Herpes (Herpes Simplex Virus Type 1 and 2)

What is herpes?

Herpes infection, commonly known as herpes, is a group of aggressive diseases caused by the herpes virus. There are many types of this aggressive organism, but most cases are associated with herpes simplex viruses – type I and II. Once the infection enters the body, the virus remains in it forever, and when the general or local immunity is weakened, it causes the appearance of clinical symptoms. Early resort to a doctor and herpes treatment prevents the spread of the infection, reduces its symptoms, and improves the patient’s condition.

About the disease

More than 90% of people are infected with the herpes simplex virus. The virus causes damage to the skin and mucous membranes, especially in the human mouth and lips (type I), and external genitalia (type II). The infected person is contagious to others permanently – the virus can be detected in any of the biological fluids in their body (saliva, blood, vaginal secretions, etc.). The maximum concentration of infection is determined in the blisters produced in the clear clinical stage of the disease, during the relapse, so the likelihood of transmitting the virus to others during this period is very high.

Types of herpes
Four stages of herpes are distinguished according to the spread of symptoms:

  • Latent stage (where the person carries the virus without external symptoms of the disease).
  • Localized stage (a single blister appears).
  • Disseminated stage (two or more blister foci).
  • Generalized stage (multiple damage to mucous membranes and internal organs).

Depending on the severity of the infection, herpes can be classified as:

  • Mild.
  • Moderate.
  • Severe (accompanied by complications).

Based on the onset time and characteristics of herpes evolution, herpes can be congenital, acquired, primary, or recurrent.

Based on the clinical picture, a distinction is made between typical and atypical forms of the disease. Typical forms include the appearance of blisters in sites such as:

  • The eye.
  • Digestive system mucous membranes.
  • Skin.
  • Nervous system.
  • Internal organs.
  • Genitalia.
  • Generalized herpes.

Atypical forms include:

  • Abortive herpes (lack of clear clinical picture development, where symptoms regress in the initial stage).
  • Edematous herpes (the main sign is tissue swelling).
  • Herpes zoster (blisters appear along the nerve pathway as in the case of shingles).
  • Hemorrhagic herpes (blisters contain bloody contents).
  • Ulcerative herpes (ulcers and sores form at the site of burst blisters).
  • Necrotizing ulcerative herpes (when blisters burst, ulcers and necrotic areas are left in the tissues).
  • Herpetic eczema (appearance of large blisters merging with each other, covering most of the body surface).

Herpes symptoms:

  • Most herpes infections manifest as viral carriage without external symptoms. The clinical symptoms of the disease appear as a result of the influence of risk factors.
  • Herpes type 1 and 2 are characterized by the appearance of skin blisters in areas such as lips, mouth membranes, sides of the nose, external genitalia, and sometimes on the skin in chest and buttock areas. Initially, the patient feels itching and burning in the affected area of the skin, then the skin reddens and a group of blisters appears. These blisters fill with a transparent content containing large amounts of live viruses, and after several days, the content becomes unclear. The blisters can enlarge and merge to form multiple chambers with a diameter of up to 1.5 cm with irregular edges. Itching, tingling, and pain continue on touching.
  • After 3-4 days, the blisters on the skin burst and gradually dry out with the formation of a gray-yellow crust, which falls off after 5-7 days, leaving non-permanent pigmentation. When blisters are present on mucous membranes or moist areas of the skin, painful and bothersome ulcers with a clearly red bottom form, which take longer to heal.
  • Infection with blisters can occur on mucous membranes of the cheeks, lips, gums – oral herpes.
  • Genital herpes may be accompanied by swelling and pain in the inguinal lymph nodes.
  • In most cases of the disease, the patient does not suffer from deterioration in general condition, but severe clinical cases, especially for patients with immunodeficiency, can lead to fever, general weakness, and other symptoms of poisoning.

