Herpes Simplex: A-to-Z Guide from Diagnosis to Treatment to Prevention

The name “herpes” often causes parents to cringe. Nevertheless, herpes infections are among the more common viral infections of childhood.

What is herpes simplex?

Herpes simplex viruses are common viruses that can cause infections in many parts of the body, including the mouth, skin, eye, brain, and genitals. Some cause disease that is spread throughout the body.

It’s important to be aware of two strains of the virus. HSV-1 (sometimes called oral herpes) most commonly affects the mouth, eyes, and skin above the waist. HSV-2 (sometimes called genital herpes) more often affects the genitals – and because of this, it can affect newborns.

These two strains, however, do not always follow that neat distinction. Up to a quarter of newborn herpes infections, for instance, are caused by type 1.

Who gets herpes simplex?

When a pregnant woman has her first episode of herpes in the genital tract late in pregnancy, somewhere between 1/3 and ½ of the time, a baby born vaginally will also get herpes.

Having said that, most babies with neonatal herpes are born to mothers who have no evidence of active herpes themselves. Babies may get herpes from other sources.

Beyond the newborn period, HSV infections are common, especially in areas of close contact, such as day-care centers and college dorms. The rates vary from time to time and in different locations, but at least one third of children tend to be infected by the end of childhood.

Herpes is especially common among wrestlers (herpes gladiatorum) and rugby players (scrum pox, or herpes rugbiaforum).

What are the symptoms of herpes simplex?

Most children infected with herpes for the first time have no symptoms at all.

The most common symptom in children with a first infection is stomatitis: painful blisters or ulcers on the gums or in or around the mouth, accompanied by fever and decreased appetite. This is most often caused by HSV-1.

Recurrent infections in this area often cause cold sores, usually at the border between the lips and the skin of the face.

Ulcers or blisters in the genital area are most often caused by HSV-2.

Infections in the eye or elsewhere on the skin are also common – especially in eczema patches or at the fingertips (herpetic whitlow).

People who are immunocompromised are at the highest risk of serious herpes infections like herpes encephalitis.

Newborns are among those at high risk. While the infections may be limited to the skin, they may also involve multiple organs, including the brain.

Is herpes simplex contagious?

Yes. It can be passed from person to person by direct contact with blisters or ulcers, or by contact with genital or oral secretions.

How long does herpes simplex last?

Once infected, the virus tends to stay for life. This first infection is called primary herpes.

The blisters of an individual outbreak tend to heal within a week to 10 days, without leaving a scar.

Herpes can flare up again at any time, especially with changes in temperature or sun exposure, or with internal changes such as fever, illness, stress, or the menstrual cycle.

How is herpes simplex diagnosed?

The diagnosis is suspected based on the story and the physical appearance of the child. It may be confirmed by a variety of available lab tests.

How is herpes simplex treated?

Antiviral medications are available to treat herpes infections and flare-ups. The earlier they are started, the more effective the treatment. Whether or not the treatment is needed depends on the severity and location of the infection.

HSV-2 or genital lesions in a child also raise the question of sexual abuse.

How can herpes simplex be prevented?

Avoiding contact with herpes blisters or ulcers can prevent many infections. People who are immunocompromised may need to take antiviral medications when exposed to herpes or known triggers of flare-ups.

Careful obstetric care can sometimes prevent newborn herpes infections. When a woman has an active first herpes infection, a Cesarean section performed within 4 hours of water breaking minimizes (but does not eliminate) the risk.

Related concepts:

HSV-1, HSV-2, Oral herpes, Genital herpes, Newborn herpes, Primary herpes, Scrum pox, Rugby herpes, Wrestling herpes, Whitlow.