Herpes simplex recurrence

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Herpes simplex Microchapters


Patient Information

Genital Herpes
Congenital Herpes



Orofacial Infection
Anogenital Infection
Ocular Infection
Herpes Encephalitis
Neonatal Herpes
Herpetic Whitlow
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Epidemiology and Demographics

Asymptomatic Shedding

Recurrences and Triggers

Natural History, Complications and Prognosis


History and Symptoms

Physical Examination

Laboratory Findings

Direct detection of Genital Lesions


Antiviral Therapy

Antivirals for First Episode of Genital Herpes
Antivirals for Recurrent Genital Herpes

Primary Prevention


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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2], Lakshmi Gopalakrishnan, M.B.B.S.


Genital herpes can cause recurrent painful genital sores in many adults, and herpes infection can be severe in patients with suppressed immune systems. It is important that women avoid contracting herpes during pregnancy because a newly acquired infection during late pregnancy poses an increased risk of transmission to the baby. If a woman has active genital herpes at delivery, a cesarean delivery is usually indicated. Patients infected with herpes are more susceptible to HIV infection; hence, herpes may indirectly play a role in the spread of HIV.

HSV Latency

  • HSV latency is static, during which no virus is produced and is controlled by a number of viral genes including Latency Associated Transcript (LAT).[1]

Triggers for HSV Reactivation

The causes of reactivation from latency are uncertain but several potential triggers have been documented.

  • Some studies suggest changes in the immune system during menstruation may play a role in HSV-1 reactivation.[8][9]

Frequency and Severity of Recurrence

  • The frequency and severity of recurrent outbreaks may vary greatly depending upon the individual.
  • Outbreaks may occur at the original site of the infection or in close proximity to nerve endings that reach out from the infected ganglia.
  • In the case of a genital infection, sores can appear near the base of the spine, the buttocks, back of the thighs, or they may appear at the original site of infection.
  • Immunocompromised individuals may experience episodes that are longer, more frequent, and more severe.


Medical Therapy

  • You can read more in detail about the episodic and suppressive antiviral treatment for the management of HSV recurrence here.


  1. Stumpf MP, Laidlaw Z, Jansen VA (2002). "Herpes viruses hedge their bets". Proc. Natl. Acad. Sci. U.S.A. 99 (23): 15234–7. doi:10.1073/pnas.232546899. PMID 12409612.
  2. Sainz B, Loutsch JM, Marquart ME, Hill JM (2001). "Stress-associated immunomodulation and herpes simplex virus infections". Med. Hypotheses. 56 (3): 348–56. doi:10.1054/mehy.2000.1219. PMID 11359358.
  3. Chambers A, Perry M (2008). "Salivary mediated autoinoculation of herpes simplex virus on the face in the absence of "cold sores," after trauma". J. Oral Maxillofac. Surg. 66 (1): 136–8. doi:10.1016/j.joms.2006.07.019. PMID 18083428.
  4. Perna JJ, Mannix ML, Rooney JF, Notkins AL, Straus SE (1987). "Reactivation of latent herpes simplex virus infection by ultraviolet light: a human model". J. Am. Acad. Dermatol. 17 (3): 473–8. PMID 2821086.
  5. Rooney JF, Straus SE, Mannix ML; et al. (1992). "UV light-induced reactivation of herpes simplex virus type 2 and prevention by acyclovir". J. Infect. Dis. 166 (3): 500–6. PMID 1323616.
  6. Oakley C, Epstein JB, Sherlock CH (1997). "Reactivation of oral herpes simplex virus: implications for clinical management of herpes simplex virus recurrence during radiotherapy". Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 84 (3): 272–8. PMID 9377190.
  7. Ichihashi M, Nagai H, Matsunaga K (2004). "Sunlight is an important causative factor of recurrent herpes simplex". Cutis. 74 (5 Suppl): 14–8. PMID 15603217.
  8. Myśliwska J, Trzonkowski P, Bryl E, Lukaszuk K, Myśliwski A (2000). "Lower interleukin-2 and higher serum tumor necrosis factor-a levels are associated with perimenstrual, recurrent, facial Herpes simplex infection in young women". Eur. Cytokine Netw. 11 (3): 397–406. PMID 11022124.
  9. Segal AL, Katcher AH, Brightman VJ, Miller MF (1974). "Recurrent herpes labialis, recurrent aphthous ulcers, and the menstrual cycle". J. Dent. Res. 53 (4): 797–803. PMID 4526372.
  10. Martinez V, Caumes E, Chosidow O (2008). "Treatment to prevent recurrent genital herpes". Curr Opin Infect Dis. 21 (1): 42–48. doi:10.1097/QCO.0b013e3282f3d9d3. PMID 18192785.

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