Herpes simplex virus

Common lifelong DNA viruses causing oral herpes, genital herpes, and severe neonatal or neurologic disease in some cases

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Herpes simplex virus (HSV) refers to two closely related double-stranded DNA viruses that infect humans: herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2). In current virus taxonomy, these are classified as Human alphaherpesvirus 1 and Human alphaherpesvirus 2 in the genus Simplexvirus, subfamily Alphaherpesvirinae, and family Herpesviridae. HSV infections are lifelong because the virus establishes latency in sensory nerve ganglia and can reactivate later.Herpes simplex virus(link). World Health Organization.Herpesviruses(link). Medical Microbiology, NCBI Bookshelf.

HSV can cause oral herpes, cold sores, genital herpes, herpetic whitlow, herpes simplex keratitis, eczema herpeticum, herpes simplex encephalitis, and neonatal herpes simplex. Many infections are asymptomatic or mild, but the virus can cause severe disease in newborns, immunocompromised people, and patients with eye or central nervous system involvement.About Genital Herpes(link). Centers for Disease Control and Prevention.Herpes Simplex Virus: Adult and Adolescent Opportunistic Infections(link). National Institutes of Health.

There is currently no approved vaccine that prevents HSV infection. Antiviral medications such as acyclovir, valacyclovir, and famciclovir can shorten outbreaks, reduce recurrences, treat severe disease, and decrease but not eliminate transmission risk.Herpes - STI Treatment Guidelines(link). Centers for Disease Control and Prevention.

Overview

HSV is one of the most common human viral infections. HSV-1 is traditionally associated with oral herpes and cold sores, while HSV-2 is more strongly associated with genital herpes. However, either type can infect the mouth, genital area, anus, skin, eye, nervous system, or newborn. Genital HSV-1 has become increasingly recognized in many settings, often related to oral-genital contact.Herpes simplex virus(link). World Health Organization."2024 European guidelines for the management of genital herpes".Journal of the European Academy of Dermatology and Venereology.2024;PMC:11934026.

After primary infection, HSV travels along sensory nerves and remains latent in nerve ganglia. Reactivation can occur with fever, stress, local trauma, ultraviolet light exposure, menstruation, immunosuppression, or no obvious trigger. During reactivation, HSV can cause symptomatic lesions or asymptomatic viral shedding.

Classification

• Herpesviridae - Family of large enveloped double-stranded DNA viruses.
• Alphaherpesvirinae - Subfamily characterized by rapid replication and sensory ganglion latency.
• Simplexvirus - Genus containing HSV-1 and HSV-2.
• Human alphaherpesvirus 1 - Formal taxonomic name for HSV-1.
• Human alphaherpesvirus 2 - Formal taxonomic name for HSV-2.
• Enveloped virus - HSV has a lipid envelope surrounding the capsid.
• Double-stranded DNA virus - HSV contains linear double-stranded DNA.
• Baltimore classification - HSV belongs to Group I DNA viruses.

Virus structure

HSV is a large enveloped DNA virus with several structural components.

• Viral envelope - Outer lipid membrane containing viral glycoproteins needed for entry into cells.
• Tegument - Protein layer between envelope and capsid that helps start infection.
• Capsid - Icosahedral protein shell containing viral DNA.
• Viral genome - Linear double-stranded DNA genome.
• Glycoprotein - Envelope proteins involved in cell attachment, entry, immune evasion, and vaccine research.
• Nucleocapsid - Capsid plus viral nucleic acid.
• Viral replication - HSV replicates in the host cell nucleus.
• Cytopathic effect - HSV can produce multinucleation, molding, and ground-glass nuclear changes in infected cells.

Types

HSV-1

HSV-1 most commonly causes oral herpes, including cold sores and fever blisters around the lips and mouth. It can also cause genital herpes, ocular herpes, encephalitis, herpetic whitlow, and severe infection in immunocompromised persons.

• Oral herpes - HSV infection of the lips, mouth, or face.
• Cold sore - Recurrent HSV lesion on or near the lip.
• Gingivostomatitis - Painful primary oral HSV infection, especially in children.
• Genital HSV-1 - Genital infection caused by HSV-1, often acquired through oral-genital contact.
• Herpes simplex keratitis - Eye infection that can threaten vision.
• Herpes simplex encephalitis - Severe brain infection most often associated with HSV-1 in adults.
• Asymptomatic shedding - HSV-1 can be shed without visible sores.

