Herpes is an infection that is caused by a herpes simplex virus (HSV). Oral herpes causes cold sores around the mouth or face. Genital herpes affects the genitals, buttocks or anal area. Genital herpes is a sexually transmitted disease (STD). It affects the genitals, buttocks or anal area. Other herpes infections can affect the eyes, skin, or other parts of the body. The virus can be dangerous in newborn babies or in people with weak immune systems.

There are two types of HSV:

• HSV type 1 most commonly causes cold sores. It can also cause genital herpes.
• HSV type 2 is the usual cause of genital herpes, but it also can infect the mouth.

HSV spreads through direct contact. Some people have no symptoms. Others get sores near the area where the virus has entered the body. They turn into blisters, become itchy and painful, and then heal.

Most people have outbreaks several times a year. Over time, you get them less often. Medicines to help your body fight the virus can help lessen symptoms and decrease outbreaks.

Did you know that the virus that causes “cold sores” or “fever blisters” on or around the mouth can also infect other areas of the body? The infection is caused by the herpes simplex virus. And it’s very common.

Most people with herpes infection don’t even know it. They may not have symptoms or not notice them.

For people who do have symptoms, a herpes infection may show up as one or more blisters. These can be on or near the mouth, eyes, genitals, or rectum. After the blisters break, they turn into sores or ulcers. These sores are painful and take about a week to heal.

Once someone is infected with herpes simplex, the virus goes into hiding and stays in the body for the rest of their lives. The virus can re-emerge at any time and cause an outbreak. Some people have outbreaks several times per year. Tingling or burning in the area can signal that an outbreak is looming.

There are two types of herpes simplex viruses: HSV-1 and HSV-2. HSV-1 is often transmitted during childhood. You can get it from close contact with someone who has the infection. For example, a family member with a cold sore may kiss a child. HSV-1 is the main cause of herpes of the mouth or eyes. Although it’s possible for HSV-2 to infect the mouth or eyes, it’s usually found in the genital area.

There’s no cure for herpes. But anti-herpes medicine can speed healing of the sores. If taken every day, this medicine can also lower the risk of future outbreaks.

“It’s the first episode that is particularly important to treat,” says Dr. Jeffrey I. Cohen, a herpes infection expert at NIH. That’s because the first outbreak is often the most severe. In addition to sores, you may have a fever and body aches. Also, the nearby lymph nodes might be swollen and painful.

A doctor may suspect a diagnosis of herpes from looking at a sore. But lab tests on a sample taken from the sore is needed to confirm the diagnosis. A blood test for HSV-1 and HSV-2 is also available to confirm if someone has been infected.

Researchers are working to develop herpes vaccines. “There are two different types of vaccines being developed for herpes virus,” Cohen explains. “One is a vaccine that would prevent infection in people who have not been infected with the virus.” Cohen’s research team at NIH is working on this type of vaccine.

“The other type of vaccine is for people who are already infected,” he says. “The idea is that we could boost their immune system so that they have fewer recurrences.”

The fact that most people don’t know that they’re infected makes vaccines especially important.

When someone is diagnosed with herpes, they may feel anger, sadness, or shame. They also may fear rejection by romantic partners.

Keep in mind that herpes outbreaks can be managed. People can lower the risk of infecting someone else by avoiding direct contact during an outbreak. For those with genital herpes, using anti-herpes medicine every day and condoms during sexual activity also reduces the risk of infection for a romantic partner.

Talk with your doctor if you have questions about preventing or managing herpes.

Help Fight the Stigma of Herpes

Don’t tell jokes with herpes as the punchline. And share the facts:

• Herpes infection is common.
• It may not cause any symptoms.
• Herpes can be spread by someone who doesn’t know they have it.
• You can get herpes in many ways, such as a kiss, sharing drinks or utensils, or sexual activity.
• Having herpes doesn’t mean you’re a bad person, immoral, or promiscuous.

No, a cold sore on your mouth usually means you have herpes simplex virus type 1 (HSV-1). You can get HSV-1 by kissing someone or sharing utensils, towels, razors, or lipstick with someone who has HSV-1.

HSV-1 cannot turn into HSV-2 (the type of genital herpes spread by sexual contact), but you can get a cold sore on your mouth from HSV-2 if you give oral sex to someone with HSV-2. Cold sores caused by HSV-1 or HSV-2 are contagious. You can spread it to other people or other parts of your body if you touch an open sore and then touch another part of your body. That means if you have a cold sore and give oral sex to someone, that person will get the herpes virus on his or her genitals.

Avoid touching your cold sore as much as possible. If you touch your cold sore, wash your hands right away to avoid spreading the infection to other parts of your body or other people.

