Herpes: what is it and what does it look like?

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Herpes is an infectious disease caused by the herpes virus, most often type 1 or 2. In most cases, external manifestations of herpes occur in the area of the nasolabial triangle and affect the lips, wings of the nose, and the skin around the mouth. However, the herpes virus can penetrate almost any tissue and organ, causing various manifestations and sometimes even leading to the development of serious complications.

What does herpes look like?

Most cases of Herpes Simplex Virus are asymptomatic, meaning those affected do not experience any symptoms. Others may notice sores or lesions. These ulcers look like blisters filled with fluid. After a few days, the sores open, ooze, and form a crust before healing.

Patients may also experience tingling, itching, or burning a few days before the sores appear. Some may also experience flu-like symptoms, such as:

heat
muscle pain

Usually the first ulcers appear within 2-20 days. They can last up to a week or 10 days.

An outbreak may involve a single sore or a cluster of sores. They often affect the skin around the mouth, genitals, or rectum. The blisters may take 2 to 4 weeks to heal.

Symptoms usually appear from time to time, although they do not become as severe as the first time.

The following sections discuss the symptoms of herpes that occur on commonly affected parts of the body.

What is herpes?

Herpes is a mild disease that causes small sores to appear on the skin.

Herpes develops after contact with the herpes simplex virus (HSV). There are two types of this virus:

herpes simplex 1 (HSV-1) or oral herpes, which usually affects the mouth
herpes simplex 2 (HSV-2) or genital herpes, which usually affects the genitals

According to the World Health Organization (WHO), 67 percent of people under the age of 50 are infected with the HSV-1 virus, and 11 percent of those aged 15 to 49 years have an HSV-2 infection worldwide.

Both HSV-1 and HSV-2 can occur on the face or genitals. Both herpes viruses can be contracted through body fluids, including genital fluids and saliva.

If someone has the virus, symptoms may appear sporadically for the rest of their life. Although ulcers can cause discomfort and even pain, they are usually not dangerous for healthy adults.

Mouth

With oral herpes, most blisters appear on the lips or in the mouth. They can also form anywhere on the face, especially around the chin and under the nose, or on the tongue.

At first, the sores look like small bumps or pimples and then turn into blisters filled with pus. They can be red, yellow or white. Once they burst, clear or yellow liquid will leak out before the blister forms a yellow crust and heals.

With oral herpes, it is common for the lymph nodes in the neck to become swollen during an outbreak.

Female genitals

Women with genital herpes may develop sores on the vulva, which is the outer part of the genitals, including the outer lips (labia), or inside the vagina. Sores that develop inside the vagina may be difficult to see.

Genital sores vary in size and number, but as with oral herpes, they appear as pimples or blisters filled with fluid. As they heal, they will burst and form a yellowish crust.

There is a possibility of experiencing urinary problems during an outbreak of genital herpes. Women may experience a burning sensation when urinating. They may also notice enlarged lymph nodes in the groin.

Male genitals

In men, ulcers may appear on or around the penis.

Small red or white bumps develop into larger, fluid-filled sores that may be red, white, or yellow. As with oral herpes and female genital herpes, these sores tend to burst before crusting over.

Along with other flu-like symptoms, men may experience swollen lymph nodes in the groin.

Rectum

Both men and women with genital herpes may develop sores or blisters on the buttocks or around the rectum.

The patient may notice open, red sores on or around the anus.

Fingers

Blisters from herpes may also form on your fingers. This is called a cold sore and is most common in children who suck their thumb.

Herpes can cause one or more sores to form around the nail. The patient often experiences pain or tingling in the area before an ulcer develops.

If multiple sores appear, they tend to join together and form into one large honeycomb-like blister. They can also spread to the nail bed.

Eyes

Herpes keratitis refers to a herpes infection in the eye. This may affect one or both eyes and cause:

eye pain
sensitivity to light
discharge from the eye

Anyone who suspects herpetic keratitis should see a doctor. Left untreated, this infection can cause a scar on the eye, leading to blurred vision or even loss of vision.

