Herpes Simplex Virus

February 8, 2017

Herpes is one of the most common sexually transmitted infections, and is caused by the herpes simplex virus (HSV). HSV can cause blister-like sores almost anywhere on a person’s skin, though it usually occurs around the mouth and nose or the buttocks and genitals. HSV are ubiquitous, host adapted pathogens and can cause variety of diseases.

Herpes is a family name for some 50 related viruses. In addition to herpes simplex, the family also contains the viruses responsible for infectious mononucleosis (Epstein – Barr virus), chicken pox (varicella), and shingles (herpes zoster).

Herpes infections proceed in three stages:

  1. Infection – During this stage, the virus enters your skin.
  2. Latency – The virus travels and reproduces.
  3. Recurrence – It re-occurs.

HSV enters the body through a mucous membrane or a small opening in the skin as a result of direct contact (i.e., through touching, kissing, and vaginal, oral, or anal sexual activity). Although the virus is most contagious through direct contact with herpes sores, it can also be transmitted through saliva or through skin contact with people who have no visible sores or other symptoms.

After the primary infection, the herpes virus travels along the nerves and becomes dormant within nerve cells. The virus is reactivated during times of stress, and travels back out through the same pathway, causing characteristic recurring crops of blisters.

Types of HSV

There are two types of herpes simplex virus: herpes simplex 1 (HSV-1) and herpes simplex 2 (HSV-2). For most people, herpes is a minor skin condition that comes and goes without causing problems.

  • HSV-1 is commonly found around the mouth, and is often called “cold sores”. It can be passed to the genitals through oral sex

Studies show that most people contract Type 1 – which usually affects the lips, mouth, nose, chin or cheeks during infancy or childhood. They usually acquire it from close contact with family members or friends who carry the virus and transmit it to them by touching, kissing, and by the use of common eating utensils and towels. A rash or cold sores involving the mouth and gums appear shortly after exposure. Symptoms may be barely noticeable or may necessitate medical attention for pain relief.

  • HSV-2 is commonly found in the genital area, but it can be passed to the mouth through oral sex. It is uncommon for HSV-2 to be found on the lips, but it is becoming more common to find HSV-1 in the genital area.

Both types are sometimes passed to other areas of the body through skin-to-skin contact. These viruses are neurotropic, i.e. capable of infecting the nervous system and causing neurological diseases. Moreover, HSV results in a lifelong infection by establishing latency in the host sensory neurons and replicating in epithelial cells during primary infection and reactivation.

Who is at risk?

Exposure to HSV-1 is extremely common — as many as 90% of American adults have been exposed to the virus — and there is no stigma to having a cold sore.  However, HSV-2, or genital herpes, can cause embarrassment. Although there is no cure for genital herpes, an infected person can take steps to prevent spreading the disease and can continue to have a normal sex life.

Most people get HSV-1 (herpes simplex type 1) as an infant or child. This virus can be spread by skin-to-skin contact with an adult who carries the virus. An adult does not have to have sores to spread the virus.

A person usually gets HSV-2 (herpes simplex type 2) through sexual contact. About 20% of sexually active adults in the United States carry HSV-2. Some people are more likely to get HSV-2. These people are –

  • Female.
  • Have had many sex partners.
  • Had sex for the first time at a young age.
  • Have (or had) another sexually transmitted infection.
  • Have a weakened immune system due to a disease or medicine.


HSV is spread by direct skin-to-skin contact. HSV can be passed even when sores are not visible, although it is less likely to happen during these times. Sometimes the virus can be found on the skin even when there are no symptoms. This is called “asymptomatic shedding”.

Once a person is infected by a type of HSV, it is unusual to get the same type on another area of your body. The exception is within the first few months after a person first gets HSV. HSV can be passed to other parts of the body during this time. It is advisable to try not to touch the sores and wash hands often, to lower the chances of passing it to another part of the body.

If a person have one type of HSV, then it is not possible to get that same type again from a new partner.

Mothers can give the herpes virus to their baby during childbirth. If the baby is born during the mother’s first episode of genital herpes, the baby can have serious problems.

