus 1 usually causes cold sores (herpes labialis) and is primarily spread through direct contact with infected people, mainly through their saliva or by kissing. HSV-1 ultimately causes blistering around the lips.

Herpes simplex virus: HSV-2

Herpes simplex virus 2 mainly causes genital herpes and is spread primarily through sexual contact. HSV-2 causes lesions and blisters in the genital area, which can be extremely painful. You should always seek medical attention if you are affected by genital herpes. 

Causes 

There are several triggers that can cause a herpes flare-up. In most cases, these are factors that either weaken or place strain on the immune system.

Herpes simplex viruses lie dormant in the body most of the time and do not cause any symptoms. However, certain situations can cause the viruses to activate, resulting in a herpes outbreak. These include:

• Injuries: both injuries and irritation caused by, for example, surgery or dental treatment can trigger the reactivation of herpes viruses.
• Stress: both physical and mental stress can weaken the immune system and cause a herpes flare-up.
• Weakened immune system: in addition to stress, medication such as immunosuppressants, illnesses or general immunodeficiency can also lead to the reactivation of herpes viruses.
• Fever: the virus can be reactivated by high temperatures in the body, such as those associated with a cold or the flu.
• UV radiation: intense sun exposure or sunburn can cause the virus to activate. This is particularly true for cold sores.
• Hormonal changes: hormonal fluctuations can trigger herpes, especially in women.

Although herpes viruses can be reactivated by a variety of factors, a specific reason for a herpes outbreak is not always apparent. Depending on the type of herpes virus, there are various possible ways it can be transmitted. These viruses are often transmitted through direct contact or bodily fluids. You can find out more about the different ways they can be transmitted in the ‘Prevention’ section. 

Symptoms 

In principle, herpes can occur anywhere on the skin or mucous membranes of the body, with the lips and genital area most commonly affected. In rare cases, however, herpes also affects the eyes. When this happens, medical assistance should be sought immediately.

Herpes usually begins with feelings of tension and itching at the site of the outbreak, followed by blistering. After some time, the blisters burst and form scabs. 

Diagnosis 

Herpes is usually diagnosed based on the typical appearance of the skin blisters and the symptoms. If necessary, the herpes virus can also be detected with a skin swab.

Treatment

The treatment of herpes is purely symptomatic. In general, herpes can be treated effectively with antiviral medication and complications can be prevented by early treatment.

Ointments or creams containing antiviral substances can be used to relieve the symptoms. Tablets or infusions are used in cases where the individual has a weakened immune system or severe symptoms, while painkillers and anti-inflammatory medications are used to alleviate the symptoms. A herpes flare-up usually heals without consequences within about a week.

Prevention

Da sich Herpesviren, abhängig von ihrer Art, auf unterschiedlichem Weg übertragen lassen, ist es wichtig, die Übertragungswege zu kennen, um Infektionen vorzubeugen.

Routes of transmission

Direct contact with infected individuals

Both HSV-1 and HSV-2 are often transmitted through direct contact with mucous membranes or skin. This is especially the case when active blistering is present.

HSV-1 in particular, which often causes cold sores, is frequently transmitted through contact with infected cold sores or saliva. HSV-2, on the other hand, is often transmitted through sexual intercourse.

During an active herpes infection, i.e. when blisters or open sores become visible, close physical contact should be avoided, especially kissing and sexual intercourse.

The risk of contracting genital herpes can be significantly reduced by using a condom as a contraceptive. However, it should be noted that herpes viruses can also infect areas of skin not covered by the condom. For this reason, using a condom doesn’t provide complete protection. 

Shared items

Shared items such as towels, cutlery or glasses can also pose a high risk of infection if viruses survive on them.

To prevent infection, items that come into contact with affected skin areas should not be shared during the acute phase. 

Birth

A herpes virus, such as HSV-2, can be transmitted by an infected expectant mother to her newborn during childbirth.

If a pregnant woman has genital herpes, she should discuss this with her doctor at an early stage, as herpes infections can be life-threatening for infants.

In some circumstances, a caesarean section may be necessary to prevent transmission of the herpes virus to the newborn. This is the case, for example, if initial infection occurs in the last trimester of pregnancy or if there is an acute flare-up at the time of birth.

General preventive measures against HSV-1 and HSV-2

There is currently no vaccination against herpes. However, there are some ways to reduce the risk of infection. These include, but are not limited to: 

• Having a strong immune system
• Reducing stress levels
• Taking good care of your skin
• Consistently practising good hygiene
• Using contraception

A strong immune system helps to prevent reactivation of the herpes virus. This can be promoted by getting enough sleep, regular exercise, a balanced diet and reducing stress.

Preventive measures against HSV-1

It’s important to start off by mentioning that it is difficult to avoid infection with HSV-1, as many people contract it in childhood and a large proportion of the world’s population is affected.

Chapped, rough lips can easily lead to infection. However, there are preventive measures that can help to avoid cold sores. Especially in the colder months of the year, the virus can reactivate. This can be prevented by taking proper care of your lips and keeping them moisturised. During the summer months, it is also recommended to protect your lips from UV damage by using care products that offer sufficient SPF levels.

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