Herpes esophagitis is a viral infection that involves inflammation and ulcers in the esophagus, the tube that carries food from the mouth to the stomach.

The herpes simplex virus causes herpes esophagitis.

Infection of the esophagus by the herpes simplex virus is rare in people with normal immune systems and usually runs its course without treatment. However, severe and difficult-to-treat esophagitis can occur in people with a suppressed or weakened immune system.

The following raise your risk for herpes esophagitis:

• HIV/AIDS
• Chemotherapy
• Diabetes
• Leukemia or lymphoma
• Organ transplants
• Other conditions that suppress or weaken your immune system

Symptoms include:

• Chills
• Difficulty swallowing
• Fever
• Herpes in the mouth (herpes labialis)
• Joint pain or other general symptoms
• Painful swallowing

• Culture of cells from the esophagus
• Esophagogastroduodenoscopy(EGD) with or without biopsy

In most people, antiviral medication such as acyclovir, famciclovir, or valacyclovir can control the infection. Some people also need pain medicine. Many people who are treated for an episode of herpes esophagitis need other, long-term medicines to suppress the virus and prevent reinfection.

Esophagitis can usually be treated effectively. Healthy people recover on their own in 3 - 5 days, but those with a weakened immune system take longer to get better.

The outcome depends upon the immune system problem that makes the person more likely to develop the infection.

• Holes in your esophagus (perforations)
• Infection at other sites
• Recurrent infection

Call your health care provider if you have any condition that can cause reduced immune response and you develop symptoms of herpes esophagitis.

The herpes simplex virus is contagious by direct contact, so avoid contact with known herpes sores (lesions).

Whitley RJ. Herpes simplex infections. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 397.

Herpes viral culture of a lesion is a laboratory test to check if a skin sample is infected with the herpes simplex virus.

See also:

• Genital herpes
• Herpes labialis(cold sores)
• Serum herpes simplex antibodies

Culture - herpes simplex virus; Herpes simplex virus culture

A sample from a skin lesion (often a genital sore) or blister is needed. The health care provider will collect the sample during an active outbreak and place it in a laboratory container. The sample must include cells, not just fluid from the blister, because the virus is in the skin cells of the blister or ulcer.

At the laboratory, the sample is placed in a special dish and watched for the growth of the herpes simplex virus, or substances related to the virus. Special tests may also be done to determine whether it is herpex simplex virus type 1 or 2.

Results are available within 16 hours to 7 days (usually 2-4 days), depending on the laboratory method used.

The sample must be collected during the worst part of an outbreak. This is considered the acute phase of infection.

When the sample is collected, you may feel an uncomfortable scraping or sticky sensation. Sometimes a sample from the throat or eyes is needed. This involves rubbing a sterile swab against the eye or in the throat.

The test is done to confirm herpes simplex infection. The diagnosis is often made by physical examination (the health care provider looking at the sores), and the cultures and other tests are used to confirm that diagnosis.

A normal (negative) result means that the herpes simplex virus did not grow in the laboratory dish and the skin sample used in the test did not contain any herpes virus.

Unfortunately, a normal (negative) culture does not guarantee that you do not have a herpes infection or have not had one in the past.

An abnormal (positive) result may mean that you have an active infection with herpes simplex virus. Herpes infections include herpes genitalis, which is genital herpes, or cold sores on the lips or in the mouth.

If the culture is positive for herpes, you may have recently become infected or you may have become infected in the past and are currently having an outbreak.

Risks include slight bleeding or infection in the area where the skin sample was removed.

The viral culture for herpes test is most likely to be accurate when a person is newly infected (during the first outbreak).

Gupta R, Warren T, Wald A. Genital herpes. Lancet. 2007; 370(9605):2127-37.

Genital herpes - resources; Resources - genital herpes

The following organizations are good resources for information on genital herpes:

• American Social Health Association - www.ashastd.org
• U.S. Centers for Disease Control and Prevention - www.cdc.gov/std/herpes/STDFact-herpes.htm

Herpes labialis is infection of the lips, mouth, or gums with the herpes simplexvirus. It leads to the development of small, painful blisters commonly called cold sores or fever blisters.

Cold sore; Fever blister; Herpes simplex - oral; Oral herpes simplex

Herpes labialis is a common disease caused by infection of the mouth area with herpes simplex virus type 1. Most people in the United States are infected with this virus by age 20.

The initial infection may cause no symptoms or mouth ulcers. The virus then remains dormant (asleep) in the nerve tissue of the face. In some people, the virus reactivates and produces recurrent cold sores that are usually in the same area, but are not serious.

Herpes virus type 2, which usually causes genital herpes and can infect babies during birth to infected mothers, can also cause herpes labialis.

