Published on
Dec 3, 2024
Herpes
Introduction
Herpes is a very common viral infection caused by the HSV-1 and HSV-2 viruses (Herpes Simplex Virus). Once contracted, the virus persists for life in the body, in the nerve ganglia, and can be reactivated in the form of recurrent outbreaks. HSV-1 is mainly responsible for labial herpes ("cold sore"), while HSV-2 causes genital herpes, but both types can infect any location. It is estimated that 70 to 90% of the adult population carries HSV-1, and 10 to 20% carries HSV-2.
If you present with a painful rash suggestive of herpes, particularly in the event of a first episode or severe symptoms, contact your treating doctor first. If they are unavailable, Docadom offers an emergency consultation by a home doctor: call 021 845 45 45 or use our application available on the App Store and Google Play.
Who is at risk?
Anyone can be infected. Risk factors include close contact (kissing, unprotected sexual intercourse), having multiple partners, immunosuppression (HIV, chemotherapy, corticosteroids), and recurrent outbreaks triggered by stress, fatigue, sun exposure, menstruation, fever, certain trauma or surgeries. A pregnant woman infected with HSV-2 late in pregnancy exposes the newborn to neonatal herpes, a rare but extremely serious complication.
Symptoms of Herpes
Labial Herpes
The primary infection is often asymptomatic. When symptoms do occur, they can take the form of acute gingivostomatitis: fever, painful oral ulcerations, cervical adenopathy, difficulty eating, mainly in children. Recurrences (cold sores) begin with tingling or burning sensations around the lips, followed by clusters of small blisters, which rupture and then crust over in 7 to 10 days.
Genital Herpes
The primary infection is often more pronounced: painful blisters on the genitals, fever, inguinal adenopathy, burning urination. Recurrences are milder: itching, tingling, clustered blisters, lasting 5 to 10 days. Outbreaks average 4 to 6 times a year in the first year, then decrease over time.
Other Forms of Herpes
Ocular herpes (herpetic keratoconjunctivitis): red, painful eye, photophobia, reduced vision — ophthalmological emergency.
Herpetic whitlow on fingers.
Eczema herpeticum in patients with severe eczema.
Herpes simplex encephalitis : neurological emergency with fever, altered consciousness, seizures.
Neonatal herpes : life-threatening emergency.
When to seek urgent medical attention?
An emergency consultation is necessary in the following cases:
First episode of genital herpes (for STI assessment and discussion of long-term suppressive treatment).
Herpes in a pregnant woman, especially in late pregnancy.
Ocular herpes : red eye with reduced vision — ophthalmological emergency.
Neurological signs : high fever, confusion, seizures, stiff neck — call 144.
Herpes in an immunocompromised patient.
Extensive, very painful lesions, or lesions occurring on pre-existing eczema.
Herpes in a newborn.
What to do before calling Docadom? Contact your treating doctor first, who can prescribe antiviral treatment if necessary. If they are unreachable, call Docadom at 021 845 45 45 or make your request directly from our smartphone application (App Store and Google Play). In case of neurological signs, reduced vision, or suspected neonatal herpes, dial 144 immediately.
Causes and Transmission
Herpes is transmitted through direct contact with a lesion or with saliva or genital secretions from an infected person, even when asymptomatic (silent viral shedding). Kissing, sexual intercourse (oral, vaginal, anal), and sharing utensils or towels are the main modes of transmission. Mother-to-child transmission can occur during delivery.
After the primary infection, the virus migrates along the sensory nerves and remains latent in the sensory ganglia (trigeminal for HSV-1, sacral for HSV-2). It reactivates through various triggers: stress, fever, fatigue, sun or cold exposure, menstruation, local trauma, or immunosuppression.
Diagnosis of Herpes
The diagnosis is most often clinical. Additional examinations are indicated in atypical or severe forms.
Diagnostic Methods
History taking : previous outbreaks, triggers, partners.
Clinical examination : typical appearance of blisters clustered in "bunches".
HSV PCR on lesions: the gold standard, highly sensitive.
HSV-1 and HSV-2 serology : useful in case of doubt, especially in early pregnancy.
Routine STI screening in case of genital herpes (HIV, syphilis, chlamydia, gonorrhea, hepatitis).
Alternative Diagnoses
Shingles (Varicella-Zoster Virus): blisters along a nerve pathway, characteristic pain.
Isolated aphthous ulcers .
Impetigo, eczema, oral or genital candidiasis .
Syphilitic chancre, ulcerations from other STIs.
Behçet's disease.
Treatment of Herpes
Treatment aims to shorten the duration of the outbreak, to relieve symptoms, and to prevent recurrences. There is no definitive curative treatment.
Antiviral Treatment
Aciclovir (Zovirax®): oral or intravenous depending on severity, 5 days.
Valaciclovir (Zelitrex®): 500 mg twice a day, more convenient.
Famciclovir : another option.
Antivirals are more effective if started within the first 72 hours of the outbreak.
Topical aciclovir (cream): useful for cold sores, started at the first sign of tingling.
Preventive Treatment (Suppressive)
In case of frequent recurrences (≥ 6 per year), daily antiviral treatment (valaciclovir 500 mg/day) may be prescribed over several months. It reduces the frequency of outbreaks and viral shedding.
Associated Measures
Pain relief (paracetamol).
Local care: cold compresses, gentle disinfection.
Moisturizing the lips in case of labial herpes.
Avoid close physical contact and sexual intercourse during outbreaks.
Do not touch the lesions, wash hands after contact.
Prevention of Herpes
Routine condom use for genital herpes (reduces but does not eliminate the risk).
Do not kiss or have sexual relations during an outbreak.
Avoid sharing utensils, towels, and lip balm during a labial outbreak.
Sun protection for lips in case of recurrent labial herpes.
Stress management, sufficient sleep.
Informing the partner in case of genital herpes.
Specific obstetric follow-up for pregnant women with a history of herpes.
Possible Complications
Herpes can lead to several complications, especially in fragile patients:
Herpetic keratitis with risk of corneal scarring and blindness.
Herpes simplex encephalitis : life-threatening emergency with frequent neurological sequelae.
Neonatal herpes : cutaneous, neurological, or disseminated form, extremely severe.
Recurrent meningitis (Mollaret's meningitis).
Disseminated herpes in immunocompromised patients.
Psychological and sexual impact in case of recurrent genital herpes.
When to Contact a Doctor for Herpes
Any first outbreak or any unusual presentation of herpes warrants a medical opinion:
As a first resort : contact your treating doctor, who can confirm the diagnosis and prescribe antiviral treatment if necessary.
If your treating doctor is unavailable (evenings, weekends, holidays), Docadom offers an emergency consultation by a home doctor. Call 021 845 45 45 or make your request via our mobile app, available for free on the App Store and Google Play.
In case of serious signs (eye involvement with reduced vision, neurological signs, herpes in a term pregnant woman or a newborn), dial 144 without delay.
Conclusion: Act Fast at the First Tingling
Herpes is an extremely common viral infection that persists for life in latent form. It is characterized by recurrent outbreaks of painful blisters (lips, genitals, or other locations), which can lead to rare but serious complications such as herpetic keratitis, encephalitis, or neonatal herpes. Antiviral treatments, when started quickly, shorten outbreaks and improve comfort. Prevention is based on protection during contact, managing triggers, and informing the partner.
At the slightest doubt, contact your treating doctor first. If they are not available, Docadom provides an emergency home doctor 7 days a week: call 021 845 45 45 or use our mobile app (App Store, Google Play) to request an emergency consultation.