Triggers for herpes breakouts

At present, getting the herpes virus is a lifelong infection. Recurrent outbreaks of symptoms may occur from time to time, especially when the immune system is compromised or the presence of the following triggers:

  • Artificial sweeteners, particularly aspartame. It can trigger an outbreak within hours.
  • Stress to the immune system. Being run down, fatigued, stressed, or suffering colds or ‘flu (influenza).
  • Menstruation.
  • Exposure to strong sunshine, cold or wind.
  • Sunburn.
  • Poor diet. Try to eat an alkaline diet with lots of fruits and green leafy vegetables. Avoid sugar, wheat and all sweet foods and drinks – manufactured drinks, candies, cookies, cakes etc.
  • Immunosuppressant drugs.
  • Tea and/or coffee. 

Additional underlying causes of herpes breakouts –

  • Metabolic imbalances – anaerobic/aerobic, anabolic/catabolic or pH imbalance (cellular, blood or tissue).
  • Nutritional deficiencies – selenium, zinc, copper, vitamins A, D, B12.
  • Iron overloads (clinical or subclinical hemachromatosis). This often occurs together with copper deficiency.
  • Hormone imbalances or swings – adrenal exhaustion, hypothyroidism, estrogen dominance, hypercortisolemia.
  • Toxins such as heavy metals, oxidants (chlorine, bleach, ozone, sulfite) or cross-linkers (alcohol, formaldehyde, acetaldehyde).
  • Chronic inflammation usually from allergies, intolerances, or an unrecognised or unresolved chronic infection.


  • HSV-1 in immunocompromised individuals – In people with weak immune systems, such as those with advanced HIV infection, HSV-1 can have more severe symptoms and more frequent recurrences. HSV-1 in a person with advanced HIV disease can also lead to more serious, but rare, complications such as dissemination, encephalitis, or ocular disease.
  • HSV and HIV – HSV-2 and HIV have been shown to influence each other. HSV-2 is amongst the most common infections in people living with HIV, occurring in 60-90% of HIV-infected persons. HSV-2 infection increases the risk of acquiring a new HIV infection by approximately three-fold. In addition, people with both HIV and HSV-2 infection are more likely to spread HIV to others.

Infection with HSV-2 in people living with HIV (and other immunocompromised individuals) often has a more severe presentation and more frequent recurrences. In advanced HIV disease, HSV-2 can lead to more serious, but rare, complications such as meningoencephalitis, esophagitis, hepatitis, pneumonitis, retinal necrosis, or disseminated infection.


Many people who get the virus that causes herpes never see or feel anything. If signs (what you see) or symptoms (what you feel) occur, a person may experience:

  • Tingling, itching, or burning – Before the blisters appear, the skin may tingle, itch, or burn for a day or so.
  • Sores – One or more painful, fluid-filled blisters may appear. Blisters break open and often ooze fluid and form a crust, before healing. The first time sores appear, they will show up between 2 and 20 days after a person has contact with an infected person. The sores can last from 7 to 10 days. Where the sores appear often varies with type:
  • Oral herpes (HSV-1) – Most blisters appear on the lips or around the mouth. Sometimes blisters form on the face or on the tongue. Although these are the most common places to find oral herpes, the sores can appear anywhere on the skin.
  • Genital herpes (HSV-2) – Sores typically occur on the penis, vagina, buttocks, or anus. Women can have sores inside the vagina. Like oral herpes, these sores can appear anywhere on the skin.
  • Flu-like symptoms – Fever, muscle aches, or swollen lymph nodes (glands) in the neck (oral herpes) or groin (genital herpes) are possible.
  • Problems urinating – People (most often women) with genital herpes may have trouble urinating or have a burning feeling while urinating.
  • An eye infection (herpes keratitis) – Sometimes the herpes simplex virus can spread to one or both eyes. If this happens, you can have pain, light sensitivity, discharge, and a gritty feeling in the eye. Without prompt treatment, scarring of the eye may result. Scarring can lead to cloudy vision and even loss of vision.


Medications – The goals of pharmacotherapy are to reduce morbidity and to prevent complications. But it is also important to know that this treatment also includes various side effects.