HSV-2

HSV-2 is a major cause of genital herpes and is usually transmitted through sexual contact. HSV-2 infection tends to recur and shed asymptomatically more often in the genital area than genital HSV-1.

• Genital herpes - HSV infection of the genital, anal, buttock, or perineal region.
• Recurrent genital herpes - Repeated outbreaks after latent infection.
• Asymptomatic HSV-2 infection - HSV-2 infection without recognized symptoms.
• Subclinical shedding - Viral shedding without visible lesions.
• HIV infection - HSV-2 infection is associated with increased risk of acquiring and transmitting HIV in some populations.
• Neonatal herpes - HSV-2 is an important cause, though HSV-1 can also cause neonatal infection.

Transmission

HSV spreads through direct contact with infected skin, mucosa, secretions, or lesions. Transmission can occur during symptomatic outbreaks or during asymptomatic shedding.

• Skin-to-skin contact - Main route of HSV spread.
• Kissing - Common route for oral HSV-1 transmission.
• Oral sex - Can transmit HSV-1 or HSV-2 between mouth and genitals.
• Vaginal sex - Can transmit genital HSV.
• Anal sex - Can transmit genital or anorectal HSV.
• Asymptomatic shedding - Transmission can occur when no sores are visible.
• Autoinoculation - Spread from one body site to another, especially during primary infection.
• Vertical transmission - Transmission from pregnant person to newborn, usually during delivery.
• Perinatal infection - Newborn infection acquired around the time of birth.
• Fomite - Transmission from objects is uncommon because HSV is fragile outside the body, but sharing items during active oral lesions should be avoided.

HSV is not transmitted through casual contact such as hugging, sharing toilet seats, or touching intact skin in ordinary social contact.

Risk factors

• Sexual contact - Main risk factor for genital HSV.
• Multiple sexual partners - Increases exposure risk.
• Unprotected sex - Lack of barrier protection increases risk.
• Oral-genital contact - Important route for genital HSV-1.
• History of sexually transmitted infection - Marker for sexual exposure risk.
• Immunocompromised status - Increases risk of severe, persistent, or disseminated disease.
• Atopic dermatitis - Increases risk of eczema herpeticum.
• Pregnancy - New genital HSV infection near delivery increases risk of neonatal HSV.
• Neonatal exposure - Newborn exposure during delivery can cause severe infection.
• HIV infection - HSV can be more severe and prolonged in advanced immunosuppression.

Pathophysiology

HSV infection begins when virus enters through mucosal surfaces or small breaks in skin.

• Primary infection - First infection with HSV, which may be symptomatic or asymptomatic.
• Epithelial replication - HSV replicates in skin or mucosal epithelial cells.
• Sensory nerve - Virus enters sensory nerve endings.
• Retrograde axonal transport - Virus travels toward sensory ganglia.
• Latency - HSV persists in a nonproductive state within nerve ganglia.
• Trigeminal ganglion - Common latency site for oral HSV-1.
• Sacral ganglion - Common latency site for genital HSV.
• Reactivation - Virus resumes replication and travels back to skin or mucosa.
• Anterograde axonal transport - Virus travels from ganglion to peripheral site during reactivation.
• Viral shedding - Release of virus from skin or mucosa, with or without symptoms.
• Cell-mediated immunity - Important for control of HSV infection.

Clinical manifestations

HSV manifestations depend on virus type, anatomic site, immune status, and whether infection is primary or recurrent.

Oral herpes

• Cold sore - Painful vesicle or ulcer on or near the lip.
• Fever blister - Common term for recurrent oral HSV lesions.
• Primary herpetic gingivostomatitis - Fever, painful mouth ulcers, swollen gums, and poor oral intake, often in children.
• Herpes labialis - Recurrent HSV lesion of the lip.
• Prodrome - Tingling, burning, itching, or pain before lesions appear.
• Vesicle - Small fluid-filled blister.
• Ulcer - Open sore after vesicle rupture.
• Crust - Healing scab over a lesion.
• Cervical lymphadenopathy - Swollen neck lymph nodes may occur during primary infection.
• Dehydration - Can occur in children with painful oral disease.