It’s an uncomfortable topic, but it’s a health issue you should know about. Nationwide, about 1 out of 6 people between ages 14 and 49 is infected with the herpes simplex virus type 2—the main cause of genital herpes. Surprisingly, most people don’t know they’re infected. Even if you have no symptoms, or only mild ones, you can still transmit the virus to others.

Herpes simplex virus (HSV) comes in 2 forms. The most common, HSV-1, is best known for causing cold sores or fever blisters on the face, especially on the lips and mouth. But HSV-1 can also cause genital herpes. HSV-2 usually affects the genitals, but can also infect the mouth. Both types of HSV can pass from one person to another through sexual or other skin-to-skin contact.

“Once people are infected with herpes simplex, the virus stays in the body for the rest of their lives,” says Dr. Carolyn Deal, who heads the sexually transmitted diseases branch at NIH. Symptoms may first appear about 2 weeks after infection. After that, the herpes virus goes into hiding in your nerve cells. It may re-emerge several times a year. Over time, reappearances occur less often.

The first outbreak is usually the most severe and lasts the longest, sometimes 2 to 4 weeks. During an outbreak, you might notice tingling or sores (lesions) near the area where HSV first entered your body. Small red bumps are the first to appear. They change into small blisters, and then become itchy, painful sores that might develop a crust. The sores eventually heal without leaving a scar.

Often, though, people don’t recognize their first genital herpes outbreak or later recurrences. A study by the U.S. Centers for Disease Control and Prevention found that more than 80% of people with HSV-2 infections have not been diagnosed with the disease.

Your health care provider can sometimes diagnose genital herpes by looking at the sores or testing a sample from infected skin. Between outbreaks, a blood test can detect evidence of HSV-1 or HSV-2.

Although there’s no cure for herpes, prescription medicines can help calm symptoms and prevent future outbreaks. Taken regularly, these medications can also reduce the risk of passing herpes to sexual partners.

“For prevention, the recommendations for genital herpes are similar to many other sexually transmitted diseases,” says Deal. The most reliable way to prevent infection is to abstain from sex or to be in a long-term monogamous relationship with an uninfected partner. Condoms can also reduce the risk of transmission, but are not a reliable solution, as they may not cover all infected areas. Infected people should avoid having sex with uninfected partners during an outbreak.

Although herpes infections generally don’t cause serious medical problems alone, they can cause complications. Genital herpes can increase your chances of becoming infected with HIV, the virus that causes AIDS. In rare cases, herpes outbreaks during pregnancy can put the newborn child at risk for serious or even deadly infections.

Although genital herpes is a lifelong disease, there are many options for managing the condition and preventing its spread. Talk to your health care provider about any concerns.

Signs of Genital Herpes

Early symptoms of the first outbreak can include:

• An itching or burning feeling in the genital or anal area
• Sores near where the virus entered the body
• Flu-like symptoms, including fever
• Swollen glands
• Pain in the legs, buttocks or genital area
• A feeling of pressure in the area below the stomach

Genital herpes is a common sexually transmitted disease (STD) that any sexually active person can get. Most people with the virus don’t have symptoms. Even without signs of the disease, herpes can still be spread to sex partners.

What is genital herpes?

Genital herpes is an STD caused by two types of viruses. The viruses are called herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2).

What is oral herpes?

Oral herpes is usually caused by HSV-1 and can result in cold sores or fever blisters on or around the mouth. However, most people do not have any symptoms. Most people with oral herpes were infected during childhood or young adulthood from non-sexual contact with saliva.

Is there a link between genital herpes and oral herpes?

Oral herpes caused by HSV-1 can be spread from the mouth to the genitals through oral sex. This is why some cases of genital herpes are caused by HSV-1.

How common is genital herpes?

Genital herpes is common in the United States. More than one out of every six people aged 14 to 49 years have genital herpes.

How is genital herpes spread?

You can get genital herpes by having vaginal, anal, or oral sex with someone who has the disease.

If you do not have herpes, you can get infected if you come into contact with the herpes virus in:

• A herpes sore;
• Saliva (if your partner has an oral herpes infection) or genital secretions (if your partner has a genital herpes infection);
• Skin in the oral area if your partner has an oral herpes infection, or skin in the genital area if your partner has a genital herpes infection.

You can get herpes from a sex partner who does not have a visible sore or who may not know he or she is infected. It is also possible to get genital herpes if you receive oral sex from a sex partner who has oral herpes.

You will not get herpes from toilet seats, bedding, or swimming pools, or from touching objects around you such as silverware, soap, or towels. If you have additional questions about how herpes is spread, consider discussing your concerns with a healthcare provider.

How can I reduce my risk of getting genital herpes?

The only way to avoid STDs is to not have vaginal, anal, or oral sex.

If you are sexually active, you can do the following things to lower your chances of getting genital herpes:

• Be in a long-term mutually monogamous relationship with a partner who is not infected with an STD (e.g., a partner who has been tested and has negative STD test results);
• Using latex condoms the right way every time you have sex.

