Herpes simplex, HSV (herpes simplex virus), cold sores, genital herpes, dermatology, viral encephalitis, Hepes simplex encephalitis
English: herpes

Definition herpes

Herpes simplex is an infectious disease that primarily affects the skin and mucous membranes. This infection is caused by herpes viruses.

There are two types of herpes simplex virus:

  • Herpes virus type 1 and
  • Herpes virus type 2

Type 1 affects the skin and mucous membranes mainly on the face, while type 2 shows itself in the genital area.


The Herpes viruses are divided into three subgroups:

  • α (HSV 1 and 2 (HSV = Herpes simplex Virus); VZV (VarizellaZEaster-Virus)
  • β (Cytomegalovirus (CMV), HHV 6 and 7 (HHV = human herpes virus))
  • γ (Epstein-Barr Virus (EBV), HHV 8)

Essential feature of the human herpes viruses is dwelling in different tissues of the body. When the immune system is weakened, the viruses are reactivated and the disease breaks out again.

Causes of Herpes

The herpes virus is caused by the herpes simplex viruses type 1 and 2. These viruses are so-called DNA viruses.
HSV 1 causes the infection in the face (herpes simplex), whereas HSV 2 causes the infection in the genital area (genital herpes).

Once it occurs, HSV 1 remains in the trigeminal ganglia.Trigeminal ganglia are switching points of nerve fibers of the trigeminal nerve, which supplies the face with sensitivity, i.e. feeling. So it conveys sensations like touch.
From the site of infection, the viruses migrate along the sensitive nerves into the ganglia (cell bodies of the nerves) and remain there for life. Does it come For example, if the immune system is weak, the viruses migrate in the opposite direction back to the skin / mucous membrane. The herpes breaks out again.

The infection of the population (i.e. contact with the virus) with HSV 1 increases during childhood and reaches 80% by puberty. That means about 80% had contact with the herpes 1 virus. However, this does not mean that 80% suffer from a cold sore.
In the case of the herpes simplex virus 2, the infection in adults is around 10 to 30%.
Transmission is only possible through direct contact. The main route of transmission of Herpes 1 is saliva. This infection happens z. E.g. by kissing, drinking from the same glass or by coughing or sneezing. HSV 2 is mainly transmitted through sexual intercourse.

Herpes zoster

Under the so-called Herpes zoster one understands a certain symptom constellation by reactivating the Varicella zoster virus (VZV). This virus belongs to the class of herpes viruses and resolves the well-known clinical picture of the virus when it is first infected (through droplet infection) chickenpox out!
Once the chickenpox was over, the virus couldn't get through that at the same time immune system has been completely eliminated from the body: Rather, it nests in certain nerve structures (at the VZV it is the Spinal ganglia) of the body and remains there for a lifetime, so that under certain circumstances (e.g. due to stress, immune disorders) it becomes a reactivation and another outbreak may occur.
This renewed outbreak does not appear in the sense of chickenpox, but it manifests as a so-called Shingles (Zoster; herpes zoster). Once you have been infected with the varicella zoster virus, you are immune to another new infection for life, the clinical picture of chickenpox so can not again happen.
Against a reactivation however, the virus that has already entered the body does not protect one. This most often happens between 50th and 70th year of life, but can generally affect any age group. The typical symptoms of herpes zoster begin with general signs of illness like fever, headache and body aches, fatigue and tiredness. As the disease progresses, pulling or dull pains become noticeable in a certain area of ​​the skin that is innervated by the cutaneous nerves that originate from the spinal ganglion infected by the virus. At the same time, tingling or numbness can be noticed in this area of ​​the skin.
Further in the course, the typical zoster skin areas appear in this exact area of ​​the skin clear as water Vesicleswhich can be arranged either in groups or "segmentally" in the form of a belt and after a few days crust and heal. The herpes zoster outbreak can often be found on the upper body, face or ear. In severe cases, so-called Antivirals (e.g. Acyclovir) given, next to it Painkiller (e.g. Ibuprofen) to relieve the accompanying skin pain. To prevent the initial infection with the virus (VZV), a vaccination be done with a live vaccine.

