Herpes Simplex

Two herpes simplex viruses cause skin infection. They are called herpes simplex type 1 and type 2.

They can be transferred from person to person by direct skin to skin contact with the affected place when enough virus is present. 

This infection is often a lesion or sore, but transmission may also occur at other times, perhaps when there is only an itch or tingle in the area.

The most common places of infection are the mouth (known as ‘cold sores’), followed by the genital area (genital herpes) and the hands.

Most people are only infected in one area and are unlikely to transfer the infection to other parts of their bodies. Infection may be followed by symptoms, such as sores or blisters, within a few days, but some people will not notice anything for months or years. Others are carriers who never have symptoms. 

The virus remains dormant in the sensory nerves close to the place of the initial infection. Reactivation may result in more blisters nearby, on the skin that is served by the same nerves (dermatome). The frequency of recurrences varies from person to person. For some people, symptoms appear several times a year, in others rarely or never.

You catch it through direct contact with an affected area of a person’s skin or mucosa when the virus is active. When the infection is active on your skin, do not let that area touch another person’s skin.

Herpes cannot be caught from towels, swimming pools, saunas, or from toilet seats. However, it can be passed on through sharing sex toys, or other intimate items such as razors, when there is an active lesion.

The very first infection is often unnoticed as it may only produce a short-lived redness of the skin. Sometimes, however, an early infection can make a person feel very unwell with a temperature, swollen lymph glands and soreness and blisters in the mouth, on the lips, or elsewhere on the skin. 

The virus may lie dormant in the nerve endings for some time, but when it becomes active again, the first symptom is a burning or stinging pain at the affected site, followed by pink bumps and small blisters. The blisters quickly dry and crust over, and the areas usually heal within a few days. Symptoms may recur at the same place or nearby.

If the herpes simplex virus infects the eye, it causes pain, discharge, and sensitivity to light, and can cause scarring.

Usually, the clinical appearance of the skin affected by herpes simplex is enough to make a diagnosis.  

Symptoms get clear in 7-10 days, with or without treatment, though the virus will remain in a dormant state.

In a majority of patients, recurrent symptoms are mild and infrequent or do not happen at all. For a minority, troublesome recurrences can usually be prevented by using oral antiviral drugs or adopting lifestyle changes. 

Factors that may increase the risk of virus reactivation are:

• Other infections, such as colds or ‘flu.’
• Getting tired and run down. 
• Sunlight on the affected area. 
• A skin injury, such as an operation or a graze, where the virus shows itself at the surface

Many mild cold sores need no specific treatment; antiviral drugs may be required if symptoms make the patient uncomfortable. 

If you have recurrent outbreaks of herpes simplex, you may be able to avoid things that seem to trigger them, or make specific lifestyle alterations:

• Get enough sleep. 
• Have a healthy diet.
• Avoid sunlight on the affected area if you find it triggers outbreaks.
• Avoid sunbeds.
• Use UV protection. Try also to avoid spreading the infection to someone else. If the infection is active on your skin:
• Do not let that area touch another person’s skin.
• Use tissues when drying the area. • Do not use a communal towel.

People are at particular risk of developing a severe primary herpes simplex infection if they are:

• Elderly.
• Very ill. 
• Eczema sufferers, especially children, may develop widespread infection and should seek urgent medical attention. • Persons with a compromised immune system due to medicines or illnesses affect the immune system, such as HIV infection.

The following treatments may help:

• Apply a cold, wet compress or wash the area gently with saltwater. Dry thoroughly but gently. • Use a greasy moisturizing cream on the skin, e.g., petroleum jelly.
• Use an antiviral cream on the affected skin surface.
• Antiviral tablets may be required if the infection is severe or recurs frequently. Occasionally, if a patient is very unwell, antiviral treatment may be given via a drip.