Herpes: risk of infection, symptoms, duration
Herpes is a widespread infectious disease caused by viruses. Once infected, the virus remains unnoticed in the body for a lifetime. However, if the immune system is weakened, it can break out again and cause the typical herpes blisters. Read more about symptoms, diagnostics and therapy of herpes here.
Herpes is caused by viruses. There are different herpes viruses that can cause very different diseases in humans. They are called human herpes viruses, or HHV, and are distinguished within this group by numbering from one to eight.
What is “herpes”?
Herpes” usually refers to the typical symptoms caused by the herpes simplex virus (HSV). The viruses of the genus Herpes simplex are divided 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 lip herpes, while HSV2 is usually the cause of genital herpes. Ultimately, however, both virus types can cause herpes in both parts of the body.
Other herpes viruses cause diseases such as chickenpox and shingles (HHV3), mononucleosis (HHV4) or three-day fever (HHV6/7).
How do you get herpes? – Infection and reactivation
Once infected with the herpes virus, the virus remains in the body for a lifetime and can become active again at any time (reactivation).
First-time herpes infection
As a viral disease, herpes is contagious. Transmission occurs from person to person, mainly through smear infection. The herpes virus has to be transferred from the site of infection or from the saliva of a sick person to the mucous membranes of a healthy person – for example during kissing or sexual intercourse. In general, the risk of herpes transmission increases with close physical contact, so that an infection can also occur, for example, among children while playing.
Sometimes herpes is also passed indirectly between people or from one part of the body to another. For example, if the infected person scratches the infected area, the herpes viruses get to his hand and can 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 virus dries up, it dies. According to recent studies, the herpes viruses can survive outside the body for up to 48 hours. Since saliva is also infected with viruses and contagious in active herpes disease of the lips and mouth, the herpes viruses can even be transmitted by droplet infection in physical proximity. When speaking, tiny droplets of saliva are produced which travel short distances through the air and can thus reach the mucous membranes of other people.
If the vesicles are very dilated, bloody or purulent – this indicates a bacterial superinfection. You should also see a doctor if you have a fever and general symptoms or if the genital region is affected.
Antiviral drugs can prevent herpes outbreaks in most cases if they are used in time. Also look for sun protection and a strengthening of the immune system as a preventive measure. So healthy food, exercise, get enough sleep and avoid stress.
Herpes is only contagious in the blister stage – the fluid in the blisters contains the virus particles. If someone has acute blisters, this area should not be touched. You should also not share towels or dishes with acutely ill patients. After the blisters have dried, i.e. after about a week, the herpes areas are no longer infectious.
How does herpes develop after the primary infection? – The Herpes Reactivation
The herpes simplex virus is not completely destroyed by the immune system, but merely put into a kind of dormant state (latency). Within certain cells it remains inactive most of the time and does not cause any damage. Under certain circumstances, the herpes disease can be reactivated.
After initial infection with the herpes simplex virus (primary infection), the viruses first multiply in so-called epithelial cells on the skin surface. Although the immune system fights them there, some of the viruses migrate along nerve fibres to their cell bodies. Here they now survive for a lifetime, unnoticed by the immune system. Herpes viruses mainly collect 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 cause the typical symptoms again. How often such reactivations occur varies greatly from individual to individual. Some people have herpes several times a year, others are rarely or never affected after the primary infection. Genital herpes triggered by HSV2 is more likely to be reactivated more frequently than lip herpes caused by HSV1. More about the triggers of reactivation can be found in the section “Herpes: Causes and Risk Factors”.
When is herpes contagious?
Herpes is only contagious during primary infection or reactivation. This 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 do not show any symptoms. Failure to take appropriate precautions will increase the risk of herpes transmission. While the virus is in dormant state, herpes infection is not possible.
There are about three to seven days (incubation period) between the infection and the appearance of symptoms; several weeks are also possible.
Who does herpes affect?
Herpes is an extremely contagious disease. According to a study, up to 85 percent of Germans are infected with the herpes simplex virus type 1. For 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 as early as infancy or toddler age.
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 reactivation.
