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Herpes: risk of infection, symptoms, duration

by Josephine Andrews
Published: Last Updated on 323 views

Herpes is a common infectious disease caused by viruses. Once infected, the virus stays in the body unnoticed for life. If the immune system is weakened, however, it can break out again and cause the typical herpes blisters. Read more about symptoms, diagnostics and therapy of herpes here.

ICD codes for this disease:

ICD codes are internationally valid codes for medical diagnoses. They can be found, for example, in doctor’s letters or on certificates of incapacity for work.

B02 O26 P35 A60 B00

Herpes: description

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

What is “herpes”?

“Herpes” usually means the typical symptoms that are triggered by the herpes simplex virus (HSV). The viruses of the genus Herpes simplex are in turn subdivided into type 1 and type 2, i.e.: HSV1 and HSV2. The corresponding abbreviation for the human herpes types is HHV1 or HHV2. HSV1 is mainly responsible for cold sores, while HSV2 is usually the cause 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-day fever (HHV6/7).

How do you get herpes? – Contagion and reactivation

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

First herpes infection

As a viral disease, herpes is contagious. Transmission is person-to-person, primarily by smear infection . The herpes virus has to get from the site of infection or from the saliva of a sick person to the mucous membranes of a healthy person – for example when kissing or having sex. In general, the risk of herpes transmission increases with close physical contact, so that infection can also take place among children while playing, for example.

Sometimes herpes is also passed indirectly between people or from one part of the body to another. If the patient scratches the infected area, the herpes virus can get to his hand and infect other parts of the body or people.

Objects, such as used glasses, can also sometimes cause infection. However, herpes needs moisture. If the herpes viruses dry out, they die. According to recent studies, the herpes virus can survive outside the body for up to 48 hours. Since the saliva is also infected with viruses and is contagious in the case of an active herpes disease on the lips and mouth, the herpes viruses can even be transmitted by droplet infection in physical proximity. When speaking, the smallest droplets of saliva are produced, which travel short distances in 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 put into a kind of dormant state (latency). Within certain cells, it remains dormant most of the time and does no harm. Under certain circumstances, reactivation of the herpes disease can occur.

After the initial infection with the herpes simplex virus (primary infection), the viruses first multiply in so-called epithelial cells on the skin’s surface. There they are fought by the immune system, but some of the viruses migrate along nerve fibers to their cell bodies. Here they survive for a lifetime, unnoticed by the immune system. Herpes viruses collect mainly in so-called nerve ganglia, accumulations of nerve cell bodies.

If the body’s defenses are temporarily or permanently weakened, individual herpes viruses can migrate from the ganglia back to the epithelial cells. There they multiply again and cause the typical symptoms again. How often such reactivations occur varies greatly from person to person. Some people experience herpes several times a year, while others are only rarely affected or not affected at all after the primary infection. The genital herpes caused by HSV2 is more likely to be reactivated than the cold sore caused by HSV1. You can find more about the triggers of reactivation in the section “Herpes: causes and risk factors”.

When is herpes contagious?

Herpes is only contagious during primary infection or reactivation. That is when viruses are excreted. However, the classic symptoms do not always have to be present. In the case of so-called latent infections, those affected excrete viruses but show no symptoms. If appropriate precautions are then not taken, the risk of herpes transmission becomes all the greater. While the virus is dormant, herpes infection is not possible.

incubation period

There are about three to seven days (incubation period) between infection and the onset of symptoms, but several weeks are also possible.

Who is affected by herpes?

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

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

Herpes: symptoms

The typical, painful herpes blisters usually appear on the face (especially on the lip) or in the genital area. In addition, herpes can also 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 in primary infection

Initially, non-specific symptoms (prodromal symptoms) often occur, later the typical symptoms on the skin appear . The first symptoms follow directly after the incubation period and can appear up to two days before the actual illness. General malaise, exhaustion and headaches are typical, fever and sometimes nausea. During this prodromal phase, itching or tingling often occurs in the areas where the blisters finally form, and slight pain is also possible. The actual herpes outbreak is then accompanied by fluid-filled blisters on reddened skin, swelling and skin damage. One can only speak of “herpes stages” to a limited extent, because the transitions are fluid. Even after blisters have already burst and become crusted, fresh blisters can form again.

herpes in children

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

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

Herpes symptoms upon reactivation

In contrast to the primary infection, the initial stage of herpes in a reactivated outbreak is usually much weaker and lasts only a few hours. Those affected often have no symptoms at all before the actual herpes symptoms appear. Although the outbreak is often weaker than with the initial infection with herpes, the course and type of symptoms are then the same.

