herpes

Herpes: description

Herpes is triggered by viruses. There are several herpes viruses that can cause very different diseases in humans. They are referred to as human herpes viruses, HHV for short, and within this group distinguished by numbering from one to eight.

What is “herpes”?

By “herpes” is meant typically the typical symptoms caused by the herpes simplex virus (HSV). The viruses of the genus Herpes simplex are subdivided into type 1 and type 2, ie: HSV1 and HSV2. The corresponding abbreviation for the human herpetic types is HHV1 or HHV2. HSV1 is mainly responsible for cold sores, while HSV2 is usually the causative agent of genital herpes. Ultimately, however, both types of virus can cause herpes on both parts of the body.

Other herpes viruses cause diseases such as chickenpox and shingles (HHV3), glandular fever (HHV4) or three-daytime fever (HHV6 / 7).

How do you get herpes? – Contagion and reactivation

Once infected with the herpes virus, the virus remains in the body for a lifetime and can become active again at every opportunity (reactivation).

First herpes infection

As a viral disease, herpes is contagious. The transmission is from person to person, mainly by smear infection. The herpes virus must reach the mucous membranes of a healthy person from the place of infection or from the saliva of a sick person – for example when kissing or having sex. In general, the risk of herpes transmission increases even with close physical contact, so that infection can take place, for example, under children playing.

Sometimes, herpes is also transmitted indirectly between people or from one body site to another. If the person scratching about at the infected site, get the herpes virus in his hand and can infect other parts of the body or people.

Also by objects, such as used glasses, it sometimes comes to a contagion. However, herpes needs moisture. Dry out the herpes viruses, they die. According to recent studies, the herpesviruses can survive up to 48 hours outside the body. Since, in active herpes disease on the lips and mouth and the saliva is infected with viruses and contagious, the herpes viruses can even be transmitted by means of droplet infection in physical proximity. When speaking small droplets of saliva are formed, which travel short distances through the air and can thus reach the mucous membranes of other people.

How does herpes develop after the primary infection? – The herpes reactivation

The herpes simplex virus is not completely destroyed by the immune system, but only in a kind of resting state (latency). Within certain cells, it remains inactive most of the time and does no harm. In certain circumstances, reactivation of the herpes disease can occur.

After the first infection with the herpes simplex virus (primary infection), the viruses multiply first in so-called epithelial cells on the skin surface. Although they are being combated by the immune system, some of the viruses migrate from nerve fibers to their cell bodies. Here they survive, unnoticed by the immune system, for a lifetime. Herpes viruses accumulate mainly in so-called nerve ganglia, accumulations of nerve cell bodies.

If the immune system is temporarily or permanently weakened, individual herpes viruses can migrate from the ganglia back to the epithelial cells. There they multiply again and again cause the typical symptoms. How often it comes to such reactivation is very different individually. In some people, herpes occurs several times a year, others are after the primary infection only rarely or not more affected. The HSV2-induced genital herpes is reactivated more frequently than HSV1-related cold sores. More about the triggers of a reactivation can be found in the section “Herpes: Causes and risk factors”.

When is herpes contagious?

Herpes is contagious only during primary infection or reactivation. Because then viruses are eliminated. However, the classic symptoms do not always have to be present. In so-called latent infections, those affected excrete viruses, but show no symptoms. Failure to take appropriate precautions, the risk of herpes transmission is greater. While the virus is at rest, a herpes infection is not possible.

incubation period

Between the infection and the appearance of symptoms are about three to seven days (incubation period), even several weeks are possible.

Who is affected by herpes?

Herpes is a very contagious disease. According to a study, up to 85 percent of Germans are infected with the type 1 herpes simplex virus. At HSV2, the rate is much lower at around 15 percent.

HSV2 usually causes genital herpes and is mainly transmitted via sexual intercourse. The herpes simplex virus 1, however, is widespread and is usually passed on already in infancy or early childhood within the family.

Herpes: symptoms

The typical painful cold sores are usually on the face (especially on the lip), or in the genital area. In addition, herpes can affect other parts of the body and in rare cases lead to serious complications. In addition, the primary infection with herpes sometimes differs from the reactivation.

Herpes symptoms at the primary infection

First, non-specific symptoms (prodromal symptoms) often appear, later it comes to the typical symptoms on the skin. The first symptoms follow directly on the incubation period and can occur up to two days before the actual illness. Typical are general malaise, fatigue, headache, fever and sometimes nausea. During this prodromal phase, there is often an itching or tingling in the areas where the blisters eventually develop, and even mild pain is possible. The actual herpes outbreak is then accompanied by liquid-filled blisters on reddened skin, swelling and skin damage. Of “herpes stages” can speak only conditionally, because the transitions are fluid. Even after bubbles are already burst and encrusted, fresh bubbles can form again.