Be aware that not all herpes sores occur in areas that are covered by a latex condom. Also, herpes virus can be released (shed) from areas of the skin that do not have a visible herpes sore. For these reasons, condoms may not fully protect you from getting herpes.

If you are in a relationship with a person known to have genital herpes, you can lower your risk of getting genital herpes if:

• Your partner takes an anti-herpes medication every day. This is something your partner should discuss with his or her doctor.
• You avoid having vaginal, anal, or oral sex when your partner has herpes symptoms (i.e., when your partner is having an outbreak).

I’m pregnant. How could genital herpes affect my baby?

If you are pregnant and have genital herpes, it is very important for you to go to prenatal care visits. Tell your doctor if you have ever had symptoms of, or have been diagnosed with, genital herpes. Also tell your doctor if you have ever been exposed to genital herpes. There is some research that suggests that genital herpes infection may lead to miscarriage, or could make it more likely for you to deliver your baby too early.

Herpes infection can be passed from you to your unborn child before birth but is more commonly passed to your infant during delivery. This can lead to a potentially deadly infection in your baby (called neonatal herpes). It is important that you avoid getting herpes during pregnancy. If you are pregnant and have genital herpes, you may be offered anti-herpes medicine towards the end of your pregnancy. This medicine may reduce your risk of having signs or symptoms of genital herpes at the time of delivery. At the time of delivery, your doctor should carefully examine you for herpes sores. If you have herpes symptoms at delivery, a ‘C-section’ is usually performed.

How do I know if I have genital herpes?

Most people who have genital herpes have no symptoms, or have very mild symptoms. You may not notice mild symptoms or you may mistake them for another skin condition, such as a pimple or ingrown hair. Because of this, most people who have herpes do not know it.

Herpes sores usually appear as one or more blisters on or around the genitals, rectum or mouth. The blisters break and leave painful sores that may take a week or more to heal. These symptoms are sometimes called “having an outbreak.” The first time someone has an outbreak they may also have flu-like symptoms such as fever, body aches, or swollen glands.

People who experience an initial outbreak of herpes can have repeated outbreaks, especially if they are infected with HSV-2. Repeat outbreaks are usually shorter and less severe than the first outbreak. Although the infection stays in the body for the rest of your life, the number of outbreaks may decrease over time.

You should be examined by your doctor if you notice any of these symptoms or if your partner has an STD or symptoms of an STD. STD symptoms can include an unusual sore, a smelly genital discharge, burning when urinating, or (for women) bleeding between periods.

How will my doctor know if I have herpes?

Your healthcare provider may diagnose genital herpes by simply looking at your symptoms. Providers can also take a sample from the sore(s) and test it. In certain situations, a blood test may be used to look for herpes antibodies. Have an honest and open talk with your health care provider and ask whether you should be tested for herpes or other STDs.

Please note: A herpes blood test can help determine if you have herpes infection. It cannot tell you who gave you the infection or how long you have been infected.

Can herpes be cured?

There is no cure for herpes. However, there are medicines that can prevent or shorten outbreaks. One of these anti-herpes medicines can be taken daily, and makes it less likely that you will pass the infection on to your sex partner(s).

What happens if I don’t get treated?

Genital herpes can cause painful genital sores and can be severe in people with suppressed immune systems.

If you touch your sores or the fluids from the sores, you may transfer herpes to another part of your body, such as your eyes. Do not touch the sores or fluids to avoid spreading herpes to another part of your body. If you do touch the sores or fluids, immediately wash your hands thoroughly to help avoid spreading your infection.

If you are pregnant, there can be problems for you and your developing fetus, or newborn baby.

Can I still have sex if I have herpes?

If you have herpes, you should talk to your sex partner(s) and let him or her know that you do and the risk involved. Using condoms may help lower this risk but it will not get rid of the risk completely. Having sores or other symptoms of herpes can increase your risk of spreading the disease. Even if you do not have any symptoms, you can still infect your sex partners.

You may have concerns about how genital herpes will impact your overall health, sex life, and relationships. It is best for you to talk to a health care provider about those concerns, but it also is important to recognize that while herpes is not curable, it can be managed with medication. Daily suppressive therapy (i.e., daily use of antiviral medication) for herpes can also lower your risk of spreading genital herpes to your sex partner. Be sure to discuss treatment options with your healthcare provider. Since a genital herpes diagnosis may affect how you will feel about current or future sexual relationships, it is important to understand how to talk to sexual partners about STDs.

What is the link between genital herpes and HIV?