Herpes viruses are contagious. Spread may occur through intimate and personal contact, or through contact with infected razors, towels, dishes, and other shared articles. Occasionally, oral-to-genital contact may spread oral herpes to the genitals (and vice versa).

The first episode may be mild or severe. It usually occurs in children between 1 and 5 years old.

• First symptoms usually appear within 1 or 2 weeks, and as long as 3 weeks, after contact with the virus. Sore throat and fever that can last up to 5 days may occur before the blisters appear. There may also be swollen glands in the neck.
• First episode may last 2 to 3 weeks. The lesions may be on the gums, in the mouth and throat, or on the face. It may hurt to swallow.

Later episodes are usually milder.

• May be triggered by menstruation, sun exposure, fever, stress, or various other unknown causes.
• Warning symptoms of itching, burning, increased sensitivity, or tingling sensation may occur about 2 days before lesions appear.

An outbreak usually involves:

• Skin lesions or rash around the lips, mouth, and gums
• Small blisters (vesicles) filled with clear yellowish fluid
  • Blisters on a raised, red, painful skin area
  • Blisters that form, break, and ooze
  • Yellow crusts that slough to reveal pink, healing skin
  • Several smaller blisters that merge to form a larger blister

Diagnosis is made on the basis of the appearance or culture of the lesion. Examination may also show enlargement of lymph nodes in the neck or groin.

Viral culture, viral DNA test, or Tzanck test of the skin lesion may reveal the herpes simplex virus.

Untreated, the symptoms will generally go away in 1 to 2 weeks. Antiviral medications taken by mouth may help the symptoms go away sooner and decrease pain. Acyclovir, famciclovir, and valacyclovir are the three oral treatments currently available.

Herpes sores often come back again and again. The antiviral medicines work best if you take them when the virus is just starting to come back -- before you see any sores. If the virus returns frequently, your doctor may recommend that you take the medicines all the time.

Topical (rubbed onto the skin) antiviral cream (penciclovir andacyclovir) may be used, but must be applied every 2 hours while you're awake. They are expensive and often only shorten the outbreak by a few hours to a day.

Wash blisters gently with soap and water to reduce the spread of the virus to other areas of skin. An antiseptic soap may be recommended. Applying ice or warmth to the area may reduce pain.

Tips to prevent future outbreaks include applying a sunblock or lip balm containing zinc oxide to the lips when you're outdoors. A moisturizing balm to prevent the lips from becoming too dry may also help.

Herpes labialis usually goes away by itself in 1 to 2 weeks. It may come back. Infection may be severe and dangerous if it occurs in or near the eye, or if it happens in immunosuppressedpeople.

• Recurrence of herpes labialis
• Spread of herpes to other skin areas
• Secondary bacterial skin infections
• Generalized infection -- may be life-threatening in immunosuppressed people, including those with atopic dermatitis, cancer, or HIV infections
• Blindness

Herpes infection of the eye is a leading cause of blindness in the United States, causing scarring of the cornea.

Call for an appointment with your health care provider if you have symptoms of herpes labialis that are severe or that don't go away after 2 weeks.

Also call if you are immunosuppressed and you develop herpes symptoms.

Avoid direct contact with herpes sores. Minimize the risk of indirect spread by thoroughly washing items such as towels in hot (preferably boiling) water before reuse. Do not share items with an infected person, especially when they have herpes lesions. Avoid triggers (especially sun exposure) if you are prone to oral herpes.

Avoid performing oral sex when you have active herpes lesions on or near your mouth and avoid receiving oral sex from someone who has oral or genital herpes lesions. Condoms can help reduce, but do not entirely eliminate, the risk of catching herpes from oral or genital sex with an infected person.

Both oral and genital herpes viruses can sometimes be transmitted even when the person does not have active lesions.

Fatahzadeh M. Human herpes simplex virus infections: epidemiology, pathogenesis, symptomatology, diagnosis, and management. J Am Acad Dermatol. 2007;57(5):737-763.

Habif TP. Warts, herpes simplex, and other viral infections. In: Habif TP, ed. Clinical Dermatology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2009: chap 12.

Not really. According to the World Health Organization, 30% of the Mexican female population has been infected with herpes in some way or another; in the United States the percentage is lower, but just a little bit: 26% of women have been infected with such virus.

In perspective, the HSV virus is quite common around the world:

• China: 29%
• Brazil: 42%
• Finland: 31%
• Canada: 13%
• South Africa: 53%

Oral herpes is an infection of the lips, mouth, or gums due to the herpes simplex virus. It causes small, painful blisters commonly called cold sores or fever blisters. Oral herpes is also called herpes labialis.

Cold sore; Fever blister; Oral herpes simplex; Herpes labialis; Herpes simplex

Oral herpes is a common infection of the mouth area. It is caused by the herpes simplex virus type 1 (HSV-1). Most people in the United States are infected with this virus by age 20.