Genital herpes

• Genital ulcer - Painful ulcer on genital, anal, buttock, or perineal skin.
• Dysuria - Painful urination may occur with genital lesions.
• Urethritis - Urethral inflammation can occur in HSV.
• Cervicitis - Cervical inflammation may occur in genital HSV.
• Proctitis - Rectal inflammation may occur, especially after receptive anal exposure.
• Inguinal lymphadenopathy - Groin lymph node swelling.
• Meningitis - Aseptic meningitis can occur during primary genital HSV, especially HSV-2.
• Recurrent outbreak - Reappearance of lesions after latency.
• Atypical genital herpes - Fissures, mild irritation, recurrent redness, or nonspecific symptoms without classic blisters.
• Asymptomatic genital herpes - Infection without recognized symptoms.

Skin and soft tissue HSV

• Herpetic whitlow - Painful HSV infection of the finger or thumb.
• Eczema herpeticum - Disseminated HSV infection in areas of eczema or atopic dermatitis.
• Herpes gladiatorum - HSV infection spread through skin contact in athletes, especially wrestlers.
• Traumatic herpes - HSV infection at a site of skin trauma.
• Disseminated herpes simplex - Widespread HSV infection, mainly in immunocompromised people.

Eye disease

• Herpes simplex keratitis - Corneal HSV infection that can cause pain, redness, photophobia, and vision loss.
• Dendritic ulcer - Branching corneal lesion characteristic of epithelial HSV keratitis.
• Stromal keratitis - Deeper corneal inflammation that can cause scarring.
• Uveitis - Intraocular inflammation that may be associated with HSV.
• Retinitis - Rare severe posterior eye disease.
• Ophthalmology - Specialist evaluation is important for suspected ocular HSV.

Topical corticosteroids can worsen some forms of epithelial HSV keratitis if used without antiviral coverage and specialist supervision.

Central nervous system disease

• Herpes simplex encephalitis - Severe brain infection, usually affecting temporal lobes and commonly caused by HSV-1 in adults.
• Aseptic meningitis - Meningitis without bacterial growth, often associated with HSV-2.
• Mollaret meningitis - Recurrent benign lymphocytic meningitis, often linked to HSV-2.
• Myelitis - Spinal cord inflammation, rare.
• Seizure - Can occur with HSV encephalitis.
• Altered mental status - Important warning sign of encephalitis.
• Cerebrospinal fluid - CSF HSV PCR is central to diagnosis of HSV CNS disease.
• Acyclovir - Intravenous therapy is used for suspected or confirmed HSV encephalitis.

Neonatal herpes

Neonatal herpes simplex is rare but potentially life-threatening. It is usually acquired during delivery from genital HSV shedding, and risk is highest when a pregnant person acquires genital HSV near the time of delivery.Congenital Herpes Simplex(link). StatPearls, NCBI Bookshelf.

• Skin, eye, and mouth disease - Neonatal HSV limited to skin, eyes, or mouth.
• Central nervous system disease - Neonatal HSV involving the brain or meninges.
• Disseminated disease - Multiorgan neonatal HSV infection.
• Sepsis-like illness - Neonatal HSV can mimic bacterial sepsis.
• Vesicular rash - May be present but can be absent.
• Lethargy - Warning sign in newborns.
• Poor feeding - Common nonspecific neonatal symptom.
• Seizure - May occur with CNS disease.
• Intravenous acyclovir - Main treatment for suspected or confirmed neonatal HSV.
• Suppressive acyclovir - May be used after initial treatment in neonatal HSV.

Diagnosis

Diagnosis depends on clinical presentation, anatomic site, timing, and availability of tests.

Lesion testing

When lesions are present, direct testing from the lesion is preferred.

