Stage 3 -- Recurrence: When people encounter certain stresses (also termed triggers), emotional or physical, the virus may reactivate and cause new sores and symptoms. The following factors may contribute to or trigger recurrence: stress, illness, ultraviolet light (UV rays including sunshine), fever, fatigue, hormonal changes (for example, menstruation), immune depression, and trauma to a site or a nerve region where previous HSV infection occurred.
Some people have recurrent outbreaks with the so-called “classic” blister-like herpes lesions that crust over, or with painful sores. In recurrent herpes, however, this process usually takes about half the time it does in first episodes. In addition, many people have very subtle forms of recurrent herpes that heal up in a matter of days. And lastly, herpes is capable of reactivating without producing any visible lesions (asymptomatic reactivation).
When herpes flares up again, it is called a "recurrence" or "outbreak." Herpes does not always recur, and if it does recur, the timing and severity are different from person to person. Some people rarely have recurrences. Others have them often. Herpes is most likely to recur in the first year after infection. Recurrences may be more frequent for people with weakened immune systems.
With the first outbreak of herpes virus infection, an individual may also experience nonspecific flu-like symptoms like fever, swollen lymph nodes, headache, and muscle aches. It is also possible to have herpes virus infection without having any symptoms or signs, or having signs and symptoms that are so mild that the infection is mistaken for another condition.
The “classic” symptoms that most people associate with genital herpes are sores, vesicles, or ulcers – all of which can also be called “lesions.” (The scientific literature on herpes uses the term “lesion” to describe any break or irregularity in the skin.) These classic lesions of genital herpes often resemble small pimples or blisters that eventually crust over and finally scab like a small cut. These lesions may take anywhere from two to four weeks to heal fully.
Varicella-zoster is transmitted though the mucosa of the respiratory system, specifically the upper respiratory tract, or the conjunctiva of the eye. Initial replication takes place in the regional lymph nodes, and then the virus spreads and replication begins in the liver and spleen. The virus is then transported to the skin where the rash develops. The incubation period of varicella is about 10 to 21 days.
Human herpes virus 3 (HHV3) is also called varicella-zoster virus. HHV3 causes chickenpox. It can also cause a recurrent virus infection of the skin, which is called herpes zoster or shingles. Shingles occurs when dormant varicella-zoster virus from an initial bout of chickenpox becomes reactivated. Like its close relative, HHV1, herpes zoster likes to infect skin cells and nerve cells. This virus may also recur along nerve fibre pathways, causing multiple sores where nerve fibres end on skin cells. Because an entire group of nerve cells is often affected, shingles is generally much more severe than a recurrence of herpes simplex. The lesions generally appear in a band-like or belt-like pattern occurring on one side of the body and are often accompanied by itching, tingling, or even severe pain. Healing usually occurs in 2 to 4 weeks, and scars may remain. Postherpetic neuralgia is a complication of shingles where the pain associated with the infection can persist for months and even years. Most people who experience shingles once do not experience it again.
The herpes virus is probably the most well-known virus after influenza (the flu) or the common cold. What most people don’t know is that this nasty little virus can take several different forms, eight to be exact. The most common form of the herpes virus is chicken pox, which is called varicella-zoster. Herpes simplex is the sexually transmitted version of the virus.
Although the cause is unknown, outbreaks are often associated with periods of weakened immune systems, skin wounds, menstruation, fever, nerve damage, tissue damage from surgery, or exposure to extreme climate situations. A genital herpes outbreak or episode occurs when the HSV-1 or HSV-2 virus is reactivated from its dormant stage. Genital herpes is an incurable disease, and once you contract it, you may experience outbreaks throughout your lifetime. Those who are experiencing their first herpes episode of genital herpes can expect to have several (typically four or five) outbreaks within a year. Over time these recurrences usually decrease in frequency and severity. The first outbreak of herpes is often the longest outbreak experienced. After that, short and inconsistent episodes can be managed and treated with antiviral medication.
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
When we say, “herpes” many of us are thinking about genital herpes, famously known as an incurable inconvenience. But there is more to it than being just a sexually transmitted infection. There are multiple ways that herpes can transmit but genital herpes is usually picked up from sexual contact. Apart from that, herpes can be transmitted when sharing an environment with someone who has the infection as well.
Herpes is transmitted via skin-to-skin contact, not through blood or saliva. Cullins explains that someone with HSV can be shedding the herpes virus without having an outbreak (known as asymptomatic virus shedding), and infect somebody that way. Suppressive antiviral medications, like acyclovir or valacyclovir, inhibit HSV replication, which decreases shedding but does not completely eliminate it, says Johnston.
What's to know about eczema herpeticum? Eczema herpeticum occurs when the herpes virus meets an area of skin that is affected by herpes. This MNT Knowledge Center feature introduces eczema, the herpes simplex virus, and how they combine to produce the effects of eczema herpeticum. Learn also about the treatments available and how it may be prevented. Read now
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"Oral herpes is an infection found in the mouth, or on and around the lips, caused by the Herpes Simplex Virus (HSV)," Michael explains. "There are two types or strains of this virus called HSV1 and HSV2. Usually, the HSV1 strain infects the mouth and lips, and the HSV2 strain infects the genitals. It is however possible for HSV2 to infect your mouth and lips."
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