Medical uk herpes virus

We hope we are finally going to get answers to the questions we've always had - both for ourselves and for Kim's children.

Ryan Mulcahy, Samantha's husband said "not knowing what happened has worsened the pain and the suffering from losing Sam". Samantha's mother Nicky hopes the inquest will help the families come to terms with what happened.

You feel like you are stuck and you can't move forward because you haven't got the answers you should have had," she said. Dr Rebecca Martin, chief medical officer for East Kent Hospitals, said: "Our deepest sympathies are with the families and friends of Kimberley and Samantha. Change to sepsis advice after mums' herpes deaths. Surgeon may have given herpes to C-section mums who died.

Finally, we show how the above struggles are exacerbated by the lack of support systems for the post-acute effects of encephalitis, describing how people are consequently forced to devise their own routines of care and strategies for managing their problems. These findings are then used to generate recommendations for improving the post-acute support for people affected by encephalitis.

The co-ordinates of speech, memory, and movement, which are part of the taken-for-granted structuring of life, are therefore altered and the daily routines which they help to stabilise become fractured. Taken-for-granted, embodied actions, such as washing, dressing, walking and talking are profoundly altered, meaning that other purposeful activities, like crossing the road, cooking, and driving become difficult and unfamiliar.

These problems also mean that the daily lives of significant others are overtaken by the requirement to support these functions: to care for people who can no longer manage the activities of independent living. This is an exhausting process for those forced to care for their relatives around the clock, and who have to adjust their own working lives to facilitate a new role as carer.

Over time, the consequences of having encephalitis becomes pronounced, and incorporates, in addition to the problems outlined above: seizures, with some participants receiving a diagnosis of epilepsy; general fatigue and difficulties concentrating on tasks; mental health problems; and behavioural issues, such as aggression.

For those who cannot return to work, they are forced to apply for welfare benefits or take early retirement see Table 1. Changes in employment status also have serious financial implications, with individuals and families struggling to maintain former lifestyles. The day-to-day work involved in domestic routines, such as cooking, and taking children to school, becomes largely the responsibility of other family members. These shifts in responsibility mean that the nature of relationships between people affected by encephalitis and their significant others changes: spouses, older parents, friends, etc.

In these cases, the financial blow is doubled, since the employment status for both the person affected and their significant other is altered by encephalitis. As we show below, the consequences of encephalitis are exacerbated by the absence of a formal support system for the post-acute care of the condition. The cases of Simon and Joanna reveal the lack of pre-defined care pathways and services for dealing with the chronic effects of encephalitis, as described by our retrospective participants.

Below, we map out the various struggles involved in obtaining information and formal care around encephalitis, and chart the work which people do to construct their own improvised systems of support for managing their difficulties.

Fundamental to the need for support after encephalitis is the provision of information about the condition and its consequences. Moreover, on their discharge from hospital most people are told that they will receive an appointment with a consultant and to visit their GP with any problems. In other words, after leaving the intensive support of the hospital ward, people return home without a prefigured plan for support, or the care which is needed to help them deal with their newly fractured lives.

The confusion which people experience post-discharge is therefore underpinned by the reality of going home without an understanding of what has happened or, most importantly, what was to come. Without this knowledge, those affected and their significant others pursue their own understanding about encephalitis and its care.

This includes researching encephalitis and available forms of support on the internet, and contacting charitable bodies, like The Encephalitis Society. Attempts to obtain care, however, involve numerous complications. These include: i having their needs taken seriously. People have trouble with gaining recognition from health professionals that problems, such as speech difficulties, memory loss, and so on, warrant attention and require formal sources of support.

While we have previously documented how patients failed to have their concerns taken seriously by health professionals during the acute onset of encephalitis, our findings here show this process continues into the chronic trajectory, indicating an overarching lack of recognition for this condition and its consequences, particularly among health professionals [ 24 ].

The services travelled through include: neurology, psychiatry, psychology, speech therapy, memory clinics, brain injury charities, like Headway , private counsellors, and alternative therapists. In turn, people are forced look for alternative options for care, often by revisiting their GP to ask for further referrals. When people are unable to find help within the NHS, some draw on other resources by pursuing privatised forms of care, such as counselling, which has obvious implications for the already compromised financial situation of people after encephalitis.