• Polymerase chain reaction - PCR or nucleic acid amplification testing is highly sensitive for HSV from lesions.
• Nucleic acid amplification test - Modern preferred method for lesion confirmation.
• Viral culture - Older test with lower sensitivity, especially for healing lesions.
• Direct fluorescent antibody test - Less commonly used.
• Type-specific testing - Differentiates HSV-1 from HSV-2.
• Specimen collection - Best from fresh vesicles or ulcers before crusting.
• False negative - Can occur if lesion is old, healed, or poorly sampled.

CDC guidance states that if genital lesions are present, clinical diagnosis should be confirmed by type-specific virologic testing from the lesion by NAAT or culture when possible.Herpes - STI Treatment Guidelines(link). Centers for Disease Control and Prevention.

Serologic testing

Blood tests can detect type-specific HSV antibodies, but interpretation requires care.

• HSV-1 antibody - Indicates prior HSV-1 infection but does not identify oral versus genital site.
• HSV-2 antibody - Usually indicates anogenital infection because HSV-2 is typically sexually acquired.
• Type-specific serology - Uses glycoprotein G-based testing to distinguish HSV-1 and HSV-2.
• False positive - Can occur, especially with low index values in some HSV-2 tests.
• Confirmatory testing - May be needed after low-positive HSV-2 serology.
• Seroconversion - Antibodies may take weeks to develop after new infection.
• Screening - Routine HSV-2 screening of the general asymptomatic population is not recommended by CDC.

CNS and disseminated disease testing

• Cerebrospinal fluid PCR - Key test for HSV encephalitis or meningitis.
• Brain MRI - Often used in suspected HSV encephalitis.
• Electroencephalography - May support evaluation of encephalitis or seizures.
• Blood PCR - May be used in neonatal or disseminated HSV.
• Liver function test - Abnormalities may occur in disseminated neonatal or immunocompromised HSV.
• Complete blood count - May help evaluate systemic illness.
• Ophthalmologic examination - Needed for suspected ocular HSV.

Differential diagnosis

• Aphthous ulcer - Noninfectious recurrent mouth ulcer.
• Varicella zoster virus - Causes chickenpox and shingles.
• Syphilis - Can cause genital ulcers.
• Chancroid - Painful genital ulcer disease caused by Haemophilus ducreyi.
• Lymphogranuloma venereum - Chlamydial infection that can cause genital ulcer or proctitis.
• Granuloma inguinale - Chronic genital ulcer disease.
• Behçet disease - Recurrent oral and genital ulcers with systemic features.
• Fixed drug eruption - Medication reaction that can mimic genital herpes.
• Contact dermatitis - Irritant or allergic inflammation.
• Candidiasis - Yeast infection causing irritation and fissuring.
• Hand, foot, and mouth disease - Enteroviral illness causing oral and extremity lesions.
• Impetigo - Bacterial skin infection.
• Eczema herpeticum - Disseminated HSV superinfection of eczema.
• Monkeypox - Orthopoxvirus infection that can cause genital or oral lesions.
• Trauma - Friction or injury can cause erosions or ulcers.

Treatment

There is no cure that eradicates latent HSV. Treatment reduces symptoms, duration, recurrence, and transmission risk.

Antiviral medications

• Acyclovir - Nucleoside analogue used orally, topically in selected settings, or intravenously for severe disease.
• Valacyclovir - Oral prodrug of acyclovir with improved bioavailability.
• Famciclovir - Oral prodrug of penciclovir.
• Penciclovir - Topical antiviral used for cold sores in some settings.
• Foscarnet - Used for acyclovir-resistant HSV, especially in immunocompromised patients.
• Cidofovir - Sometimes used for resistant HSV under specialist care.
• Suppressive therapy - Daily antiviral medication to reduce recurrences and transmission.
• Episodic therapy - Short course started early during recurrence.
• Intravenous therapy - Used for encephalitis, neonatal HSV, disseminated disease, and severe immunocompromised infections.

First clinical episode of genital herpes

First episodes can be prolonged and severe. CDC recommends antiviral therapy for all patients with first episodes of genital herpes.Herpes - STI Treatment Guidelines(link). Centers for Disease Control and Prevention.

• Acyclovir - Used orally for first-episode genital herpes.
• Valacyclovir - Common oral treatment option.
• Famciclovir - Common oral treatment option.
• Pain control - Analgesics and supportive measures may be needed.
• Urinary retention - Severe genital HSV can cause urinary difficulty requiring care.
• Counseling - Education about transmission, recurrence, and partner communication is essential.