Herpes simplex

Herpes simplex infection is an infection with a herpes simplex virus (HSV), which is characterized by its typical appearance of local, vesicular appearances on the skin and mucous membranes. However, a distinction is made between two different herpes simplex viruses, which differ in the frequency of infection and the preferred place of infection manifestation (the place where the vesicles first appear):

  • Type 1 virus is the more common of the two and is also known as the oral strain of herpes because of its preferred location of the breakout on the lips (and mouth).
  • The type 2 virus, on the other hand, manifests itself primarily with symptoms in the male and female genital organs and is therefore called the genital herpes strain. In general, around 85-90% of all people in the world are infected with a herpes simplex virus, whereby the virus lingers in certain nerve structures (ganglia) of the body and can be reactivated again and again.

The first infection with the type 1 virus occurs in most cases before the age of 5, the transmission occurs through the typical droplet or smear infection (e.g. via saliva or hand contact, e.g. when kissing, petting, sharing cutlery or glasses, by sneezing etc.).
In 99% of the cases, this initial infection proceeds without any noticeable symptoms; only rarely can a very painful inflammation of the entire oral and pharyngeal mucosa develop (herpetic stomatitis). The respective reactivations of the type 1 virus usually take the form of blistering on the lip (cold sore), whereby the cause can be varied (e.g. stress, immune weakness).

During pregnancy in particular, the immune system of the expectant mother is burdened by the hormonal changes, so that herpes (type 1) often breaks out in the form of the typical lip sores.

Learn more about this at: Cold Sores During Pregnancy - Is It Dangerous?

Since the type 2 virus is a pathogen that can be transmitted through unprotected sexual intercourse, the preferred age for the initial infection is more likely to be adolescent or adult. During the respective reactivations, vesicles form mainly on the limb and vagina, but in some cases also in the area of ​​the buttocks.

The infections (of both virus types) are treated with so-called antivirals. These are drugs that inhibit the growth or multiplication of viruses and can be administered locally (as an ointment for mild infections, e.g. only on the lip) or systemically (as a tablet for more severe infections). As a rule, the initial infections and reactivations proceed without complications, the symptoms subside after a week without permanent damage. In rare cases, however, the infection or inflammation can spread to the brain and meninges (herpes simplex meningoencephalitis).

Read more on the topic: Herpes simple

Herpes in the mouth

A herpes infection in the mouth - too Aphthous stomatitis or Herpetic stomatitis called - is a characteristic inflammation of the oral mucosa and is caused by an initial infection or reactivation with the herpes simplex virus type 1. Children between the ages of 1 and 3 are most frequently affected, as this is the preferred age for a first viral infection (transmission, for example, through lip contact with an infected parent; the child's immune system is not yet fully developed, the virus passes through the immune system more easily ).

You may also be interested in this topic: Viral infection

An initial infection - if there is no infection in toddler age - is still possible across any other age group. After initial contact with the virus, after a latency period of 3-7 days without symptoms (incubation period), pronounced, painful inflammation of the entire oral and pharyngeal mucosa occurs, which is often accompanied by fever and swollen lymph nodes in the head and neck area and general symptoms of illness. The inflamed, reddened oral mucous membrane shows the typical vesicles that break open after a while (canker sores) and cause considerable pain when eating, drinking and swallowing. However, not every initial infection proceeds with the same intensity; in some cases, uncomplicated, minor involvement of individual mucosal areas can also occur. As a rule, the initial infection is much more violent than the subsequent reactivation, in which often only vesicles appear on the lip.

Read more on the topic: Herpes in the mouth

Herpes by body region

Genital herpes

Of the Genital herpes belongs to the infectious diseases of the male and female genital organs and is caused by the herpes simplexVirus type 1 (in 20-30%) and Type 2 (in 70-80%) triggered. The transfer of the Type 2 Virus usually happens through a transmission of Body fluids during unprotected intercourse, the infection with Type 1 in the genital area, however, is through a active cold sore on the Genital organs transfer (Oral sex, Smear infection about the hands). Further possibilities of infection, which are rather rare, are direct infection via virus-carrying objects (used condoms, worn underwear) or the infection of a newborn when passing through the birth canal during a vaginal birth if the mother has an active genital herpes at that time.
Typical symptoms of genital herpes are the characteristic vesicles on the skin and mucous membrane of the genital organs by Burn and itch can be accompanied (preferably on the glans, foreskin, labia and buttocks). Like cold sores, symptoms subside with or without therapy (local or oral antivirals such as acyclovir) after some time, but genital herpes also tends to recur and thus returns after an indefinite period of time.