In travelling through and seeking out care services, people formulate their own improvised care pathways: work which is essential for creating a system of support which is not easily forthcoming [ 28 ]. That patients are forced to create their own care pathways ostensibly adds to the vulnerability of people experiencing life-altering problems, like memory loss. This raises questions about whether lack of access to appropriate care potentially contributes to differing outcomes in encephalitis.

Being given explanations for why they struggle with routine tasks, like washing, means that people are better able to make sense of their situation. This contrasts with the experience of others, who return home unable to understand the nature of their problems; ii The care which is received during rehabilitation, such as having help to re-learn activities like cooking, enables people to re-orient themselves to their everyday lives upon their return home. Focused rehabilitation therefore facilitates a more supported transition between the hospital and the home.

This work involves harnessing everyday materials and technologies, such as diaries and mobile phones, which act as aides for memories which no longer function in the way they used to.

In lieu of adequate support systems for the chronic effects of encephalitis, those affected are thus forced to cobble together their own ad-hoc methods and improvised pathways in attempts to establish their own coherency of care [ 28 , 29 ]. However, these concepts usually refer to patient work which is organised by health professionals and directed around treatment regimes. In the context of HSV encephalitis in the UK, it is clear that patients are poorly provided with the knowledge or resources to inform their self-management.

As a result, the management for the post-acute effects of encephalitis becomes largely, if not wholly, outsourced to being the responsibility of patients and their social networks. This study has shown that improving outcomes in encephalitis cannot be achieved by virtue of focusing on the acute stages of encephalitis alone.

While the Introduction of National Clinical Guidelines have been vitally important in enhancing early diagnosis and treatment of viral encephalitis, more needs to be done to ensure that encephalitis care continues beyond the acute hospital setting, and there are equal opportunities for the receipt of this care.

The National Service Framework currently provides a template for the long-term care of people with neurological conditions, including the recommendation that everyone should have access to rehabilitation [ 33 ]. However, findings from this study show that, in practice, this is not the case for our participants, who experience a lack of communication about what to expect after encephalitis and fragmented provision of services. We therefore recommend that, first, all patients should be provided with, or signposted to, information about encephalitis and its effects, such as the resources provided on the website of The Encephalitis Society [ 34 ].

This would enable those affected and their significant others to gain an understanding of what has occurred and the forms of support which are available to them. Second, there is urgent need for the production of an integrated care pathway to cover the chronic consequences of encephalitis.

This pathway should specify what aftercare can be provided to people post-encephalitis, and supply information and links to resources about its potential sequelae. This would ensure that health professionals are better able to inform patients about what to expect after encephalitis and provide appropriate referrals.

The pathway could be developed as part of revisions of the National Guidelines for the management of suspected viral encephalitis, which are currently being planned [ 3 , 14 ]. To ensure the effectiveness of this pathway, there should be further consultations between patient groups like The Encephalitis Society and Headway , health professionals, and researchers.

This would begin the process of generating practical ways for tackling the current inadequacies around provision of care, and ensure that pathways of support are informed by the everyday reality facing people after encephalitis.

In so doing, we will ensure a more holistic approach to improving the outcomes of encephalitis, one in which the entire trajectory acute and chronic of this devastating condition is fully addressed.

There are a number of limitations to this study and routes for further research. First, the majority of people who participated in this study had more moderate problems following encephalitis, in that most were able to discuss their experiences. Only a handful of cases had been severely affected to the extent that they could not understand enough about the research to take part. As such, the results of this study may not reflect the experiences of people who are left more severely disabled after encephalitis, such as people who are unable to talk.

However for those people who are severely affected, recognition of the problems is typically easier, and there may be better provisions of care. Second, as we noted in a previous publication, the small number of paediatric cases in this study means it is difficult to generalise our conclusions to the experiences of children and their parents [ 24 ].

Differences in paediatric care, and the fact that children are in education, may mean that the problems experienced are quite different from those of adult patients. It is important that there is further research to examine the challenges for children following encephalitis. Finally, since only a small number of cases in our study received rehabilitation after hospital we were unable to examine the processes involved in this care. Since our results highlight the importance of rehabilitation for recovery, future ethnographic research is needed to examine rehabilitation from the perspective of both patients and healthcare staff.

This paper has documented the challenges which face people once they return home after HSV encephalitis.

What is important to understand, however, is that these problems do not play out in isolation of wider social contexts, like access to healthcare. Improving outcomes in HSV encephalitis is therefore not only about creating the conditions for more timely diagnoses and better acute management. If we are to fully intervene in this devastating disease, we need to improve the systems of communication and care across the entire trajectory of encephalitis, which means extending support outwards, from the ward into the home.

