General herpes is a viral infection caused by the human herpes virus (HHV), which belongs to the family of enveloped double-stranded DNA viruses. The genus primarily responsible for herpes infections is the simplex virus, commonly referred to as herpes simplex virus (HSV). There are two main types involved in general herpes: HHV-1 and HHV-2. HHV-2 is most commonly associated with genital herpes, accounting for approximately 50% to 85% of genital herpes cases, depending on the population studied. HHV-1 typically causes oral herpes, presenting as oral lesions, but it can also cause genital herpes through oral-genital contact, contributing to 15% to 50% of genital herpes cases.
The transmission of herpes simplex viruses occurs mainly through direct contact with infectious secretions. HHV-2 spreads primarily via genital contact, while HHV-1 spreads through oral contact and less commonly through genital contact. Infectious fluid-filled vesicles, or herpes lesions, and mucus secretions contain high concentrations of the virus, facilitating transmission. Importantly, asymptomatic individuals can also transmit the virus through secretions such as semen. Although condom use reduces the risk of herpes transmission, it offers limited protection because herpes lesions often appear on areas not covered by condoms, such as the external genitalia or the base of the penis.
Herpes symptoms typically include multiple small, painful blisters or vesicles on the genitals or rectum. These vesicles are clear and sit on a reddened base, often described as a "dew on rose petal" appearance—a poetic term also used to describe chickenpox lesions, which are caused by a related virus. The blisters usually heal within a few weeks but can cause significant discomfort, sometimes making walking painful. However, symptoms can vary widely, and some individuals may have mild or unnoticed lesions mistaken for minor skin irritations.
A hallmark of herpes infections is the recurrence of symptoms after periods of dormancy. Recurrences are often triggered by factors that weaken the immune system, such as stress. Approximately 80% of HHV-2 infections experience recurrent outbreaks, sometimes as frequently as four to five times per year, with symptoms that can be severe and painful. Over time, the frequency and severity of recurrences tend to decrease. HHV-1 recurrences are less common and generally milder.
Diagnosis of herpes is primarily clinical, based on the characteristic appearance of the lesions. Confirmation and differentiation between HHV-1 and HHV-2 infections are achieved through polymerase chain reaction (PCR) testing, which detects viral DNA from blister fluid. Treatment involves antiviral medications such as acyclovir, which can reduce the severity and duration of symptoms, decrease the frequency of recurrences, and lower the risk of transmission. However, acyclovir is not a cure, and no permanent immunity develops after infection.
Current research is focused on developing vaccines to prevent herpes infections, aiming to provide long-term protection and reduce the global burden of this common viral disease.
