Herpes simplex virus (HSV) is a viral infection that can affect different parts of the body, most commonly the mouth (oral herpes) and the genital area (genital herpes). Most of the time, it appears as groups of fluid-filled blisters that break open, turn into sores and heal over time. This is referred to as a herpes outbreak. However, some people who are infected with HSV may not show any symptoms and might not realize that they have been infected by the virus.

HSV spreads easily through direct skin-to-skin contact.The infection occurs when the virus enters the body through the skin or mucous membranes (mucosa). Once inside, it uses the body’s own cells to replicate. After the first infection, the virus remains in the body permanently. Most of the time, it stays inactive (dormant), but it can react later and cause new outbreaks.

HSV can affect people differently based on factors such as the virus type and their immune system health. As of now, there is no cure for HSV, but treatments can help reduce the intensity of outbreaks and make the condition easier to manage.

Types of herpes simplex virus?

What activates herpes simplex virus?

Factors that can lead to an oral or genital herpes outbreak include:

• Stress

• Fever

• Hormonal changes, such as those during menstruation.

• A weakened immune system, caused by medication or health conditions.

Factors that commonly cause oral herpes outbreaks include:

• Respiratory infections like colds or flu

• Exposure to sunlight

• Injury or irritation around the mouth

Sometimes, outbreaks happen without any clear cause or warning.

What are the stages of a herpes simplex infection?

When Herpes simplex virus (HSV) first invades the body, it is called a primary infection. The virus travels to nearby nerve cells to start multiplying, usually targeting the trigeminal nerves for oral infections or the sacral plexus in the pelvic area or genital infections. It then moves through these nerves to the skin or mucous membranes, where the immune system detects it and sends immune cells to fight back. This response causes inflammation and blister formation, and you might notice swollen lymph nodes near the affected area, such as under the jaw or in the groin. Some people do not have any symptoms during the primary infection and may not even be aware that they are infected with HSV.

HSV latency 

After a few weeks, the immune system controls the primary infection, but HSV remains hidden and inactive in the nerve cells it first infected, a phase called latency. Most of the virus stays inactive, but sometimes some nerve cells reactive. When this happens and enough cells become active, your immune system detects it, causing what is called HSV reactivation.

HSV reactivation 

When the virus becomes active again, the infected nerve cells start working, which causes your immune system to respond. At this point, a few different things can happen:

Virus containment within nerves - The virus momentarily becomes active but stays limited to the nerves cells. Your immune system manages it quickly, preventing it from reaching your skin or mucosa. This may involve short bursts of activity without causing symptoms or viral shedding.

Asymptomatic viral shedding - Some of the infected cells move up to the outer layer of the skin (epidermis). Even though the virus isn't active enough to cause visible symptoms, it can still be released from skin and spread to another person through close contact. This process is one of the main ways HSV is transmitted between people.

Symptomatic outbreak - When the infected cells become highly active on the skin’s surface, they cause noticeable signs of infection. Blisters usually form during this phase, which most people recognize as a herpes outbreak. At this stage, the virus is highly contagious and can be transmitted to others through direct contact.

Asymptomatic viral shedding - Some of the infected cells move up to the outer layer of the skin (epidermis). Even though the virus isn't active enough to cause visible symptoms, it can still be released from skin and spread to another person through close contact. This process is one of the main ways HSV is transmitted between people.

Symptomatic outbreak - When the infected cells become highly active on the skin’s surface, they cause noticeable signs of infection. Blisters usually form during this phase, which most people recognize as a herpes outbreak. At this stage, the virus is highly contagious and can be transmitted to others through direct contact.

Diagnosis and Tests

How do doctors identify HSV infections?

How is herpes simplex infection treated?

The common way to manage HSV infections is by taking prescription antiviral drugs. These medications are available in various forms:

• Oral medication

• Skin lotion

• Medicine administered directly into your vein

• Eye treatment drops (For ocular herpes)

Your healthcare provider will recommend the most suitable medication depending on:

• The category of your infection

• The seriousness of it

• How effectively your immune system functions

Your doctor will let you know the right dose and how long you gotta take the meds. For oral and genital herpes, there are basically two treatments: episodic therapy, which you use when an outbreak happens and chronic suppressive therapy, which you take all the time to stop outbreaks from coming.

Episodic Treatment

This is a brief, focused treatment that focuses on managing a single episode of symptoms. It involves taking antiviral medicine at the very first signs of a breakout, such as tingling or itching of the skin. Taking the medication early can increase its effectiveness. Healthcare provided use this episodic treatment for both first-time HSV cases and when symptoms rise again.

Episodic treatment can make symptoms feel less painful, help the pain fade away faster, heal sores more quickly, and lower the amount of virus on your skin. However, treating just one breakout won't change whether you get another one later, nor will it make future outbreaks worse. For ongoing prevention and control, a long-term treatment called suppressive therapy is needed.

Long-term suppressive treatment 

Outlook / Prognosis

Can herpes be cured?

Herpes simplex virus stays in your body forever and can become active again, causing outbreaks at unpredictable times. The frequency of these breakouts varies significantly between individuals With oral herpes, many people experience fewer outbreaks as they get older, especially after passing 35 years of age. Similarly, genital herpes outbreaks tend to decrease over time. Importantly, genital HSV-1 generally causes fewer outbreaks than genital HSV-2.

Prevention

Are there ways to avoid HSV infections?

HSV is a widespread virus that can be easily spread between people, making it difficult to prevent. However, you can reduce your chance of catching it by taking the following steps:

• Avoid direct contact during outbreaks. Avoid kissing someone with a cold sore or engaging in sexual activity with someone who has genital sores.

• Discuss STI testing with your partners. HSV can be transmitted even when there are no symptoms showing, so knowing a partner’s HSV status allows you to take precautions.

• Use protection during sexual activity. Condoms and dental dams can reduce the chance of spreading the virus, but they do not offer full protection. They cover some areas where the virus is active and also helps protect against other sexually transmitted infections.

If you live with oral or genital herpes, it’s important to have honest conversations with sexual partners about risks. Both types of HSV can be transmitted through various sexual activities, so clear communication about testing and protective measures is key.

When should I seek medical advice?