The authors would like to thank all the participants who gave their time to help with this study. We would also like to thank The Encephalitis Society for their help with recruitment.

This article is independent research funded by the National Institute for Health Research www. JC participated in the design of the study, collected and analysed the data and drafted the manuscript; CK participated in the conception and design of the study, data analysis and helped draft and edit the manuscript; TS, SD, RK and AE conceived and designed the study and contributed to preparation, revisions and approval of the manuscript.

All authors read and approved the final manuscript. All participants provided written consent to take part in the study. To date, there is no cure for HSV infection, except for some antiviral drugs that can reduce the severity of the symptoms [ 4 , 5 , 20 ]. Attempts at developing vaccines against HSV have not yet been successful due to the complex host—pathogen interaction.

Early diagnosis of the infection can help patients with proper disease management and also lower the risk of transmission. Disease management studies have shown the importance of early testing and prior knowledge of patient history in guiding the proper course of treatment as well as providing counseling to patients and their significant others [ 2 , 21 ].

In this review, we focus on the different diagnostic technologies for herpes. These include conventional methods as well as the different advanced technologies, particularly the POC [ 7 , 22 , 23 , 24 ]. Diagnosis of HSV typically involves detecting the whole virus or viral proteins, genetic materials, or HSV-specific antibodies in the blood. The conventional diagnostic strategies include viral culture, serological tests, and molecular techniques [ 25 , 26 ].

Viral culture involves extracting the virus from the specimen, such as swab or needle aspiration, and culturing them for a few days, followed by microscopic analysis for determining HSV cytopathic effects CPE [ 26 ].

This type of test required high-quality specimen collection, with proper handling and transportation of the specimen. Molecular diagnosis of the virus can be achieved by nucleic acid amplification using polymerase chain reaction PCR [ 27 ] and loop-mediated isothermal amplification LAMP [ 28 ].

This method is extremely sensitive and specific in detecting the virus. Immunological assays include enzyme-linked immunosorbent assays ELISA [ 29 ] and Western blot assays [ 30 ] for effective detection of antigens HSV glycoproteins or antibodies specific to HSV glycoproteins, which have proven to be an excellent marker for HSV infection. Other methods include immunofluorescence assays [ 31 ], luminescence assays [ 32 ], and advanced microscopic techniques [ 26 , 33 , 34 , 35 , 36 ].

All these methods have their own advantages and drawbacks [ 37 ]. We also focus on the different POC devices for herpes diagnosis that are portable, cost-effective, and can be easily operated without the need for expert handling [ 7 , 23 ]. These devices can be used for testing the patient at home, with no or minimal supervision, which is particularly useful in remote locations and resource-limited settings.

Several such kits are commercially available [ 38 , 39 , 40 , 41 ]. Traditional diagnosis of HSV from lesions involves the direct detection of tissues or cells infected by the virus, viral proteins, whole virus, or genetic materials.

The virus is collected from lesions on skin or genitals by swabbing or scraping with a scalpel. This is followed by detection using the various techniques discussed in the following sections. Brightfield Microscopy: Historically, the most widely used HSV diagnostic tests were based on Brightfield microscopy [ 25 , 26 ]. Brightfield microscopy involves imaging the transmitted light after passing through the specimen or the back-reflected light.

However, brightfield microscopy can be used to image cells and tissues infected with the virus. The specimen for this method is collected by scraping the lesion Tzanck smears using a scalpel blade and transferring the sample to a glass slide, followed by staining with Giemsa, methylene blue, or toluidine blue [ 43 , 44 , 45 ].

These stained tissues are imaged in order to detect HSV cytopathic effects. Figure 1 A shows a Tzanck smear stained with methylene blue of a sample collected from the vesicles of an HSV-infected patient, showing multinucleated giant cells under brightfield microscopy.

This method is simple, inexpensive, and can be used for a wide variety of clinical specimens. Additionally, a large amount of tissue is needed for accurate identification, and this can be painful for patients. Secondly, the accuracy of this method depends on the stage of lesions [ 46 , 47 , 48 ]. A Microscopic image showing large multinucleated giant cells indicated by arrows surrounded by multiple normal cells in an HSV-infected patient.

