Dermatologists and Skin Care

Herpes - a Common STD

Written by Dr. Suvash Sahu and medically reviewed by iCliniq medical review team.

Image: Herpes - a Common STD

Herpes disease is caused by herpes simplex virus. The herpes simplex virus (HSV) is a double stranded DNA virus, infects humans alone and is almost ubiquitous. There are two closely related species of HSV, type 1 (HSV-1) and type 2 (HSV-2). They cause primary as well as recurrent mucocutaneous infections. HSV-1 and HSV-2 are usually responsible for non-genital and genital infections respectively, though the reverse can occur in a minority of cases.

True primary infection is usually quite severe as it occurs in a seronegative individual with no previous exposure with HSV. Following primary infection, the virus establishes a latent or dormant state within the posterior root ganglia neurons and on reactivation travels down the nerve fiber to cause recurrent infection.

Clinical Presentation:

The most common presentation of herpes occurs in two ways. They are orofacial infection and genital infection.

Orofacial Infection:

  • Infection at the skin and lip junction known as herpes labialis. It is usually due to HSV-1 and may develop in 20% to 30% of young adults. It is recurrent in one third cases. It is colloquially known as cold sores or fever blisters.
  • After an incubation period of 3 to 10 days, primary HSV infection is heralded by itching and burning at the vermilion border of the lip, followed by an erythematous papule that rapidly becomes studded with grouped vesicles which ulcerate, crust and then heal.
  • A primary infection usually lasts for 1 to 3 weeks.

Genital Infection:

  • Primary genital herpes, the most common cause of genital ulcerations in the industrialized world, accounts for 20% to 50% of all genital ulcers.
  • After the usual incubation period of 3 to 14 days, small grouped vesicles make their appearance over 4 to 6 days and soon ulcerate. Most patients report with pain, itching and dysuria as main symptoms, with painful and tender lymphadenopathy.
  • Primary genital herpes may last for 18-21 days. 80% of the primary genital herpes infections are due to HSV-2, which recur more frequently than those due to HSV-1.

Recurrent Herpes Infection:

The grouped vesicular lesions of recurrent herpes are preceded by itching or burning by one or two days. New lesions cease to appear after one or two days. The course of the eruption is faster; the lesions erode, crust over in four to five days and completely heal in 8-9 days.


Diagnosis is based on the clinical picture and the following investigations.

  1. Tzanck smear from the vesicles shows giant cells in the blister cavity.
  2. The virus can be typed by appropriate serological tests.


Tablet Acyclovir 200 mg five times a day for 7 days in primary and for 5 days in recurrent HSV infections is the recommended treatment for herpes.

For further doubts regarding herpes infection, consult a herpes simplex specialist online -->

Last reviewed at: 07.Sep.2018



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