Herpes on the eye

A manifestation of the herpes disease in or on the eye is usually caused by the herpes simplex virus Type 1 but the eye is more likely to cause it rarer ones Represents place for the reactivation of chronic viral disease. The eye infection can be triggered by a reactivation of the herpes virus there or by a Smear infection a contagious herpes outbreak, for example on the lips or nose. Often only one eye is affected at the beginning, but the other eye can become ill as the disease progresses.
Either the Eyelids, the Cornea, the Conjunctiva or else the Choroid of the eye. A superficial herpes reactivation on the eyelids is noticeable through the appearance of small herpes vesicles on the eyelid skin, a Corneal infection (Herpes corneae), in which the conjunctiva is involved in many cases (keratoconjunctivitis) with the typical symptoms of a Cornea- or. Conjunctivitis: Reddened eyes, increased tears, foreign body sensation, photophobia and impaired vision. The herpes virus can only attack the superficial layer of the cornea or penetrate into the deeper layers of the cornea, with the risk of an infection spreading into the interior of the eye (e.g. to the choroid). Deep corneal infections carry the risk of corneal scarring and clouding and permanent visual impairment, infections of the choroid even the risk of blindness.

Herpes on the nose

The typical symptoms of a reactivated herpes infection can affect other parts of the body in addition to the classic places of infection such as the lips, mouth and genital organs. This always happens when the virus is transferred to any minimally damaged skin / mucous membrane areas by a droplet or smear infection. For example, it can lead to an independently caused infection of the nose come when your own hands come into contact with the contents of the broken blisters of a currently active cold sore and these then transfer the pathogens to the nasal mucous membrane (the same applies to the eye).
The infection is always favored if the mucous membrane to which the virus is transmitted is previously damaged (smallest, invisible Micro injuries are usually sufficient). Of the Nasal herpes (Nasal herpes) is very similar in appearance to cold sores, as the characteristic vesicles also form in the area of ​​the skin and mucous membrane of the nose, which are accompanied by burning sensations, feelings of tension and itching and which break open as the disease progresses.

Read more on this topic at: Herpes nose


An existing neurodermatitis can also become infected with HSV.

In addition to a severe form with Necrosis (dead tissue) and Ulcers (Ulcers), there is some involvement of other organs.

In the context of the disease there may be involvement of the eyes come: a so-called Ocular herpes. Conjunctivitis and corneal inflammation are common. It can lead to scarring and thus deterioration in vision. Therefore, this complication must be taken very seriously.

Likewise, it can be one Eczema hepeticatum come. This is an HSV superinfection of an atopic Eczema (atopic eczema = Neurodermatitis). This means that atopic dermatitis also deals with the Herpes virus infected.

In addition to the atopic eczema (nerodermitis), the appearance has cold sores. The distribution is extensive according to the atopic dermatitis. Spontaneous healing occurs after several weeks.

Another complication is that Herpes simplex encephalitis, an inflammation of the brain. This form of Encephalitis is the most common Viral encephalitis.
Further information on these topics can also be found at:

  • Herpes simplex encephalitis
  • Viral encephalitis

In immune-compromised patients, it can even be caused by the herpes virus lung infection come.

In general, the course is more severe in people with a weakened immune system than in healthy people. For example at AIDS patients tissue-destroying skin and mucous membrane changes often occur that are difficult to heal. Also Conjunctivitis and Inflammation of the retina occur. Also one Involvement of the meninges (meningitis) occurs.
This form of the course is called a generalized course, since the reactions to the virus not only occur locally in one place, but also become noticeable in several organ systems.


Most of them are Symptoms, about which the patients complain already groundbreaking.
Vesicles mostly to the Lipscausing pain, itching and / or burning. One can possibly use the virus detect in the vesicle contents with the help of a smear. It will mostly be the Virus - DNA or that Virus - antigen proven. The antigen is the component of the virus to which the body reacts with a defense reaction and against which it so-called antibody forms.

