Herpes — BIMC Hospital Bali


Posted on : October 7, 2011

herpesHerpes simplex is a common infection caused by the herpes simplex virus (HSV) which can cause a vesicular rash anywhere on the skin or mucous membranes. There are two major strains, HSV-1 and HSV-2. Both types of herpes simplex virus can cause oral or genital infection. Most often, HSV-1 cause infection in the mouth (gingivostomatitis), lips (herpes labialis), and eyes (herpes keratitis). While, HSV-2 usually causes genital lesions. Transmission occurs from close contact with someone who is actively shedding virus, i.e. people who are showing herpetic lesions. But transmission still can happen even when there are no apparent lesions.

After the initial infection, HSV remains dormant in the nerve which it can periodically emerge, causing symptoms. Recurrent herpetic eruptions are precipitated by overexposure to sunlight, febrile illnesses, physical or emotional stress, immunosuppressant, or sometimes it just happens with any known trigger. The recurrent attacks are generally less severe, and generally occur less frequently over time.

The most common herpes infections are the ones infecting the mouth, lips, and genitals.

  • Mouth Herpes (Gingivostomatitis)

Usually results from primary infection with HSV-1, typically in children. Occasionally, HSV-2 can be the cause of mouth ulcer through oral-genital contact. Usually small blisters appear, and then break to form ulcers. These ulcers are painful and in children they may refuse to eat or drink which may lead to dehydration. After resolution, the virus resides dormant.

  • Cold sores (Herpes labialis)

Usually is a secondary outbreak from mouth herpes. The blisters appear on the border of the lips, though some blisters in the mouth may still appear.

  • Genital Herpes

In the 1960’s there was a rule of thumb that “HSV-2 was below the waist, HSV-1 was above the waist”. However, reports of genital HSV-1 has increased, and that rule of thumb no longer applies. In a majority of cases, 80-90%, it gives no symptoms, which are why it spreads widely since the carrier most of the time does not know they are infected and can transmit the disease to their partner. It is estimated 20% of the community is infected by genital herpes. Oral herpes can be transmitted to the genitals, and vice versa. When it does show symptoms, there will be multiple blisters on the genital area which are noticed due to pain.


Both oral and genital herpes can recur. Some people have frequent recurrences, while other people have them rarely. The average for genital herpes is about 4 recurrences per year. Most people with genital herpes do have recurrences.

In the beginning of the infection, the herpes virus escapes the immune defenses by entering the nerve endings and travelling to the ganglia, which are clusters of nerve cells. In the ganglia, the virus is inactive and it causes no harm to the body or the nerve cells. From time to time, however, the virus can be reactivated. When that happens, it travels back down the nerve to the surface of the skin. There it starts to multiply, causing another outbreak. Recurrences usually develop near the site of the initial infection.

Herpes infections have different patterns in different people. Any one or combination of the following factors might sometimes, not always, induce an outbreak: surgery, illness, stress, fatigue, skin irritation (such as sunburn), diet, menstruation, or vigorous sexual intercourse.

A recurrence of the herpes infection may occur when latent viruses are triggered by immunosuppressive events such as emotional stress, sunlight, menses, cold or fevers, certain foods, beverages, vitamins and medications.

Since the recurrence pattern of herpes is almost as varied as the people who harbor the virus, you should take every precaution possible to keep the virus in remission.


When you are currently have an active infection here are some ways to relieve the symptoms:

  • avoid excessive heat or sunlight, which makes the irritation more uncomfortable;
  • not use perfumed or antibacterial soaps, feminine deodorant, or douches;
  • wear comfortable, loose fitting cotton clothing;
  • take aspirin, acetaminophen (paracetamol) or ibuprofen ;
  • Use cool cloths on the affected area if it soothes the pain.

When to see a doctor

  • With an initial outbreak, if an individual has signs or symptoms of a genital herpes infection, he or she should seek the care of a doctor as soon as possible, particularly if the diagnosis of genital herpes has not been previously diagnosed. Although genital herpes infections generally are not medical emergencies, treatment is more effective when it is started within the first few days of the outbreak.
  • People with severe underlying medical problems (particularly HIV or AIDS) are at higher risk of severe illness if the disease is untreated. These individuals should contact a doctor immediately upon noticing genital herpes sores.
  • A pregnant woman with signs or symptoms of genital herpes must inform her doctor as soon as possible. Prompt medical therapy may reduce the risk of transmitting the disease to newborn children by exposure in the birth canal.
  • Some people can become quite ill from genital herpes infections. If an individual has a high fever, severe headache, shortness of breath, or extreme fatigue, he or she should go to the hospital for evaluation.


There are many ways to prevent herpes transmission:

  • Avoid sharing of drinking and eating utensils and toothbrushes, because it is present in the saliva.
  • Perform safe sex practice, by using a condom. Laboratory studies have shown that the herpes virus does not pass through latex condoms. When properly used, such condoms are likely to reduce your risk of spreading or getting herpes. Non latex polyurethane condoms break up to five times more often, but even the best latex condoms don’t guarantee safety. Sometimes herpes sores occur in places not covered by a condom. In these cases, the condom is of little help, if any. In fact, condoms and foams should not be relied upon when herpes sores or symptoms are present.
  • Abstain from having oral sex or kissing if you have a cold sore.
  • Get tested if you think you may have herpes and always use protection.
  • Be aware if you have sex during an outbreak, you can spread the virus to your partner and you may prolong your own episode.
  • If you are not sure that you and your partner are free from infection, use protection during sex. Latex condoms, used properly from start to finish for each sexual encounter, can be useful protection.

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