The cells were stained with methylene blue, taken using an optical brightfield microscope [ 45 ]. The cell nuclei were stained with DAPI [ 68 ]. In addition to tissues, the presence of the virus in swabs can be detected by culturing them in susceptible cell lines such as Hep-2, A, MRC-5, WI38, Vero, rhabdomyosarcoma cells, rabbit kidney, and human diploid fibroblasts [ 26 ].

The changes in cell morphology, such as cytoplasmic granulation, cell rounding, or lysis, indicate the presence of the virus. The process of specimen collection and transport is very sensitive as viral envelopes are extremely labile.

Contamination of the samples with bacteria or fungus can be an issue and, thus, antibiotics are used in the transport media. The sensitivity of HSV detection depends on the cell line, e. This process typically requires 5—14 days to generate the result and lacks specificity in differentiating HSV-1 and HSV-2; it also requires extreme care in collecting, handling, and transporting the specimen, which may have an effect on the test result.

Fluorescence Microscopy: In fluorescence microscopy, the fluorescently labeled specimen is illuminated with light of a specific wavelength, which is absorbed by the fluorophore, and results in the emission of another photon with lower energy longer wavelength , which is captured by the photomultiplier tubes PMT or cameras in the microscope [ 52 ].

In order to visualize the virus using fluorescence microscopy, it needs to be stained with fluorescent molecules [ 53 , 54 , 55 ]. The most widely used method of visualizing the virus using fluorescence microscopy is direct immunofluorescence assay DFA. DFA uses specific targeting moieties, such as antibodies, tagged with fluorophores to stain the virus [ 52 , 56 , 57 , 58 , 59 , 60 , 61 ].

These antibodies typically target the glycoproteins present on the surface of the viral particles. A comparison between the efficiency of fluorescence microscopy and viral culture for detection of HSV was performed by Caviness et al. In this study, samples were collected by swabbing and scraping the base of a skin lesion of the infected patients.

The sample obtained was then rubbed onto glass microscope slides, air-dried, fixed, and made to react with the commercially available monoclonal antibodies labeled with fluorescein isothiocyanate a fluorescent probe specific to HSV type 1 and 2 to form an immunocomplex.

The emission of green fluorescence from the cells indicated the presence of HSV infection, as observed under a fluorescence microscope. The turnaround time of this assay was about 60—90 min.

However, there can be an issue of cross-reactivity with the use of monoclonal antibodies, and this might give rise to false- negative or false-positive results. Another disadvantage is the requirement of clean microscopic glass slides with a controlled thickness that may not be available in resource-limited settings. Confocal microscopy: Fluorescence confocal microscopy, which has a higher spatial resolution compared to conventional fluorescence microscopes, has been used to study viral cytopathology [ 52 , 63 , 64 , 65 , 66 , 67 ].

Li et al. After a few days of incubation, the infected cells were extracted at different passage times, washed, and fixed on slides. Mev infection was detected using the antibody for the anti-Mev matrix protein, indicated by green fluorescence, whereas HSV-1 was detected using an anti-HSV ICP0 antibody, indicated by red fluorescence.

It was observed that fluorescence red due to HSV-1 appears strong only after the 6th passage and gradually increases thereafter, whereas the green fluorescence Mev decreases. This study, conducted on 40 measles patients, suggests Mev as a primary infection, whereas HSV-1 infection was due to the reactivation of the latent virus in most cases. In another study, Cinotti et al. In this study, HSV samples were collected from skin lesions of infected patients and incubated with anti-HSV1 and anti-HSV2 antibodies tagged with fluorescein isothiocyanate for the identification of the virus.

Reflectance confocal microscopy RCM is another promising noninvasive skin imaging technique [ 69 , 70 ] used to study the histopathology of cells for diagnosing various skin diseases. It enables the imaging of the epidermis and papillary dermis directly, with high resolution at the cellular level without altering the skin surface.

RCM imaging of a patient experiencing pustular eruptions showed the characteristics of large lobated multinucleated cells and acantholysis that are similar to the herpes-infected cytopathic effect on skin cells, and the findings were validated by the Tzanck cytodiagnosis method. These microscopic techniques are sensitive to light and motion and have a small field of view, which severely limits the throughput of the tests. A large number of images need to be acquired to obtain statistically relevant data so as to achieve results with a high degree of accuracy.

In addition, these microscopes are expensive and involve complex instrumentations, making the instrument bulky and not readily available in resource-limited settings.

