Herpes simplex.jpg
Herpes Simplex affecting the lower lip


Herpes Simplex (also HSV, with subtypes HSV-1 and HSV-2) is a viral infection that can cause cold sores (also called gingivostomatitis and usually caused by HSV-1) and genital herpes (usually HSV-2).


Up to 10% of people are seropositive for HSV-2 and between 30 and 80% are seropositive for HSV-1


Seropositivity increases with age


No difference between males and females

Risk Factors

  • Immunosuppressed
  • High risk sexual behaviour (HSV-2)

Signs and Symptoms



Herpes simplex infects people through mucosal surfaces or breaks in the skin. Replication occurs in the epidermis at first before moving to sensory or autonomic nerve endings. Here it travels by retrograde axonal transport to sensory ganglia where it can remain latent and cause lifelong infection. Acquiring herpes may be asymptomatic.

During reactivation the virus travels by anterograde transport down axons to the mucosal or cutaneous surface. Transmission of the virus can also occur when the patient is asymptomatic.




  • Viral cultures - virus detected
  • HSV PCR - positive
  • Serological assay - positive; rising titres in primary infection


Diagnosis is based on viral detection or serological response.

Differentials to rule out





Patients should be followed up yearly to decide whether suppressive or episodic treatment is better. Patients who are positive for HSV-2 should also be tested for HIV.
It is important to educated patients with HSV-2 about the risks of transmission during sex.



Herpes Simplex is highly variable with some patients experiencing frequent outbreaks while others are completely asymptomatic.

See Also

BMJ Best Practice - Herpes Simplex infection
Oxford Handbook of Clinical Medicine - 9th edition p400


Herpes Simplex Lip image: "Herpes(PHIL 1573 lores)". Licensed under Public Domain via Commons - https://commons.wikimedia.org/wiki/File:Herpes(PHIL_1573_lores).jpg#/media/File:Herpes(PHIL_1573_lores).jpg
  1. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/53.html
  2. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/53.html
  3. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/53.html
  4. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/53.html
  5. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/53.html
  6. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/53.html
  7. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/53.html
  8. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/53.html
  9. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/53.html
  10. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/53.html