  • Penciclovir (Denavir) – Inhibitor of DNA polymerase in HSV-1 and HSV-2 strains, inhibiting viral replication.
  • Acyclovir (Zovirax) – Synthetic purine nucleoside analogue with activity against a number of herpesviruses, including herpes simplex and varicella-zoster.
  • Vavacyclovir (Valtrx) – Prodrug rapidly converted to the active drug acyclovir. More expensive but has a more convenient dosing regimen than acyclovir.
  • Famciclovir (Famvir) – Prodrug rapidly converted to the active drug acyclovir. More expensive but has a more convenient dosing regimen than acyclovir.
  • Lidocaine gel for pain control of cold sores.
  • Local analgesic for gingivostomatitis – benzydamine mouthwash (over 13 years) or spray.
  • Chlorhexidine mouthwash for gingivostomatitis.

Pregnant women infected with HSV can be treated with antivirals to reduce the likelihood of an outbreak of genital herpes during delivery. In addition, a caesarean-section can be performed to avoid transmission to the neonate when HSV lesions are present during labour.

Laser treatment – Laser therapy decreases pain and reduces the number of recurrences. It is particularly useful for elderly patients, due to the low frequency of side effects. However, large-scale double-blind trials have not yet been conducted


To lower the chances of passing or getting HSV:

  • Condoms and dental dams may help to prevent HSV
  • You can still be sexual when you have an outbreak, but take care to avoid skin-to-skin contact in the area of the sore (this would mean not having oral sex when you have a sore on the mouth, but genital contact is fine).

Alternative Treatment

Nutrition & Dietary Supplements

  • Lysine – Studies suggest that lysine may help reduce the number of recurring outbreaks of cold sores. A few studies also suggest that lysine may help shorten the length of an outbreak. Lysine can increase the amount of calcium that the body absorbs.
  • Propolis – A resin made by bees, propolis is loaded with antioxidants that help fight infection and boost immune function. Studies show that, it can stop HSV-1 and HSV-2 from reproducing.
  • Zinc – Zinc is effective against HSV-1 and HSV-2. In one small study, people who applied zinc oxide cream to cold sores saw them heal faster than those who applied a placebo cream.
  • Vitamin E – Topical application of vitamin E helps to relief pain and aid the healing of oral herpetic lesions.
  • Vitamin C – Ascorbic acid has been shown to inactivate a wide range of viruses in vitro, including Herpes simplex virus, and to enhance immune function.
  • Lithium – Preliminary evidence suggests that oral or topical lithium is beneficial. Lithium inhibited the replication of HSV-1 and HSV-2 in vitro at concentrations that did not inhibit host cell replication.


  • Lemon balm – Several studies suggest that topical ointments containing lemon balm may help heal cold sores.
  • Aloe (Aloe vera) – Preliminary evidence suggests that aloe gel used topically may improve the symptoms of genital herpes in men.
  • Rhubarb cream (Rheum palmatum) – A topical cream made from sage (Salvia officinalis) and rhubarb was as effective as Zovirax in healing cold sores.
  • Eleutherococcus or Siberian ginseng – Siberian ginseng reduced the frequency, severity, and duration of outbreaks. People with high blood pressure, certain heart conditions; diabetes; obstructive sleep apnea; hormone-related cancers such as breast cancer, ovarian cancer, or uterine cancer; narcolepsy (frequent day time sleeping); mania; or who are pregnant or breastfeeding should not take Siberian ginseng.
  • Peppermint oil (Mentha x piperita) – Peppermint oil helps to stop a number of viruses from reproducing, including herpes.
  • Tea Tree Oil – This substance has been hailed as a veritable cure-all when it comes to any ailment that involves open sores.
  • Samento extract – This substance is available in both pill and liquid form. It is extracted from a plant found in many rain forests around the world and is thought to be a major immune system booster. Most herpes outbreaks happen when the immune system is at a low point and the virus is able to cause an outbreak.

Mind Body Treatment

Having genital herpes can impact your social and emotional life. In fact, if you have herpes, it is common to feel depressed, angry, and even guilty. Worrying about possible rejection by someone with whom you want to be intimate is also common. Joining a support group where members share experiences and problems can help relieve the stresses associated with having genital herpes. This may also include –

  • Relaxation Techniques
  • Self Hypnosis
  • Emotional Support

There are a number of natural options available for the prevention and treatment of Herpes simplex infections. These medications can be used to alleviate the symptoms of an outbreak and shorten its course or to suppress recurrences, reduce the number outbreaks and prevent spreading the disease.


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