Recurrent genital herpes

• Episodic antiviral therapy - Best started within 1 day of lesion onset or during prodrome.
• Suppressive antiviral therapy - Reduces frequency of recurrences and decreases HSV-2 transmission risk.
• Partner protection - Suppressive therapy plus condoms and avoiding sex during outbreaks reduces risk.
• HSV-1 genital herpes - Usually recurs less often than HSV-2 genital herpes; suppressive therapy is individualized.
• HSV-2 genital herpes - More likely to recur and shed asymptomatically; suppressive therapy is often considered.

Oral herpes treatment

• Cold sore treatment - Oral or topical antivirals may shorten duration if started early.
• Prodrome treatment - Treatment is most effective when started at tingling or burning stage.
• Sun protection - Lip sunscreen may reduce ultraviolet-triggered recurrences.
• Pain relief - Topical anesthetics or oral analgesics may help.
• Hydration - Important in children with painful gingivostomatitis.

Severe or complicated HSV

• Herpes simplex encephalitis - Requires urgent intravenous acyclovir.
• Neonatal herpes simplex - Requires intravenous acyclovir and specialist management.
• Ocular herpes - Requires ophthalmology-guided antiviral therapy.
• Eczema herpeticum - Requires prompt systemic antiviral therapy.
• Disseminated HSV - Requires intravenous antiviral therapy.
• Immunocompromised host - May require longer treatment and evaluation for resistance.
• Acyclovir resistance - Suspect when lesions persist or progress despite adequate therapy.

Prevention

HSV prevention focuses on reducing exposure, recognizing symptoms, suppressing outbreaks, and preventing neonatal transmission.

General prevention

• Avoid contact with lesions - Do not kiss or have oral, vaginal, or anal sex during active lesions.
• Prodrome awareness - Avoid contact during tingling, burning, or pain that precedes lesions.
• Condoms - Reduce but do not eliminate genital HSV transmission.
• Dental dams - May reduce risk during oral sex.
• Hand hygiene - Reduces autoinoculation and spread to others.
• Avoid sharing personal items - Do not share lip balm, razors, towels, or utensils during active oral lesions.
• Partner communication - Discuss HSV status and prevention strategies.
• Suppressive antiviral therapy - Can reduce recurrence and transmission risk in genital HSV-2.
• Testing and counseling - Type-specific diagnosis helps guide counseling.

Pregnancy and neonatal prevention

• Pregnancy - Genital HSV should be discussed with obstetric providers.
• New genital HSV infection - Acquisition near delivery carries the highest neonatal risk.
• Suppressive therapy in pregnancy - Antiviral suppression near term may be recommended for recurrent genital herpes.
• Cesarean delivery - Recommended in many guidelines when active genital lesions or prodrome are present at labor.
• Neonatal evaluation - Newborns exposed to HSV may need testing and antiviral treatment.
• Breastfeeding - Usually allowed if no herpetic breast lesions are present and lesions elsewhere are covered.
• Hand washing - Essential before touching newborns.
• Avoid kissing newborns - Persons with active cold sores should avoid kissing infants.

CDC guidance states that providers caring for pregnant women and newborns should be informed when a woman has genital herpes.Herpes - STI Treatment Guidelines(link). Centers for Disease Control and Prevention.

Vaccines and research

No HSV vaccine is currently approved for prevention or treatment. Vaccine research continues, including preventive vaccines, therapeutic vaccines for people already infected, mRNA approaches, viral-vector approaches, protein subunit vaccines, and immune-modulating strategies. A 2024 report noted that one GSK experimental HSV vaccine candidate failed to meet the primary goal in a mid-stage trial and was not advanced to late-stage testing, highlighting the difficulty of HSV vaccine development.GSK's experimental herpes vaccine fails to meet main goal in trial(link). Reuters.