Herpes symptoms during primary infection
At first, unspecific complaints (prodromal symptoms) often occur, later on the typical symptoms on the skin appear. The first symptoms follow directly after the incubation period and can occur up to two days before the actual disease. Typical symptoms are general malaise, fatigue, headaches, fever and sometimes nausea. During this prodromal phase, there is often itching or tingling in the areas where the vesicles 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. The term “herpes stages” can only be used to a limited extent, as the transitions are fluid. Even after bubbles have already burst and become encrusted, fresh bubbles can form again.
Herpes in children
Herpes that occurs for the first time in children is often more severe than in adults. The children often feel very miserable, with high fever, similar to a severe cold or flu. The classic herpes symptoms do not necessarily have to occur, so that herpes in infants and children is sometimes not recognized as such, but is considered a normal viral infection.
A special form of herpes in children is Gingivostomatis herpetica, in which there is a pronounced infestation in the mouth, occasionally adults are also affected. You can read more about this under “Herpes in the mouth”.
Herpes symptoms during reactivation
In contrast to the primary infection, the initial stage of herpes is usually much weaker in a reactivated outbreak and lasts only a few hours. Often the affected persons have no symptoms at all before the actual herpes signs appear. Although the outbreak is often weaker than the initial infection with herpes, the course and type of symptoms are the same.
How long does herpes last?
The liquid-filled blisters usually heal after six to ten days, but the “herpes duration” can also be two or three weeks until the complete healing. 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 persistent; in the case of reactivation, the body’s defence is already familiar with the herpes virus and gets a grip on the infection more quickly.
If the herpes symptoms persist for an unusually long time, a so-called superinfection can exist in addition to an immune deficiency – an additional bacterial infection of the affected skin areas. This is because damaged skin is an ideal entry point for bacteria when the body’s defenses are weakened.
How long has herpes been contagious?
Herpes is contagious when viruses are excreted and fresh blisters are visible. The greatest risk of herpes infection is posed by the fluid in the blisters, which contains a large number of viruses. As soon as all vesicles are encrusted and no new ones appear, the risk of infection is already much 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 occur on the lips and in the genital area. Under certain circumstances, other parts of the body can also 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 site of infection – for example by scratching – to other areas of skin. Preferably this happens on injured or very thin skin areas. 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 the eczema herpeticatum. This is a more extensive herpes infection with rapidly bursting blisters in patients who also suffer from skin diseases such as neurodermatitis or psoriasis. A pronounced feeling of illness is typical.
Herpes of the eye is a dangerous special case. A distinction is made between an infection of the cornea (herpes simplex keratitis) and the retina (herpes simplex retinitis). While corneal infestation can be caused both by external transmission and reactivations, herpes in the eye with mere retinal involvement is exclusively caused by reactivations. Herpes simplex keratitis can usually be well treated by a doctor, but retinal infection can lead to blindness of the affected eye. Eye herpes is a serious complication that must be treated as soon as possible.
Herpes encephalitis (inflammation of the brain) can also trigger the virus, usually HSV1. If herpes is located in the brain, life-threatening complications are possible. At the beginning, severe nausea with vomiting and headaches are often present, later epileptic seizures, confusion and odour disorders may occur before the patients finally fall into a coma. 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 viruses then enter the bloodstream where they multiply excessively (viremia). Doctors also refer to severe forms as herpes simplex sepsis, which is 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.
You will find exact details about the most common variant of herpes in the text Lip Herpes.
In the genital area, herpes is particularly annoying and usually associated with high levels 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 about this under Herpes in the mouth.
Herpes in pregnancy
During pregnancy there are a number of things to consider with regard to herpes. 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 occur. In most cases, the virus is transmitted in childhood within the family environment.
Children are often in close physical contact, making herpes particularly contagious for them. The liquid content of the blisters is the main cause of herpes infection, so they should not be punctured.