Factors that trigger recurrent herpes symptoms:

  • Influenza and other acute infectious diseases.
  • Severe physical illnesses.
  • Exposure to cold.
  • Excessive heat exposure.
  • Prolonged exposure to ultraviolet radiation (under sunlight, in tanning beds).
  • Sudden changes in climate and time zones.
  • Fatigue and lack of adherence to work and rest regimen.
  • Sleep disorders and insomnia.
  • Unhealthy and unbalanced nutrition.
  • Psychological stress.
  • Hormonal disorders.

Causes of herpes:
The causative agent of the disease is the herpes simplex virus (HSV). The first type of herpes simplex virus primarily causes oral herpes (on the lips, skin, and mucous membranes of the face), while the second type causes genital herpes (on the external genitalia).

The herpes simplex virus is a DNA-containing virus characterized by its ability to adhere to the skin and mucous membranes and actively replicate in infected cells without causing any symptoms during this process. It also interacts with nervous tissues – where it remains “dormant” in nerve ganglia for years, retaining its ability to remain alive and ready to “awaken” and cause disease under favorable conditions.

The first type of herpes simplex virus is mainly transmitted through saliva by airborne and physical contact (during conversation, kissing), while the second type is transmitted through sexual contact. Both types can be transmitted through household contact, or through infected blood, or from mother to fetus through blood (5% of cases) or during childbirth (95% of cases).

The second type of herpes simplex virus has oncogenic properties and increases the likelihood of infection with and spread of human immunodeficiency virus (HIV).


Confirming symptoms and treating herpes is the responsibility of dermatologists, venereologists, and sometimes general practitioners. Initially, the doctor speaks with the patient – inquiring about complaints, collecting medical and personal history. Then, a physical examination is performed – examining the patient’s skin and detecting skin rash, and determining the presence of herpes infection by the appearance of the rash. The skilled doctor examines not only the area indicated by the patient (such as the lips) but all skin tissues in the body. Therefore, they can detect signs of the beginning of the rash in other areas or signs of another disease process.

To confirm the diagnosis, the following tests may be ordered for the patient:

  • General clinical blood analysis (there may be a decrease in white blood cell count or an increase with a shift in white blood cell formula towards the left – in cases of secondary bacterial infection).
  • Chemical blood analysis (increase in concentration of liver enzymes in severe infections and spread of the disease process).
  • Blood analysis by the viral load technique (an increase in IgG and IgM concentrations for herpes simplex virus type 1 or 2 will be detected).
  • Biological sample reverse transcription-polymerase chain reaction (viral genetic material will be detected).


Mild cases of herpes infection can be treated topically. Patients with severe and complicated infection forms require internal treatment. The basis for treating herpes in adults is effective antiviral medications against the herpes simplex virus. Patients can use them locally or orally, according to the condition. Tablets or capsules containing antiviral drugs can be taken according to one of two strategies:

  • Long-term suppressive therapy (used when infection recurs every 1-2 months or more; the medication is taken daily for a year or more).
  • Episodic therapy (used when outbreaks occur rarely, less than once every 2 months; when the first signs of infection appear, the patient takes a high dose of medication – which prevents the virus activity and recurrence of outbreaks).

To reduce the risk of disease occurrence and prevent its recurrence, the following measures can help:

  • Healthy lifestyle (adherence to work and rest regimen, daily physical activity, balanced diet, adequate sleep).
  • Stress reduction.
  • Prevention and early treatment of infectious diseases.
  • Monitoring the development of chronic physical illnesses and maintaining important indicators of body functions (blood pressure, cholesterol and blood glucose levels, etc.) within acceptable values.
  • Avoiding prolonged exposure to direct sunlight.
  • Avoiding exposure to extreme cold.
  • Using barrier contraception methods (condoms) during sexual intercourse (in the case of the second type of herpes simplex virus).

To prevent recurrent infection with the already existing herpes simplex virus in the body, vaccines against herpes simplex virus can help.

Article Author:

Dr. Ibrahim Mansour
A general practitioner and orthopedic specialist with 9 years of experience in the emergency department. Specializes in treating infectious diseases and gastrointestinal diseases, with a focus on skeletal aspects using therapeutic, surgical, and conservative methods for injuries, including sports-related ones, and major joint diseases in the extremities. His area of interest includes joint-preserving procedures in the knee and hip joints.


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