• Preventive vaccine - Intended to prevent HSV acquisition.
• Therapeutic vaccine - Intended to reduce recurrences or shedding in infected persons.
• mRNA vaccine - Vaccine platform under study for several viral infections.
• Neutralizing antibody - Antibody that blocks viral entry.
• T cell immunity - Important immune response for HSV control.
• Viral latency - Major obstacle to cure and vaccine development.
• Gene editing - Experimental approach being studied for latent HSV.
• Microbicide - Topical prevention approach studied for sexually transmitted infections.

Complications

HSV is usually manageable but can cause significant complications.

• Recurrent infection - Repeated outbreaks can affect quality of life.
• Psychological distress - Stigma, anxiety, and relationship concerns are common after diagnosis.
• Urinary retention - Severe genital HSV can impair urination.
• Aseptic meningitis - Can occur during primary or recurrent HSV-2 infection.
• Herpes simplex encephalitis - Life-threatening CNS infection.
• Ocular scarring - Recurrent keratitis can damage vision.
• Neonatal herpes simplex - Severe newborn infection with high morbidity and mortality.
• Eczema herpeticum - Potentially serious disseminated skin infection.
• Disseminated HSV - Severe multiorgan infection, especially in immunocompromised persons.
• Acyclovir resistance - More common in immunocompromised patients.
• HIV transmission - Genital HSV-2 is associated with increased HIV acquisition and transmission risk.

HSV and HIV

HSV and HIV infection interact clinically and epidemiologically.

• Genital ulcer disease - HSV ulcers can increase susceptibility to HIV acquisition.
• HSV-2 - Associated with increased risk of HIV acquisition in some populations.
• Immunosuppression - HIV-related immunosuppression can make HSV more severe or persistent.
• Suppressive therapy - May reduce HSV recurrences but does not replace HIV prevention or treatment.
• Antiretroviral therapy - HIV treatment improves immune function and may reduce severe HSV complications.
• Opportunistic infection - Severe, chronic, or atypical HSV can occur in advanced HIV.

NIH opportunistic infection guidelines provide specific recommendations for HSV prevention and treatment in adults and adolescents with HIV.Herpes Simplex Virus: Adult and Adolescent Opportunistic Infections(link). National Institutes of Health.

Epidemiology

HSV infection is common worldwide. WHO estimates that billions of people live with HSV-1 infection and hundreds of millions live with genital HSV infection caused by HSV-2 or genital HSV-1. Many infections are unrecognized because symptoms are absent, mild, atypical, or mistaken for other conditions.Herpes simplex virus(link). World Health Organization.

• HSV-1 - Often acquired in childhood and commonly causes oral infection.
• HSV-2 - Usually sexually acquired and more strongly associated with recurrent genital herpes.
• Genital HSV-1 - Increasingly important cause of first-episode genital herpes in some countries.
• Asymptomatic infection - A major reason HSV spreads unnoticed.
• Women - HSV-2 prevalence is often higher in women than men in many populations.
• Age - Prevalence generally increases with age and cumulative exposure.
• Socioeconomic factors - HSV-1 acquisition in childhood varies by living conditions and region.
• Global burden - HSV causes substantial medical, psychological, sexual health, neonatal, and ocular disease burden.

Prognosis

For most immunocompetent people, HSV is chronic but manageable. Recurrences often become less frequent or less severe over time, especially for genital HSV-1. HSV-2 genital infection tends to recur more often and shed more frequently. Severe disease can occur in newborns, immunocompromised people, and patients with eye or CNS disease.

• Lifelong infection - HSV remains latent after acquisition.
• Recurrent outbreak - Frequency varies by virus type and host factors.
• Suppressive therapy - Can reduce recurrence frequency and transmission risk.
• Quality of life - Counseling and treatment can reduce distress.
• Ocular prognosis - Depends on prompt diagnosis and prevention of recurrence.
• Encephalitis prognosis - Depends on rapid intravenous acyclovir treatment.
• Neonatal prognosis - Depends on disease form and early treatment.

History

Herpes lesions have been recognized since antiquity. The modern understanding of HSV developed with virology, cell culture, electron microscopy, antiviral drug discovery, and molecular diagnostics.

