Herpes simplex virus type II causes 85 percent of genital herpes cases. Type I, which causes most herpes infections above the waist, is responsible for the other 15 percent. The infection is spread by contact with the genital secretions of a person with an active lesion. It is possible, however, for a person with no active lesion to shed virus and infect a sex partner.
The virus can infect any skin or mucous membrane surface on the body. For example, a person with a cold sore who engages in oral sex can transmit genital herpes to a partner.
"Neonatal herpes" is the term for a herpes infection in newborns that is acquired from an infected mother during birth.
Only about 40 percent of patients with herpes ever have symptoms. When they do, the first appearance of herpes lesions is the worst, with many painful lesions lasting up to 10 days; it may take two to three weeks to completely recover from this first attack. When the sores fade away, the virus remains behind. The virus is now latent. During the first attack, some people have a generalized sick feeling, with swollen glands in the pelvic area and fever, fatigue, headache, muscle ache, and nausea. People with no antibodies to herpes type I (cold sores) usually will be sicker during a first attack. Girls usually have lesions on the cervix or vulva, with recurrences on the vulva, the skin between vagina and anus, upper thighs, anal area, or buttocks. Boys have lesions on the head or shaft of the penis and the anus.
Most people have a recurrence within six months of their first attack that begins with a tingling, itching, or prickling sensation in the area where the virus entered the body. This is followed in a few days by a raised cluster of small painful blisters; there may be several groups of blisters. Eventually, the sores will crust over and dry up. Most people do not have the generalized sick feeling with recurrent infections.
Patients are infectious until the sores heal completely, usually up to 12 days; recurrent infections usually remain infectious for up to a week. Recent studies have shown that it is quite possible to shed virus without symptoms, which is how it is possible to infect a partner when no sores are present.
Neonatal herpes can take many different forms. About one-third of affected babies will have skin, eyes, or mouth lesions before any other symptoms; another third will have a brain infection (encephalitis), pneumonia, or infection of other organs; and the final third will have symptoms of both types. Respiratory distress, fever, skin lesions, or convulsions are common herpes symptoms in newborns.
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