Therapy of herpes

On top is that therapy the possibly present immunodeficiency.

Furthermore, the primary infection (first infection with the virus) is treated symptomatically if the course is mild. So the symptoms are treated, not the cause of the disease.
If the initial illness is severe or if there are extensive relapses (relapse = recurrence), the entire body is treated systemically, i.e. via the bloodstream. In this case, drugs are given that inhibit the growth of the virus. Here, for example, the doctor has Acyclovir in tablet form.
The cold sore can also locally Acyclovir ointment be treated.

Homeopathic medicines can also help. Please also read our topics:

  • Homeopathy for cold sores
  • Homeopathy for genital herpes
  • Homeopathy for shingles


Acyclovir only works against that which copies itself active herpes virus - which in z. E.g. the vesicles are present -, Not but against that passive herpes viruswhich is “hidden” in the ganglia.

Home remedies for herpes

The common home remedies that can be used in the context of a blooming herpes include various herbal remedies that have a disinfecting, antiviral and, on the other hand, an anti-inflammatory, drying and itching effect. So is suitable for example honeythat is applied to the cold sore because it causes a antibacterial and antiviral Contains active ingredient and supports the regeneration of the affected area.
But the im black tea contained active ingredient Tannin which also has antiviral and anti-inflammatory effects (put a lukewarm or cold tea bag on the affected area).
Other home remedies, such as for example, have a drying effect on the blisters essential oils (Tea tree oil, lemon balm oil, rose hip oil, St. John's wort oil, marigold oil, jojoba oil) Toothpaste or baking powder / cornstarch (apply to the blisters with a dusted cotton pad), which can accelerate the healing of the blisters. Aloe vera, cooling with ice cubes or Epsom salts also help against itching and burning.


Illustration herpes

You should try to avoid getting herpes in the first place. At this high 95% infection rate in adults, however, this approach is relatively unrealistic.
Once you have herpes simplex, it will accompany you throughout your life. To avoid recurrence, the Provocation factors are largely eliminated. For example, a Lip protection can be applied (lip balm sticks with sun protection factor SPF).

If a pregnant woman is infected with genital herpes, a Caesarean section - Delivery (med. Caesarean section) preferred to avoid infection of the newborn.

If a patient with herpes simplex has an immune deficiency, prophylactic measures can be taken Acyclovir be treated.

A vaccine against herpes simplex viruses is being tested.


If there is only a local infection with herpes - for example, blisters on the lip - the prognosis is good.
At a generalized herpes infection and viral encephalitis / Hepes simplex encephalitis (inflammation of the brain), as well as an existing immune deficiency, often lead to life-threatening courses high mortality.

Herpes in the baby

A herpes infection in infancy or childhood is in many cases much more serious than in adulthood, since it is usually an initial infection and the baby's body comes into contact with the virus for the first time. The little ones can get an infection with the herpes simplex virus type 1 or 2, although they are rarely responsible for it themselves. On the one hand, the virus (especially type 1) can be transmitted after birth through a smear infection (e.g. kissing, cuddling, transmission via hands, etc.), on the other hand, the viruses can already be transmitted to the during birth Newborns are transmitted (especially type 2, but also type 1). This happens when the newborn baby passes through the birth canal during vaginal delivery. However, if an expectant mother herself suffers an initial infection with a herpes virus during pregnancy, a so-called viraemia and a direct transmission of the virus to the unborn child via the placenta can occur - albeit rarely.
The last two cases can then be associated with serious, possibly life-threatening symptoms such as:

  • sepsis-like conditions (blood poisoning)
  • Eye / mouth involvement
  • Skin rash (rash
  • Fever and vomiting
  • Infested with
    • Brain (herpes encephalitis)
    • lung
    • liver
    • Kidneys,
    • spleen
    • Etc.

Due to the good diagnostics, however, infections in the mother during pregnancy can in most cases be detected in good time, so that the infection of the newborn can then be prevented and thus occurs only very rarely. In addition, a severe form is rather rare, should the newborn be infected in the womb or birth canal (only blisters on the skin, fever and lethargy).

Read more on the subject at: Herpes in babies - how dangerous is it?