What is herpes?

The herpes simplex virus (HSV) is a highly contagious virus that causes a lifelong infection.

There are two main types of HSV:

1. HSV-1: Primarily causes oral herpes, resulting in cold sores or fever blisters around the mouth. However, it can also cause genital herpes through oral-genital contact.
2. HSV-2: Mainly causes genital herpes, characterized by sores or blisters in the genital or anal area. It is almost always sexually transmitted.

Both types of herpes can be transmitted through direct contact with an active lesion or through skin-to-skin contact during viral shedding, even if no symptoms are present.

You may not notice for a long time that you have been infected.

“After the virus infects a person, regardless of whether it manifests itself on the skin or not, it penetrates into the local sensory nerves,” 

explains Tatyana Svyatenko, Vice-President of the Ukrainian Association of Dermatovenereologists and Cosmetologists.

“There, it can lie dormant for a long time until the next reactivation, which happens weeks, months or even years after the virus got on the skin.”

Types of herpes simplex virus

HSV-1 and HSV-2 have different primary infection sites and modes of transmission:

1. HSV-1: Typically infects the mouth and lips, causing oral herpes. It is often transmitted through non-sexual contact, such as kissing or sharing personal items like toothbrushes or utensils. 

In some cases, HSV-1 can cause genital herpes if there is oral-genital contact with an infected person.

1. HSV-2: Primarily infects the genital and anal areas, causing genital herpes. It is almost exclusively sexually transmitted through vaginal, anal, or oral sex with an infected partner. HSV-2 rarely causes oral herpes.

Both types of herpes can cause similar symptoms and remain dormant in the body, leading to periodic outbreaks. 

However, HSV-1 outbreaks tend to be less severe and less frequent compared to HSV-2.

How herpes is transmitted

Herpes is highly contagious and can be transmitted through various means:

1. Direct contact with herpes sores or blisters: The virus is most easily spread when there are active lesions present. Touching, kissing, or having sexual contact with the affected area can lead to transmission.
2. Skin-to-skin contact during viral shedding: Even without visible symptoms, the virus can be present on the skin’s surface and spread through skin-to-skin contact, such as during sexual activity.
3. Oral-genital contact: HSV-1 can cause genital herpes if there is oral-genital contact with an infected person, such as during oral sex.
4. Vertical transmission: A pregnant woman with genital herpes can pass the virus to her baby during vaginal delivery, potentially causing neonatal herpes, a severe and life-threatening condition.

According to the World Health Organization, an estimated 3.7 billion people under the age of 50 have HSV-1 infection globally, while 491 million people aged 15-49 have HSV-2 infection worldwide. 

The high prevalence of herpes infections can be attributed to the fact that many people are asymptomatic or have mild symptoms, which can lead to unintentional transmission.

Symptoms and manifestations of herpes

Primary infection symptoms

The primary infection is often invisible, as it may only cause short-term redness of the skin. 

However, sometimes the entry of the virus into the body leads to a deterioration in health – fever, swelling of the lymph nodes, the appearance of soreness and blisters in the mouth, on the lips or in other places on the skin. 

Recurrent outbreak symptoms

When the virus becomes active again, the first symptoms are itching, burning, tingling, and pain in the affected area. 

They are followed by a pink rash that turns into small blisters. They dry out quickly, form crusts, and such areas heal within a few days or a week. 

Repeated flashes usually occur in the same place, such as the upper lip on the right.

Herpes simplex in the eye

If the herpes simplex virus affects the eyes, it is accompanied by pain, discharge, sensitivity to light, and can cause scarring.

Common triggers of herpes outbreaks

The most common causes of herpes simplex are: other infectious diseases, such as colds or flu, fatigue and exhaustion, excessive insolation (often a prolonged vacation at the sea provokes the appearance of bubbles), the effect of sunlight on the damaged area of the skin, abrasions and scratches on the skin where the virus manifests itself on the surface. 

Most often, the infection bothers the elderly and seriously ill people, adults and children suffering from eczema, people with reduced immunity and those who take steroid drugs.

Diagnosing and treating herpes

How herpes is diagnosed

As a rule, dermatovenereologist do not hesitate to make a diagnosis – the clinical appearance of the skin affected by herpes simplex is enough to make a verdict. 

To confirm the diagnosis, a nurse or doctor may take a swab from the surface of the affected area. However, you have to wait several days for the result.

Can herpes be cured?

As a rule, yes. Symptoms of the disease disappear in 7 to 10 days with or without treatment, although the virus will now remain dormant in the body for life. 

In most patients, recurrent symptoms are mild and infrequent, if not at all. For the rest, unpleasant relapses can usually be prevented with oral antiviral medications and lifestyle changes.

Treatment options for herpes outbreaks

“Many mild forms of herpes simplex do not require special treatment,” says Tatyana Svyatenko. “However, there is one universal rule in its prevention and treatment: any methods of therapy work best if you start using them as early as possible.”

Antiviral medications

Treatment with antiviral medications can help reduce the severity of the outbreak and/or shorten it. 