Main

In addition to the mucous membranes of the mouth and genitals, the Herpes simplex virus can also cause skin lesions.
Diagnosis is based on the clinical picture and recurrence of rashes with the same localization.
Herpetic infection of the periorbital area requires immediate consultation with an ophthalmologist.
Antiviral drugs are used to relieve symptoms and shorten the duration of the disease; the virus cannot be completely eliminated.
With frequent recurrence of herpes infection, antiviral drugs are prescribed for prophylactic purposes.

Etiology

The Herpes simplex virus (HSV-1 and HSV-2) causes skin infections. HSV-1 most often affects the skin, HSV-2 - the genital area.
Primary infection with HSV-1 usually occurs during childhood. A low-symptomatic or asymptomatic course leads to the fact that the primary infection often goes undetected. HSV-2 infection usually occurs in adulthood.
In some people, primary infection is accompanied by severe symptoms (eg, gingivostomatitis, pharyngitis, genital herpes).
Primary skin infection is rare.
The virus lies latent in the nervous system and is activated from time to time under the influence of environmental factors.

Prevalence

Carriage of the herpes virus is widespread among the adult population: 50 - 60% and 15 - 20% of HSV-1 and HSV-2, respectively. Most carriers are asymptomatic.

Symptoms

Symptoms and clinical picture of the disease are often typical, and diagnosis is based on clinical manifestations.
Before the rash appears, there is usually soreness, burning, and tingling in the affected area.
First, focal erythema with clear boundaries is formed, later grouped vesicles with transparent contents appear.
Individual vesicles can transform into pustules or vesicles with hemorrhagic contents.
Grouped vesicles may also appear in nearby areas of the skin. After opening the vesicles, small erosions of irregular shape remain on the skin.
The disease usually lasts 1-2 weeks, but in some cases the course is longer.
Typical affected areas are the skin of the perioral area, face, genital area, buttocks, perianal area, hands and fingers.
Skin manifestations of herpes usually indicate reactivation of a latent infection.
Factors that provoke such reactivation are colds or flu, mechanical trauma, medical or dental procedures, injury, stress, insolation, menstruation, secondary infection through the fingers, for example, lips or genital area (self-infection).
Generalization of infection (disseminated disease) is possible in persons with immunodeficiency (for example, HIV infection) and/or receiving immunosuppressive therapy (for example, antirheumatic drugs, cytostatics).
The infection can also spread in patients with atopic eczema, predominantly affecting the face (Kaposi's eczema herpeticum). This does not indicate the presence of immunodeficiency.

Survey

In typical cases, there is no need for additional examination; the clinical picture is sufficient.
The virus can be typed by identifying its antigen or by culture.
It is best to obtain a sample for culture by puncturing the vesicle and running a cotton swab over the exposed eroded surface.
A negative culture result is possible, especially if the specimen is taken long after the onset of symptoms.
Antibody tests confirm carriage of the virus, but do not provide information about the timing or area of infection. The level of antibodies during an isolated skin infection (reactivation) is usually not increased; a slight increase is possible during primary infection. It is useless to assess antibody levels in herpetic skin lesions.
To diagnose HSV infection of the central nervous system and neonatal herpes, if necessary, PCR (in cerebrospinal fluid) and determination of antibody levels are used.
In unclear cases or in the absence of response to empirical therapy, samples should be taken for bacteriological and/or mycological examination from the surface of the affected skin area.
Allergic contact dermatitis is diagnosed using skin tests.
With pronounced clinical manifestations and low effectiveness of therapy, one should not forget about the possibility of immunodeficiency (for example, HIV infection, hematological malignancies, other malignant diseases).