Transmission Electron Microscopy TEM : The electron microscope EM uses a thin monochromatic beam of electrons that is focused on the sample using a magnetic lens operating at a high voltage of kV. The transmitted electron beams are used to form an image and extract the structure and morphology of the samples.

Folkers et al. For this study, the sample was collected from the base and edges of the lesion and adsorbed on a carbon-coated TEM grid. Another technique is solid-phase immunoelectron microscopy, which involves viral capture using a bilayer of protein A and an antibody.

Indirect labeling is another technique that involves capturing the virus using a monoclonal antibody specific to HSV-1 and HSV-2, followed by labeling with gold-tagged rabbit anti-mouse antibodies. The virus samples are prepared by collecting the lesions and homogenizing them with ultra-fine sterile quartz sand particles. This homogenized sample is centrifuged, and the virus particles present in the supernatant are used for testing [ 71 ].

The requirement of bulky and expensive instruments and its low throughput, which are the major drawback of this technique, have limited its utilization.

Nowadays, these techniques are largely replaced by immunofluorescence based assays that can provide more sensitive type-specific detection of HSV. Digital Holographic Microscopy: Digital holographic microscopy DHM is an interferometric technique that has been extensively used for the detection and imaging of biological samples [ 36 , 74 , 75 , 76 , 77 , 78 ].

In this type of computational microscopy, the images are digitally reconstructed from holograms, which result from the interference between the scattered optical wave and the non-diffractive wave [ 79 ]. The holograms are then backpropagated to the object plane in order to reconstruct the images. The images contain both the phase and amplitude information.

Several different algorithms can be used to reconstruct the images. For example, the widely used angular spectrum approach involves multiplying a transfer function with the Fourier transform of the captured hologram and then taking the inverse Fourier transform of the product to retrieve the image [ 80 ].

The absence of lenses enables imaging over a wide field of view, giving this technique higher throughput compared to conventional lens based microscopy techniques. Additional advantages include low cost, portability, and ease of use, thereby making this technique a promising candidate for POC detection of HSV. Detection of the whole virus using DHM is performed by first capturing the virus on a specially prepared substrate using monoclonal antibodies as shown in Figure 2.

The virus samples are first mixed with biotinylated antibodies to form an antibody—antigen complex and then incubated on a glass substrate coated with streptavidin. Once the virus is immobilized onto the glass surface due to the biotin—avidin bond, the samples are thoroughly washed and dried prior to imaging. Nonspecific binding is minimized by coating the bare glass surface with poly-ethylene glycol.

The viruses are directly detected using DHM by creating localized liquid droplets, called nanolenses, specifically around the virus. These nanolenses help to amplify the signature of the virus, which would otherwise be too weak to detect. The nanolenses are created by depositing PEG vapor on the substrate containing the virus.

Another approach that utilizes a new method of creating nanolenses using acoustic actuation was used to detect the whole viral particles in solution, thereby expanding the capabilities of DHM for detecting HSV in both dry state and in solution [ 81 ]. A Schematic representation of lensless holographic microscope. B Step-wise process showing attachment of the virus to the surface substrate. Firstly, the chip for specific capture of HSV-1 particles is prepared by coating a glass substrate with streptavidin and poly-ethylene-glycol.

In this approach, HSV-specific-antibody-coated polystyrene microparticles were added to the virus sample and imaged using DHM [ 82 , 83 ]. The presence of the virus and the viral antigen led to clustering of the microparticles, which were quantified using a deep-learning-based algorithm. The degree of clustering was used as a metric to detect the presence of the virus and its concentration.

The sensitivity, i. The specificity of these techniques depends on the type of antibodies used, their antigen-binding affinity, and their rates of association and dissociation. Agglutination Assay: Agglutination assays are simple assays that involve the clustering of microparticles due to immunogenic reactions in the presence of the target antigen or antibody.

These assays are binary, and the outcome of this test can most often be observed by the naked eye. One of the most widely used assays is based on latex microparticles [ 84 , 85 , 86 , 87 ]. For latex agglutination assays, swab samples are collected from infected patients and the test sample is prepared using specimen buffers, e. After gently mixing the solution by stirring and rotating, the latex particles coated with HSV-specific antibodies are added to the test well, with the control latex anti-human IgG in another well.

The positive samples usually form small clumps or agglutination with a cloudy background, which can be easily detected with the naked eye. Western Blot Assay: In Western blot assays, the viral proteins are separated and identified using gel electrophoresis. The viral proteins are first extracted from the cells or tissue lysates collected from the patients and loaded onto a gel for electrophoretic separation with a load marker such as bromothymol blue or Coomassie blue.