Herpes in children

First-time herpes in children is often more difficult than in adults. The children often feel very miserable, with a high fever, similar to a strong cold or flu. The classic herpes symptoms do not necessarily occur, so that herpes in infants and children sometimes not recognized as such, but is held for a normal viral infection.

A special form of herpes in children is Gingivostomatis herpetica, in which it comes to a pronounced infestation in the mouth, occasionally adults are affected. You can read more about this under “Herpes in the mouth”.

Herpes symptoms at a reactivation

In contrast to the primary infection, the initial stage of herpes in a reactivated outbreak usually falls significantly weaker and takes only a few hours. Often, those affected before the onset of the actual herpes signs even no complaints. Although the outbreak is often weaker than the first infection with herpes, the course and type of symptoms are then the same.

How long does herpes last?

The fluid-filled blisters usually heal again after six to ten days, but the “herpes duration” can also be two or three weeks, until complete healing. How long the disease lasts depends on the stage of the disease. In a first infection, the complaints are often more persistent, in the case of reactivation, the body defense with the herpes virus is already familiar and gets the infection faster under control.

If the herpes symptoms last unusually long, in addition to an immunodeficiency synonymous so-called superinfection exist – an additional bacterial infection of the affected skin. Because the damaged skin is an ideal entry point for bacteria with weakened body defense.

How long is herpes contagious?

Herpes is contagious when viruses are eliminated and fresh blisters are detected. The biggest herpes infection risk comes from the liquid in the blisters, in which there are a large number of viruses. Once all the bubbles are encrusted and no new ones occur, the risk of infection is already much lower. Nevertheless, even some time after the fall of the herpes crust small amounts of virus can be eliminated.

Herpes special forms and complications

Herpes simplex infections typically occur on the lips and genital area. Under certain circumstances, other body regions can be infected. If the eyes or the brain are affected, serious complications are imminent.

Herpes on the skin

The herpes simplex virus can be transmitted from the actual infection site – such as scratching – to other areas of the skin. Preferably this happens on injured or very thin skin regions. For example, it can be herpes on the eyelid and herpes on the back as well as herpes on the arm or herpes on the finger.

A special case is the eczema herpeticatum. It is a large-scale herpes infection with rapidly bursting vesicles in those who additionally suffer from skin diseases such as atopic dermatitis or psoriasis. Typical is a pronounced sense of illness.

Herpes on the eye

A dangerous special case is herpes on the eye. A distinction is made here between an infection of the cornea (herpes simplex keratitis) and the retina (herpes simplex retinitis). While corneal involvement can be caused by both external transmission and reactivation, in the case of herpes on the eye with mere retinal involvement, only reactivations are the trigger. A herpes simplex keratitis can usually treat the doctor well, in a retinal infection, however, threatens blindness of the affected eye. Eye herpes is a serious complication that needs to be treated as quickly as possible.

Herpes encephalitis

A herpes encephalitis (inflammation of the brain) can trigger the virus, usually HSV1. If herpes is located in the brain, life-threatening complications are possible. In the beginning, you may experience severe nausea with vomiting and headache, and epileptic seizures, confusion, and odor disturbances may occur before patients eventually become comatose. Left untreated, herpes simplex encephalitis is fatal in about 70 percent of cases.

Generalized herpes simplex

Another complication is the generalized form of the disease. Then the viruses enter the bloodstream and multiply there excessively (viremia). Doctors also refer to severe forms as herpes simplex sepsis, ie blood poisoning with herpes viruses.

Generalized forms usually occur only in high-risk patients with severely weakened immune systems – such as after chemotherapy or organ transplants.

Cold sores

For details on the most common variant of herpes, see the text “Cold sores”.

Genital herpes

In the genital area, herpes is particularly annoying and usually associated with high shame. The most important thing about this topic can be read under Genital herpes.

Herpes in the mouth

First-time herpes in children sometimes leads to a large-scale infection in the mouth. More on this under herpes in the mouth.

Herpes in pregnancy

In pregnancy, there are some things to consider regarding herpes. For more information, see Herpes in pregnancy.

Herpes: cause and risk factors

The herpes simplex virus type 1 or type 2 is a relatively large DNA virus, which is usually strictly on its host, ie humans, specialized. From animals to humans or vice versa, a herpes infection usually does not take place. In most cases, the virus is transmitted during childhood within the family environment.

Children are often in close physical contact, herpes is therefore particularly contagious with them. It mainly makes the liquid content of the bubbles for the infection with herpes, you should not prick them therefore.