Such medications (acyclovir, famciclovir, or valacyclovir) can be taken as tablets and have few side effects. 

Be sure to follow the correct dosage (medications need to be taken frequently). Recurrent forms of herpes infection require long-term antiviral treatment.

Topical treatments

Medications with acyclovir and famciclovir are also available in the form of creams, but they are less effective than tablets. 

In any case, the drug and dosage should be prescribed by a doctor. Especially if the infection manifests itself in the eye area.

Risks of herpes during pregnancy and childbirth

Genital herpes is a common sexually transmitted infection caused by the herpes simplex virus (HSV). While herpes is generally manageable in adults, it can pose serious risks during pregnancy and childbirth.

Risks to the baby from herpes

If a pregnant woman contracts genital herpes for the first time during the last 6 weeks of pregnancy, there is a higher risk of transmitting the virus to the baby during vaginal delivery. This can lead to neonatal herpes, a rare but potentially life-threatening condition for newborns.

Neonatal herpes can cause:

• Blindness
• Deafness
• Seizures
• Serious infections, such as viral meningitis
• Recurrent skin infections
• Death, if left untreated

Transmission during pregnancy and childbirth

HSV can be transmitted to the baby in the following ways:

• During pregnancy, if the mother experiences a primary genital herpes infection in the last trimester
• During vaginal delivery, through contact with active genital lesions
• After birth, through contact with cold sores or herpes blisters (e.g., if someone with an active cold sore kisses the baby)

Managing herpes during pregnancy

Pregnant women with a history of genital herpes should inform their healthcare provider. 

Antiviral medication may be prescribed during the last month of pregnancy to prevent an outbreak during labor.

If genital herpes occurs for the first time during the last 6 weeks of pregnancy or if active lesions are present at the time of delivery, a cesarean section is recommended to reduce the risk of transmission to the baby.

Preventing transmission after birth

To prevent transmitting HSV to a newborn:

• Avoid kissing the baby if you have an active cold sore
• Wash hands thoroughly before contact with the baby
• Cover any cold sores or herpes blisters when breastfeeding to avoid accidentally touching the mouth and then the breast

In summary, while the risk of neonatal herpes is low, the consequences can be severe. Pregnant women with genital herpes should work closely with their doctors.

Tips for managing herpes outbreaks

Home remedies for cold sores

Sometimes a cool, moist compress or salt bath helps with the initial manifestations of cold sores. To prevent blistering, it is helpful to moisturize the skin, sometimes with regular petroleum jelly.

Hygiene practices during outbreaks

Gently clean the affected area. Dry your skin thoroughly, but gently.

Limiting contact with others during active outbreaks

It should be remembered that at the moment when the bubbles are opened, the person poses the greatest danger to others due to the high risk of infection. 

At this point, it is advisable to limit contact with people to a minimum, because the virus can be transmitted through household items.

Preventing herpes outbreaks and transmission

Lifestyle changes to prevent outbreaks

Avoid exertion, physical and mental exhaustion, and hypothermia. Take care of your health and get enough sleep.

Avoiding triggers like sun exposure

Avoid sunlight on the herpes favorite area of the skin, exclude tanning beds if you notice that they cause a flare-up.

Using UV protection

Use creams with UV protection.

Hygiene tips to avoid spreading the virus

Not sharing lipstick/makeup

Do not use saliva to wet eyeliner pencils, as the virus causes severe eye damage. 

Never take someone else’s lipstick or borrow your own.

Using separate towels and utensils

For the duration of the illness, provide yourself with separate towels, cutlery, cups, plates (others should not use them).

Refraining from intimate contact during outbreaks

If you notice cold sores on your partner’s lips, refrain from kissing for 7 to 10 days, as a herpes infection is easily transmitted this way. 

During this time, the immune system will cope with the virus, and you will be able to kiss again. 

Do not touch the inflamed area of skin with herpes rashes to other people’s skin. 

Exclude oral sex for the duration of the illness, as you can infect your partner with genital herpes, and then he, in turn, will “return” it to you during normal sexual contact.

Conclusion

Key takeaways about herpes transmission and kissing

Herpes is a very old and common viral skin infection caused by the herpes simplex virus that is transmitted through direct contact. 

Kissing someone with active herpes lesions can transmit the virus. 

Limiting contact, practicing good hygiene, and taking antiviral medications can help manage outbreaks and reduce transmission.

When to see a doctor

If you experience symptoms of herpes, especially a primary infection, it’s important to see a doctor for diagnosis and treatment. 

Pregnant women with genital herpes should inform their obstetrician to reduce risks during childbirth.

About the Author

Ainur Abdullayeva

is a healthcare journalist and medical writer at Mister Blister, based in Almaty. With a medical degree from Kazakh National Medical University, she specializes in demystifying complex topics like pharmaceutical regulations and drug development. Ainur provides insights into the evolving healthcare landscape across Central Asia, including pharmaceutical marketing strategies and traditional Kyrgyz medicine.