Herpes infection can cause sores or breaks in the skin or lining of the mouth, vagina, and rectum. This provides a way for HIV to enter the body. Even without visible sores, having genital herpes increases the number of CD4 cells (the cells that HIV targets for entry into the body) found in the lining of the genitals. When a person has both HIV and genital herpes, the chances are higher that HIV will be spread to an HIV-uninfected sex partner during sexual contact with their partner’s mouth, vagina, or rectum.

What is HSV (Herpes Simplex Virus) keratitis?

HSV (Herpes Simplex Virus) keratitis is an infection of the cornea—the clear dome that covers the colored part of the eye—that is caused by HSV. The infection usually heals without damaging the eye, but more severe infections can lead to scarring of the cornea or blindness. HSV keratitis is a major cause of blindness worldwide. HSV-1, which is the type of HSV that also causes cold sores on the mouth, is the most common cause of corneal infections.

What are the symptoms of HSV keratitis?

Symptoms of HSV keratitis include:

• Eye pain
• Eye redness
• Blurred vision
• Sensitivity to light
• Watery discharge

If you experience any of these symptoms, remove your contact lenses (if you wear them) and call your eye doctor right away. If left untreated, HSV keratitis can result in vision loss or blindness.

Where is HSV found?

HSV is only found in humans and is spread through direct contact with someone who is infected with the virus. Most HSV keratitis infections happen after another part of the body—most commonly the mouth—has already been infected by HSV. HSV keratitis is often the result of a “flare up” (reactivation) of the earlier infection.

What puts people at risk for HSV keratitis?

People who have had HSV keratitis are at risk for recurrences of the same infection. For these people, wearing contact lenses may further increase the risk.

People most at risk for HSV-1 (but not necessarily HSV keratitis) are:

• Female
• Non-Hispanic black or Mexican American
• Born outside the United States
• Sexually active, or have had 3 or more lifetime sex partners

How is HSV keratitis diagnosed?

HSV keratitis is usually diagnosed based on a patient’s health history and findings from an eye exam. Lab testing is not usually necessary, but certain lab tests may further help to confirm HSV-1.

How is HSV keratitis treated?

The treatment of HSV keratitis usually involves medicine, including eye drops or antiviral medications taken by mouth. Surgery is rarely necessary but may be considered if scarring on the eye from HSV keratitis causes vision problems. Each case of HSV keratitis is unique, and an eye doctor should determine the best treatment for each patient. While some treatments can greatly lower the severity and recurrence of symptoms, there is no cure for HSV.

How do you prevent HSV keratitis?

Currently there are no proven methods for preventing HSV keratitis, but some steps available from the Mayo Clinic may help to control HSV keratitis recurrences:

• Avoid touching your eyes or the area around your eyes unless you have washed your hands properly—especially if you have a cold sore or herpes blister.
• Only use eye drops that have been prescribed or recommended by an eye doctor or health care provider.

Your daily habits, your contact lenses and supplies, and your eye doctor are all important.

Protein Complexes Identified that Control Infection and Reactivation

Herpes simplex virus (HSV) infections last a lifetime. Once a person has been infected, the virus can remain dormant (latent) for years before periodically reactivating to cause recurrent disease. This poorly understood cycle has frustrated scientists for years. Now, National Institutes of Health (NIH) scientists have identified a set of protein complexes that are recruited to viral genes and stimulate both initial infection and reactivation from latency. Environmental stresses known to regulate these proteins also induce reactivation.

Globally, the World Health Organization estimates that one-half billion people are infected with HSV-2 while two-thirds of the population are infected with HSV-1. These viruses cause human diseases ranging from oral cold sores to genital lesions to serious eye conditions that can lead to blindness. In infants, HSV can cause neurological and developmental problems. People infected with HSV also have an enhanced risk of acquiring or transmitting human immunodeficiency virus (HIV).

Scientists at NIH’s National Institute of Allergy and Infectious Diseases previously made progress toward understanding the role of cellular protein HCF-1 in initiating HSV infection and reactivation. HCF-1 and associated proteins are recruited to the viral genome to enable the virus to replicate and spread. This previous work identified targets for the development of therapeutics to suppress infection and reactivation.

Their latest work, with collaborators from Princeton University, identifies new HCF-1 protein complexes that play additional roles in initiating viral infection and reactivation. The scientists found they could reactivate latent HSV in a mouse model using compounds that turn on components of these HCF-1 protein complexes. Interestingly, some of these HCF-1-associated proteins also are involved in HIV reactivation from latency.

The researchers are continuing to investigate the protein complexes involved in promoting HSV gene expression, infection, and reactivation from latency. Identifying these complexes and understanding the mechanisms by which they function can potentially reveal additional targets for the development of new therapeutics.

ARTICLE:
R Alfonso-Dunn et al. Transcriptional elongation of HSV Immediate Early genes by the Super Elongation Complex drives lytic infection and reactivation from latency. Cell Host & Microbe DOI: 10.1016/j.chom.2017.03.007 (2017).