Are Symptoms of Herpes Visible?

Herpes simplex virus comes in two forms, or types, known simply as herpes simplex virus 1 (HSV-1) and herpes simplex virus 2 (HSV-2). Both belong to the Alphaherpesvirinae subfamily of the Herpesviridae family. Both cause painful lesions in the skin, either around the mouth or genitals of the infected party.

In the US, one in five adolescents is infected with herpes simplex.

Disease Pathology: HSV-2, Genital Herpes.

• Typically HSV-2 is responsible for genital herpes, although this is not always the case. HSV-1 can also appear as genital herpes. HSV-2 is the more virulent type of the virus, and it typically creates more discomfort than HSV-1.

  When infected with genital herpes, the virus is transmitted during sexual contact, across the epithelial mucosal cells or through contact with a lesion on the skin. It then migrates to the nerve cells (most commonly in the lumbosacral ganglia) and persists in a latent state in the cytoskeletal highway.

  Outbreaks occur within 2 to 20 days. Blisters teeming with the virus rise up on the skin, around the genitalia and anus. They then burst and form a sore or ulcer. Contact with these lesions should be minimized--if you touch one, immediately wash your hands with soap and water. Do not share towels or clothing. Herpes is most transmissible during an outbreak, but transmission is also possible with no visible symptoms.

Disease Pathology: HSV-1, orofacial outbreaks.

• HSV-1 typically causes orofacial sores, cold sores or fever blisters. These outbreaks are less painful and typically less frequent than HSV-2 manifestations of the disease. In the case of HSV-1, the virus is transmitted in saliva. After infection, the virus travels to the nerves in the face, typically in the trigeminal ganglia, where it lies dormant until triggered through either stress or disease. While less contagious when in its dormant state, transmission is still possible with no visible symptoms. HSV-1 is the most common form of herpes infection, the majority of infections occurring early in life from daily contact with friends and family.

Symptoms

• Over time, outbreaks become less frequent and are of shorter duration as the immune system contains the virus. The first outbreak, typically within 20 days of primary infection, is usually the worst. Symptoms typically persist from 7 to 10 days. Orofacial sores typically appear around the mouth, usually at the site of the primary infection. However, the sores (especially HSV-2) can manifest on the inside of the mouth, on the roof of the soft palate, on the sides and underside of the tongue, and even around the nose. When appearing around the genitals, the sores typically appear around the labia and vulva in women, and on and around the penis in men. Lesions are also common in and around the anus.

  Symptoms return as outbreaks at varying intervals. Some patients, due either to a more virulent strain of the virus or a weaker immune system in general, may have outbreaks as frequently as once a month. Some patients have reported fatigue and tiredness as additional symptoms, although there is little objective evidence for this. Other symptoms may include fever, headache, flu-like symptoms (ague, aches and pains), burning and painful urination, and vaginal discharge for female HSV-2 sufferers.

  The frequency lessens over time. Orofacial outbreaks from HSV-1 may appear less than once or twice a year.

  For around approximately 10% of people living with herpes simplex, there are no symptoms at all.

Triggers

• As the immune system combats the virus, the periods of latency increase and outbreaks decrease in magnitude and frequency. Outbreaks are then often associated with triggers. Triggers can be stress, fatigue, diet, sun burn, other disease or sickness, trauma (car crash, post operative stress or otherwise), depression, or even for no apparent reason at all.

Prodrome, a sign of a coming outbreak

• Some patients can tell before they have an outbreak, when a tingling sensation precedes the lesions (more often associated with HSV-2 infection). This sensation is called a prodrome and indicates the virus is activating within the neurons.

  Someone carrying the virus is very contagious at this stage, even before the lesions appear.

Treatment and Cure

• At present, there is no known cure for herpes infection, although certain anti-viral drugs can help control it. A healthy and nutritional diet can all help boost the body's natural ability to control the disease.

Congenital herpes

• Warning: The herpes virus can be devastating to newborns. Never handle a newborn if you have an herpes outbreak, either orofacial or genital. If you are a pregnant mother who suffers from genital herpes, you should tell your doctor so preventative steps can be taken. Herpes can be sometimes fatal to newborns if contracted congenitally (see Resources).