How long does herpes last?

The fluid-filled blisters usually heal after six to ten days, but the “herpes duration” can also be two or three weeks until they heal completely. How long the disease lasts also depends on the stage of the disease. In the case of an initial infection, the symptoms are often somewhat more stubborn. In the case of reactivations, the body’s defense system is already familiar with the herpes virus and gets the infection under control more quickly.

If the herpes symptoms last for an unusually long time, a so-called superinfection can also exist in addition to an immune deficiency – an additional bacterial infection of the affected skin areas. Because the damaged skin is an ideal entry point for bacteria when the body’s defenses are weakened.

How long is herpes contagious?

Herpes is contagious when viruses are excreted and fresh blisters can be seen. The greatest risk of herpes infection comes from the liquid in the blisters, which contains a large number of viruses. As soon as all the blisters are encrusted and no more new ones appear, the risk of infection is already significantly lower. Nevertheless, small amounts of virus can still be excreted some time after the herpes crust has fallen off.

Herpes special forms and complications

Herpes simplex infections typically appear on the lips and genitals. Other parts of the body may also be infected. If the eyes or the brain are affected, there is a risk of serious complications.

herpes on the skin

The herpes simplex virus can be transmitted from the actual site of infection to other areas of the skin, for example by scratching. This preferably happens on injured or very thin skin regions. For example, herpes on the eyelid and herpes on the back can occur as well as herpes on the arm or herpes on the finger.

A special case is eczema herpeticum. This is a larger-scale herpes infection with rapidly bursting blisters in those affected who also suffer from skin diseases such as neurodermatitis or psoriasis. A pronounced feeling of illness is typical.

herpes on the eye

A dangerous special case is herpes in the eye . A distinction is made between an infection of the cornea (herpes simplex keratitis) and the retina (herpes simplex retinitis). While an infestation of the cornea can be caused by an external transmission as well as by reactivations, only reactivations are the trigger for herpes in the eye with mere retinal involvement. Herpes simplex keratitis can usually be treated well by the doctor, but if there is an attack on the retina, there is a risk of blindness in the affected eye. Eye herpes is a serious complication that needs to be treated as soon as possible.

Herpetic encephalitis

The virus, usually HSV1, can also trigger herpes encephalitis (inflammation of the brain). If herpes settles in the brain, life-threatening complications are possible. At the beginning there is often severe nausea with vomiting and headaches, later epileptic seizures, states of confusion and olfactory disorders can occur before the patients finally fall into a coma . 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. The virus then enters the bloodstream and multiplies excessively there (viremia). Doctors also refer to severe forms as herpes simplex sepsis, i.e. blood poisoning with herpes viruses.

Generalized forms usually only occur in high-risk patients with a severely weakened immune system – for example after chemotherapy or organ transplants.

cold sores

Exact details on the most common variant of herpes can be found in the text Cold sores .

genital herpes

In the intimate area, herpes is particularly annoying and usually associated with a high level of shame.  You can read the most important information on this topic under Genital herpes .

herpes in the mouth

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

Herpes in pregnancy

There are a few things to keep in mind when it comes to herpes during pregnancy. More detailed information can be found under Herpes in pregnancy .

Herpes: cause and risk factors

The herpes simplex virus type 1 or type 2 is a relatively large DNA virus that is usually strictly specialized for its host, i.e. humans. From animals to humans or vice versa, herpes infection does not normally take place. The virus is usually transmitted in childhood within the family environment.

Children are often in close physical contact, so herpes is particularly contagious with them. Above all, the liquid content of the blisters is responsible for the infection with herpes, so you should not pierce them.