Risk factors for herpes reactivation
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 many and varied. Common causes of herpes are:
- Colds and flu-like infections
- Mental and physical stress
- Certain drugs, such as cortisone or chemotherapeutic agents
- Too much UV light irradiation
- Hormonal changes
- Immunodeficiency disease HIV
Colds weaken the immune system and encourage dormant herpes viruses from the nerve ganglia to return to the surface of the skin. The herpes symptoms then often occur together with fever, which is why they are also called “cold sores”. But fever alone does not cause blisters.
Why do people often get herpes after sunburn? Excessive UV radiation not only irritates the skin but also the nerves and herpes viruses can be activated. In the same way, skin injuries can promote reactivation.
People with a chronically weakened immune system are also more susceptible to reactivations with herpes. Triggers of a permanent immune deficiency are for example an infection with the immune deficiency disease HIV or the consequences of chemotherapy. But not everyone who complains of “constantly having herpes” must have an immune deficiency. Some people suffer more often from reactivations than others, without specific reasons being found for this. Especially stress, whether physical or mental, seems to favour herpes and frequent reactivations.
Herpes: examination and diagnosis
Based on the medical history and the symptoms, the doctor can usually easily recognise herpes, often a mere gaze diagnosis is sufficient. In rare cases it is helpful to identify the pathogen precisely in the laboratory.
Examination methods for herpes
The following procedures are available to rule out similar diseases or check herpes viruses for possible resistance to drugs:
Antibody determination (serology)
When 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 results of such tests are not always conclusive. Especially in immunocompromised patients, sometimes no herpes antibodies are found even though the patient is infected.
Antibody determination is helpful in determining the spread of the infection in a population group.
A much more precise method of detecting herpes is the detection of so-called antigens. This refers to the smallest biological components that stimulate the body’s immune system to produce antibodies. In most cases, 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 for the reliable detection of herpes viruses is the artificial propagation of viral DNA in the laboratory. Even with the smallest amounts of viruses, 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).
Cultivation of the herpes virus
The most complex method of detection is the cultivation of the herpes virus. For this purpose, a sample is placed in a nutrient fluid – by adding drugs, the reaction of the viruses can be tested and therapies can be adapted. A distinction between HSV1 and 2 is also possible.
How exactly to treat herpes you can read in the text Herpes: Treatment
Home remedy for herpes
It does not always have to be the expensive herpes ointment. Which alternatives there are and which of them make sense is in the text Household remedies against herpes
Herpes: course of the disease and prognosis
In the vast majority of cases, herpes is harmless. In the case of a primary infection, especially in children, the symptoms are sometimes somewhat more severe, but even here they rarely last longer than two weeks. In adulthood, it is mainly reactivations that cause a herpes outbreak. The complaints are then usually milder. If the herpes symptoms last significantly longer than two weeks, you should consult a doctor to rule out complications or diseases with a similar appearance.
How can herpes be prevented?
Herpes infection with HSV1 is almost impossible to avoid, since a large part of the population is infected with it and one is usually infected with the virus as a child. The risk of contracting genital herpes can be significantly reduced by using contraceptives (condoms).
A strong immune system offers the best protection against frequent reactivations. You should therefore ensure a healthy, balanced diet, sufficient sleep and regular exercise. You should also avoid stress if possible. Particularly in the cold season, the right lip care can prevent many a reactivation, because brittle, roughened lips facilitate an infection. In summer, you should protect your lips from UV damage with sufficient sun protection factor.
Is there a herpes vaccine?
An effective, regularly used vaccination against herpes does not yet exist, although some vaccines are currently being tested in clinical trials. Since the Herpes simplex virus of type 1 is only slightly different from type 2, a working vaccine would automatically be effective against both types. Herpes can hardly be prevented, but some measures can be taken.
What should you avoid if you have active herpes?
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 viruses unnecessarily.
- Avoid any contact with 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. This prevents the virus from getting into the eye via smear infection.
- Do not share glasses, napkins, towels, cutlery, etc. with other people in case of HSV1 infection.
- If you want to cover herpes, do not use make-up, but a herpes patch. Otherwise, the viruses get into the make-up utensils and can be spread further.
- Avoid direct skin contact, especially kissing, with other people.
- Do not scratch open the blisters or remove the crust of herpes.