Herpes viruses affect either the oral area or the genitalia (herpes simplex virus) or appear as Herpes Zoster. The latter is due to the activation of the chickenpox virus (Varicella-Zoster Virus).

Herpes simplex:

  • Type 1 (HSV-1): It is mainly associated with oral and facial infections. It appears periodically as small, sore bubbles (vesicles) which go away on their own after a few days. It is highly contagious. Usually its duration does not exceed 8 days.
  • Type 2 (HSV-2):  It is mainly associated with genital and rectal infections (anogenital herpes). It is transmitted by skin-to-skin contact, usually during sexual intercourse. The incubation period is on average 5 days. Active lesions of HSV-2 contain live viruses and are infectious. People with relapsing genital herpes secrete the virus asymptotically between outbreaks (asymptomatic transmission). This secretion occurs simultaneously from more than one anatomical region (penis, vagina, uterine, cervix and rectum) and can occur through seemingly intact skin and intact mucosa. In addition, people with HSV-2 infection may have lesions that are not recognized to be caused by HSV (undiagnosed flare) or may have relapsing lesions that do not cause symptoms (subclinical flare).

However, either virus can affect almost any area of skin or mucous membrane. The first episode of herpes simplex (primary herpes infection) is usually characterized by high fever, headache and painful cervical/groin lymphadenitis. The lesions that are created are multiple and small, break and leave round ulcers usually appear on the gums, lips, cheeks or genitals. The duration varies from 10-14 days. Systemic medication is required. On the other hand, mild, uncomplicated relapsed eruptions of herpes simplex require no treatment. Topical creams are not effective. Oral treatment may be needed to make the episode less intense and lasting.

Herpes Zoster usually occurs after middle age or in periods with weakened immune systems. It presents as painful bubbles on a red background, which quickly break down and leave small wounds. Fever, malaise, and headache may occur several days before the rash, which has a typical, zoster-like distribution. It is usually located in the trunk. Immediate initiation of anti-herpetic treatment (oral therapy) is needed.