Risk factors for a herpes reactivation

A reactivation of the herpes disease usually occurs when the immune system is weakened or irritated by the nerve along which the viruses migrate. The reasons can be many. Common herpes causes are:

• Colds and flu infections
• Mental and physical stress
• Certain medications, such as cortisone or chemotherapy
• Too strong UV light radiation
• Hormonal changes
• injury
• Immunodeficiency disease HIV

Colds weaken the immune system and favor that dormant herpes viruses from the nerve ganglia can get back to the skin surface. The herpes symptoms often occur together with fever, which is why one also speaks of “cold sores”. Fever alone does not cause any blisters.

Why do you often get herpes after a sunburn? Excessive UV radiation irritates not only the skin but also nerves and herpes viruses can be activated. Similarly, skin lesions may favor reactivation.

People with a chronically weakened immune system are also more prone to reactivation with herpes. The cause of permanent immunodeficiency is, for example, an infection with the immunodeficiency syndrome HIV or the consequences of chemotherapy. But not everyone who complains of “constantly having herpes” must have an immune deficiency. Some people are more likely to reactivate than others without finding specific reasons. Especially stress, be it physical or mental, seems to favor herpes and frequent reactivations.

Herpes: examination and diagnosis

On the basis of the medical history and the symptoms, the doctor can usually recognize herpes easily, often a pure eye diagnosis is sufficient. In rare cases it is helpful to identify the pathogen in the laboratory.

Examination methods for herpes

To rule out similar diseases or to check herpes viruses for possible drug resistance, the following procedures are available:

Antibody determination (serology)

If the body is confronted with a pathogen, the healthy immune system forms so-called antibodies, which play an important role in the destruction of the pathogens. The detection of certain antibodies now indicates a herpes infection, but the result of such tests is not always clear. Especially in immune-compromised individuals can sometimes find no herpes antibodies, although the patient is infected.

It is helpful to determine the antibody to determine the distribution of the infection in a population group.

antigen determination

A much more accurate method of detecting herpes is to detect so-called antigens. This refers to the smallest biological components that stimulate a body’s immune system to produce antibodies. Most such antigens are foreign substances, such as components of viruses or bacteria. The herpes virus also has components that the test can detect.

Direct virus detection with PCR

The most accurate method to safely detect herpes viruses is the artificial propagation of virus DNA in the laboratory. Even with very small amounts of virus, the genetic material of the viruses can be multiplied with this method until it can finally be detected. This method is called polymerase chain reaction (PCR).

Breeding the herpes viruses

The most elaborate detection variant is the cultivation of herpes viruses. For this purpose, a sample is added to a nutrient fluid – the addition of drugs can be used to test the response of the virus and to adapt therapies. A distinction between HSV1 and 2 is also possible.

Herpes: treatment

How exactly to treat herpes can be read in the text Herpes: Treatment

Home remedies for herpes

It does not always have to be the expensive herbal ointment. Which alternatives are there and which make sense in the text is home remedies for herpes

Herpes: disease course and prognosis

In most cases, herpes is harmless. In a primary infection, especially in children, the symptoms occasionally appear somewhat stronger, but again, they rarely last longer than two weeks. In adulthood, reactivations mainly cause a herpes outbreak. The complaints are then usually milder. If the symptoms of herpes last much longer than two weeks, you should see a doctor to rule out complications or diseases with a similar appearance.

How can you prevent herpes?

A herpes infection with HSV1 can hardly be avoided, since a large part of the population is infected with it and it is usually infected as a child with the virus. The risk of genital herpes can be significantly reduced by contraceptive measures (condoms).

A strong immune system offers the best protection against frequent reactivations. Therefore, ensure a healthy, balanced diet, sufficient sleep and regular exercise. You should also avoid stress whenever possible. Especially in the cold season can be with the correct lip care to prevent some reactivation, because brittle, roughened lips facilitate infection. In summer you should protect the lips from UV damage with a sufficient sun protection factor.

Is there a herpes vaccine?

There is no effective, regularly used herpes vaccine yet, but some vaccines are currently being tested in clinical trials. Since type 1 herpes simplex virus is only minimally different from type 2, a functioning vaccine would automatically be effective against both types. Preventing herpes can hardly, but you can take some measures.

What should you avoid when having an active herpes disease?

Who suffers from herpes, should pay attention to some things, so as not to delay the course of the disease and not spread the virus unnecessarily.

• Avoid as much as possible any contact with the infected area.
• Wash hands thoroughly after touching an infected area.
• If you are a contact lens wear glasses during a herpes outbreak. This will prevent the virus from getting into the eye via smear infection.
• Do not share glasses, napkins, towels, cutlery, etc. with other people during an HSV1 infection.
• If you want to cover herpes, then not with make-up, but with a herpes patch. Otherwise, the viruses get to the make-up and can be further spread.
• Avoid direct skin contact, especially kissing, with other people.
• Scratch herpes Do not blister or remove the crust.