Treatment

Local lesions due to herpetic infection do not require mandatory drug therapy.
In the treatment of herpetic infections of the skin, mucous membranes and genital area, the effectiveness of antiviral drugs has been proven.
The earlier treatment is started, the higher its effectiveness.
The patient must learn to recognize the first signs of the disease and begin therapy on their own.
In patients with immunodeficiency, systemic use of antiviral drugs (orally or intravenously, depending on the clinical picture) is started even with mild symptoms or suspicion of herpes infection in order to avoid its possible generalization and/or progression to the development of necrotizing lesions.
Systemic therapy Duration of treatment is 5 days; in patients with severe manifestations, it is possible to extend the treatment period to 7–10 days.
Higher doses are recommended for immunocompromised patients (eg Valacyclovirum 500 mg, 2 tablets twice daily).
Local treatment There is no convincing evidence of the effectiveness of local therapy for herpetic skin infections, but for mild cases it may be sufficient.
For mild cases, it is possible to use antiviral drugs (Acyclovirum (acyclovir) or Pencyclovirum (penciclovir)) topically in the form of a cream or ointment every 2-4 hours during the day for 5-10 days.
At the stage of blistering, lotions are used to dry the skin, for example, for 15 minutes 2-3 times a day, then zinc paste or lotion is applied
Some patients require analgesics.

Recurrent herpetic infection

For rare relapses, a course of treatment with the above-mentioned antiviral drugs is used. A prescription should be written in advance so that the patient can quickly begin treatment as soon as symptoms appear.
In case of frequent relapses of the disease (to reduce their frequency), antiviral drugs are prescribed for prophylactic purposes for a period of 6-12 months. Treatment should be selected individually, depending on the severity of the manifestations. If possible, pauses between courses of treatment and assessment of indications for further preventive therapy are necessary.
In case of initially severe clinical manifestations or recurrence of infection during preventive therapy, higher starting doses are recommended, for example, Valacyclovirum (valacyclovir) 500 mg twice a day.
During the prophylactic use of antiviral drugs in patients with immunodeficiency, resistance to therapy often develops. Therefore, in this group of patients, the use of higher daily doses is recommended (for example, Valacyclovirum (valacyclovir) 500 mg twice a day).
Short-term prophylaxis is a short course of treatment for 1 - 2 weeks, for example, during holidays, menstruation, etc.

Specialist consultation

In case of immunodeficiency, the presence of even a mild form of herpetic infection or suspicion of it requires the fastest possible initiation of systemic therapy, preferably at the stage of primary care.
For patients with severe generalized forms, especially those with immunodeficiency (cancer patients, patients receiving immunosuppressants), parenteral use of Acyclovirum (acyclovir) is indicated, most often as emergency therapy in a hospital. Specialist consultation is required.
Localization of a herpetic infection in the eye area, even with minor manifestations, is an indication for emergency consultation with an ophthalmologist.

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Conclusion

Herpes is a mild skin disease caused by the herpes simplex virus. Because of it, ulcers similar to blisters appear on any part of the body. The areas most commonly affected are around the mouth, genitals and buttocks.

There is no cure for HSV, and people infected with the virus usually experience occasional rashes. Ulcers usually go away on their own, although you can help treat outbreaks with antiviral medications, such as:

acyclovir
famciclovir
valacyclovir
zinc (works only before rashes appear)

These treatments, which are available as creams or tablets in pharmacies or by prescription, can shorten the duration of a herpes outbreak.

To avoid spreading herpes to others, avoid skin-to-skin contact during flare-ups of herpes, especially when the sores are open.

People with oral herpes can reduce the risk of transmission by avoiding kissing and sharing utensils.

How does herpes infection occur?

There are several main ways of contracting the virus: airborne (through saliva released when sneezing, coughing), household contact (through household objects, touching), through blood transfusion, and from mother to fetus. Herpes on the finger is usually a consequence of infection through airborne droplets or household contact, although in a child it can in very rare cases be a manifestation of an infection received from the mother.

The herpes virus enters the human body through mucous membranes, which are less protected from infections than the skin, or through microcracks, cuts and other minor lesions on the skin. By touching infected areas (for example, a herpetic rash on the face), the patient can transfer the infection to other parts of the body and to the fingers. In this case, if local immunity cannot cope with the infection, the disease begins to develop and external manifestations appear. In addition, sometimes herpes affects the nerves that innervate the fingers: in this case, it simply rises along the nerve processes to the surface of the skin on the hands.