Risk factors for herpes reactivation

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

  • Colds and flu infections
  • Mental and physical stress
  • Certain medications, such as cortisone or chemotherapy drugs
  • Excessive exposure to UV light
  • hormonal changes
  • injuries
  • Immunodeficiency disease HIV

Colds weaken the immune system and encourage dormant herpes viruses from the nerve ganglia to reach the surface of the skin again. The herpes symptoms then often occur together with fever, which is why one also speaks of “cold sores”. However, fever alone does not cause blisters.

Why do you often get herpes after a sunburn ? Excessive UV radiation not only irritates the skin but also nerves and herpes viruses can be activated. Skin injuries can also promote reactivation.

People with a chronically weakened immune system are also more prone to reactivation with herpes. Triggers for a permanent immune deficiency are, for example, an infection with the immunodeficiency disease HIV or the consequences of chemotherapy. But not everyone who complains of having “constant herpes” must have an immune deficiency. Some people suffer from reactivations more often than others without concrete reasons being found. Especially stress, be it physical or mental, seems to favor herpes and frequent reactivations.

Herpes: investigation and diagnosis

Based on the medical history and the symptoms, the doctor can usually easily recognize herpes, often a simple visual diagnosis is sufficient. In rare cases, it is helpful to precisely identify the pathogen in the laboratory.

Research methods for herpes

The following methods are available to rule out similar diseases or to check herpes viruses for possible resistance to drugs:

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 destroying the pathogen. The detection of certain antibodies now points to a herpes infection, but the result of such tests is not always clear. Sometimes there are no herpes antibodies, especially in immunocompromised people, even though the patient is infected.

Antibody determination is helpful to determine the spread of the infection in a population group.

antigen determination

A much more precise method with which one can recognize herpes is the detection of so-called antigens. This describes the smallest biological components that stimulate the body’s immune system to form antibodies. Such antigens are usually 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 reliably detect herpes viruses is the artificial replication of the viral DNA in the laboratory. Even with the smallest amounts of virus, the genetic material of the virus can be duplicated with this method until it can finally be detected. This method is called polymerase chain reaction (PCR).

Cultivation of the herpes virus

The most complex detection variant is the cultivation of the herpes virus. For this purpose, a sample is placed in a nutrient liquid – by adding drugs, the reaction of the viruses can be tested and therapies adapted. A distinction between HSV1 and 2 is also possible.

Herpes: treatment

You can read how exactly you can treat herpes in the text Herpes: Treatment

Home remedies for herpes

Some sufferers use home remedies to treat herpes. What is there and which of them are useful is in the text of home remedies for herpes .

Herpes: course of the disease and prognosis

In the vast majority of cases, herpes is harmless. With a primary infection, especially in children, the symptoms are occasionally more severe, but again they rarely last more than two weeks. In adulthood, mainly reactivations cause a herpes outbreak. The symptoms are then usually milder. If the symptoms of herpes last significantly longer than two weeks, you should consult a doctor to rule out complications or diseases with a similar appearance.

How can you prevent herpes?

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

A strong immune system offers the best protection against frequent reactivations. Therefore, make sure you eat a healthy, balanced diet, get enough sleep and exercise regularly. You should also avoid stress if possible. Especially in the cold season, some reactivation can be prevented with the right lip care, because chapped, roughened lips facilitate an infection. In summer you should protect your lips from UV damage with a sufficient sun protection factor.

Is there a herpes vaccination?

An effective, regularly used vaccination against herpes does not yet exist, but some vaccines are currently being tested in clinical studies. Since type 1 herpes simplex virus differs only minimally from type 2, a working vaccine would automatically be effective against both types. Herpes can hardly be prevented, but you can take some measures.

What should you avoid if you have active herpes disease?

Anyone who is currently suffering from herpes should pay attention to a few things in order not to delay the course of the disease and not to spread the virus unnecessarily.

  • Avoid touching the infected area if possible.
  • Wash your hands thoroughly after touching an infected area.
  • If you wear contact lenses, wear glasses during a herpes outbreak. In this way you avoid the virus getting into the eye via smear infection.
  • If you have an HSV1 infection, do not share glasses, serviettes, towels, cutlery, etc. with other people.
  • If you want to cover herpes, then not with make-up, but with a herpes patch. Otherwise the viruses get to the make-up utensils and can be spread further.
  • Avoid direct skin contact, especially kissing, with other people.
  • For herpes , do not scratch the blisters or remove the crust.

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