• Herpes - Term derived from a Greek word meaning to creep or crawl, reflecting spreading lesions.
• Herpes simplex - Term used for localized recurrent blistering disease.
• Electron microscopy - Helped visualize herpesvirus structure.
• Viral culture - Older laboratory diagnostic method.
• Acyclovir - Major antiviral advance for HSV treatment.
• Polymerase chain reaction - Modern molecular test that greatly improved diagnosis.
• Genital herpes - Became a major focus of sexual health and counseling.
• Neonatal herpes - Recognition led to prevention and treatment protocols.

Patient education

Patients should understand that HSV is common, manageable, and often transmitted by people who do not know they have it.

• Common infection - HSV is widespread and does not define a person's worth or relationships.
• Lifelong virus - The virus remains latent but can be managed.
• Outbreak recognition - Tingling, burning, itching, or pain may precede lesions.
• Avoid sex during outbreaks - Sexual contact should be avoided during lesions or prodrome.
• Condom use - Reduces but does not eliminate transmission risk.
• Suppressive therapy - Daily antiviral medication may reduce outbreaks and partner transmission.
• Partner notification - Honest discussion helps shared decision-making.
• Pregnancy planning - People with genital HSV should inform obstetric providers.
• Eye symptoms - Eye pain, redness, or vision change needs urgent care.
• Newborn protection - Persons with cold sores should avoid kissing newborns.
• Stigma reduction - Education and counseling can reduce shame and anxiety.

When to seek medical care

Medical evaluation is recommended for suspected first episodes, severe symptoms, pregnancy, eye involvement, neurologic symptoms, or neonatal exposure.

• First genital ulcer - Should be evaluated and tested.
• Severe pain - May need antiviral therapy and pain control.
• Eye redness - Possible ocular HSV requires urgent ophthalmologic evaluation.
• Vision change - Emergency evaluation is needed.
• Headache with fever - May suggest meningitis or encephalitis.
• Confusion - Possible encephalitis requires emergency care.
• Seizure - Requires emergency evaluation.
• Pregnancy - Genital lesions or exposure should be discussed with an obstetric provider.
• Newborn fever - Newborn illness after HSV exposure needs urgent evaluation.
• Immunocompromised status - Persistent, extensive, or atypical lesions require care.
• Lesions not healing - May suggest resistant HSV or another diagnosis.
• Frequent recurrences - Suppressive therapy may be appropriate.

See also

• Oral herpes
• Cold sore
• Genital herpes
• Herpes simplex keratitis
• Herpes simplex encephalitis
• Neonatal herpes simplex
• Herpetic whitlow
• Eczema herpeticum
• Herpes gladiatorum
• Acyclovir
• Valacyclovir
• Famciclovir
• Sexually transmitted infection
• Viral shedding
• Latency
• Trigeminal ganglion
• Sacral ganglion
• Varicella zoster virus
• Human herpesvirus
• Herpesviridae
• Simplexvirus

Further reading

• Herpes simplex virus(link). World Health Organization.
• About Genital Herpes(link). Centers for Disease Control and Prevention.
• Herpes - STI Treatment Guidelines(link). Centers for Disease Control and Prevention.
• "2024 European guidelines for the management of genital herpes".Journal of the European Academy of Dermatology and Venereology.2024;PMC:11934026.
• Herpes Simplex Virus: Adult and Adolescent Opportunistic Infections(link). National Institutes of Health.
• Congenital Herpes Simplex(link). StatPearls, NCBI Bookshelf.
• Herpes Simplex Type 1(link). StatPearls, NCBI Bookshelf.
• "Diagnosis and Management of Genital Herpes: Key Questions and Review of the Evidence for the 2021 CDC Sexually Transmitted Infections Treatment Guidelines".Clinical Infectious Diseases.2022;74(Supplement_2)

S134-S143.doi:10.1093/cid/ciac032.PMID:35416970.

External links

• WHO - Herpes simplex virus
• CDC - About Genital Herpes
• CDC - Genital Herpes Treatment Guidelines
• NIH - Herpes Simplex Virus in Adults and Adolescents with HIV
• NCBI Bookshelf - Herpes Simplex Type 1
• NCBI Bookshelf - Congenital Herpes Simplex
• 2024 European guidelines for genital herpes
• American Academy of Ophthalmology - Herpes Keratitis