The presence of a particular target protein is detected with the addition of a fluorescent or radioactive isotope-labeled antibody specific to the protein. The location of the target protein is found out using a standardized protein ladder with a specific molecular weight [ 88 ]. Polymerase Chain Reaction: The most common and standard molecular diagnosis technique is polymerase chain reaction PCR , which allows the rapid amplification of viral genomes and can be used in clinical laboratories for the detection of HSV, as shown in Figure 3 [ 27 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 ].

The PCR method, involving the use of either a TaqMan probe or the HydProbe system that targets specific sequences of the genome, undergoes several thermal cycling processes of amplification and generates the result in the form of fluorescence signal readouts; gel electrophoresis can also be used.

This PCR technique is highly sensitive, has high precision, eliminates any post-amplification handling, and can be operated automatically.

Over the years, different PCR assays have been used for the detection of HSV [ 97 , , , , , , ]. Marshall et al. For this study, patient samples were collected, and DNA was extracted for the assay.

After several thermal cycling steps, the amplified DNA was subjected to the gel-electrophoresis technique for HSV detection and typing. They were successful in detecting HSV infection in four suspected patients who were shown as negative with the viral culture method. A General representation of steps of DNA amplification using polymerase chain reaction. For this study, the DNA was extracted from samples collected from oral swabs and saliva samples and prepared using commercially available sample processing kits.

The viral load quantification was done with a standard curve. Among a pool of samples tested for the human herpes virus, 4.

Loop-Mediated Isothermal Amplification Technique: DNA amplification, with high efficiency and specificity, can also be achieved using the loop-mediated isothermal amplification LAMP method [ 28 , , , , , , , , , ]. The single-stranded DNA is further primed by a second inner and outer primer hybridized to the other end of the target DNA, forming a loop DNA structure; it facilitates the amplification through the extension of the loop and the annealing of primers.

The amplification cycling reaction continues, with the accumulation of 10 9 copies of the target in less than an hour. These viral infections show similar symptoms but require different clinical prognoses, which makes it important to differentiate these viruses.

Kaneko et al. Each amplified product was further analyzed using the agarose gel electrophoresis technique. LAMP is more convenient due to its temperature-independent mechanism and less hardware requirement, which makes it suitable for point-of-care testing applications. Helicase-Dependent Amplification Technique: The helicase-dependent amplification technology is similar to PCR, but in this technique, a thermostable helicase enzyme is used to separate the DNA strands instead of thermal denaturation.

This enables labeled primers hybridized to DNA templates and initiates the elongation process in the presence of DNA polymerase [ 40 , , ]. The sample specimen from the viral transport media is diluted and transferred to an amplification tube to which a master mix is added.

The target amplicon is fluorescein- and digoxigenin-labeled, which are captured and visualized as colored lines in the case of positive samples on a vertical flow strip within the disposable cassette. The turnaround time of the assay is less than 1. There is no cure for herpes, but treatment can help manage symptoms and reduce the likelihood of them recurring.

HSV is a common virus. In this article, we describe the symptoms of genital and oral herpes, how to treat them, and how to prevent these infections. People who develop symptoms of herpes may first experience tingling, itching, or burning, then notice sores or blisters forming around the mouth or genitals. Symptoms tend to develop 2—20 days after exposure to the virus. Oral herpes causes blisters, sometimes called fever sores or cold sores, to develop in or around the lips and mouth.

Sometimes these blisters form elsewhere on the face or on the tongue, and more rarely on other areas of skin. The sores usually last 2—3 weeks at a time. These sores tend to develop on the penis, around or inside the vagina, on the buttocks, or on the anus, though they can form on other areas of skin. The first time a person develops the sores, they may last 2—6 weeks. Soon after this initial outbreak, symptoms may recur frequently. Over time, outbreaks may occur less often and the symptoms tend to become less severe.

Symptoms that reappear are similar to the initial symptoms, though they tend to be less severe and last for shorter periods. During each recurrence, symptoms of oral herpes tend to last 8—10 days , according to the American Sexual Health Association. Symptoms of a genital herpes recurrence also last 8—10 days , and there will be fewer sores than in the initial phase. During a recurrence, a person can pass on genital herpes for 2—5 days.

When HSV is present on the skin, it can easily pass from person to person through contact with the moist skin of the mouth and genitals, including the anus.