After the first infection, the virus goes to sleep (becomes dormant) in the nerve tissues in the face. Sometimes, the virus later "wakes up" (reactivates), causing cold sores.

Herpes virus type 2 (HSV-2) usually causes genital herpes. However, sometimes HSV-2 is spread to the mouth during oral sex, causing oral herpes.

Herpes viruses spread easily. You can catch this virus if you have intimate or personal contact with someone who is infected. You can also catch it if you touch items infected with the herpes virus, such as infected razors, towels, dishes, and other shared items. Parents may spread the virus to their children during regular daily activities.

Some people get mouth ulcers when they first come into contact with HSV-1 virus. Others have no symptoms. Symptoms usually occur in kids between 1 and 5 years old.

Symptoms may be mild or severe.

They usually appear within 1-3 weeks after you come into contact with the virus. They may last up to 3 weeks.

Warning symptoms include:

• Itching of the lips or skin around mouth
• Burning near the lips or mouth area
• Tingling near the lips or mouth area

Before blisters appear, you may have:

• Sore throat
• Fever
• Swollen glands
• Painful swallowing

Blisters or a rash may form on your:

• Gums
• Lips
• Mouth
• Throat

Many blisters are called an "outbreak." You may have:

• Red blisters that break open and leak
• Small blisters filled with clear yellowish fluid
• Several smaller blisters may grow together into a large blister
• As the blister heals, it gets yellow and crusty, eventually turning into pink skin

Symptoms may be triggered by:

• Menstruation or hormone changes
• Being out in the sun
• Fever
• Stress

If the symptoms return later, they are usually more mild.

Your doctor or nurse can diagnose oral herpes by looking at your mouth area. Sometimes, a sample of the sore is taken and sent to a laboratory for closer examination. Tests may include:

• Viral culture
• Viral DNA test
• Tzanck test to check for HSV

Symptoms may go away on their own without treatment in 1 to 2 weeks.

Your health care provider can prescribe medicines to fight the virus. This is called antiviral medicine. It can help reduce pain and make your symptoms go away sooner. Medicines used to treat mouth sores include:

• Acyclovir
• Famciclovir
• Valacyclovir

These medicines work best if you take them when you have warning signs of a mouth sore, before any blisters develop. If you get mouth sores frequently, your doctor may tell you to take these medicines all the time.

Antiviral skin creams may also be used. However, they are expensive and often only shorten the outbreak by a few hours to a day.

The following steps can also help make you feel better:

• Apply ice or a warm washcloth to the sores to help ease pain.
• Wash the blister gently with germ-fighting (antiseptic) soap and water. This helps prevent spreading the virus to other body areas.
• Avoid hot beverages, spicy and salty foods, and citrus.
• Gargle with cool water or eat popsicles.
• Rinse with salt water.
• Take a pain reliever such as acetaminophen (Tylenol).

Oral herpes usually goes away by itself in 1 to 2 weeks. However, it may come back.

Herpes infection may be severe and dangerous if:

• It occurs in or near the eye
• You have a weakened immune system due to certain diseases and medications

Herpes infection of the eye is a leading cause of blindness in the United States. It causes scarring of the cornea.

Other complications of oral herpes may include:

• Return of mouth sores and blisters
• Spread of the virus to other skin areas
• Bacterial skin infection
• Widespread body infection, which may be life threatening in people who have a weakened immune system due to atopic dermatitis, cancer, or HIV infection

Call for an appointment with your health care provider if you have :

• Symptoms that are severe or that don't go away after 2 weeks
• Sores or blisters near your eyes
• Herpes symptoms and a weakened immune system due to certain diseases or medicines

Here are some tips to prevent mouth sores:

• Apply sunblock or lip balm containing zinc oxide to your lips before you go outside.
• A moisturizing balm to prevent the lips from becoming too dry may also help.
• Avoid direct contact with herpes sores.
• Wash items such as towels and linens in boiling hot water after each use.
• Do not share utensils, straws, glasses, or other items if someone has oral herpes.

Do not have oral sex if you have oral herpes, especially if you have blisters. You can spread the virus to the genitals, causing herpes simplex virus 2, or genital herpes. Both oral and genital herpes viruses can sometimes be spread even when you do not have mouth sores or blisters.

Haile-Mariam T, Polis MA. Viral illnesses. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier; 2009:chap 128.

Habif TP. Warts, herpes simplex, and other viral infections. In: Habif TP, ed. Clinical Dermatology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2009: chap 12.

Review Date: 12/04/2011

David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc., Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine.

Herpes simplex is a viral infection that mainly affects the mouth or genital area.

There are two strains of herpes simplex viruses:

• Herpes simplex virus type 1 (HSV-1) is usually associated with infections of the lips, mouth, and face. It is the most common herpes simplex virus and many people develop it in childhood. HSV-1 often causes sores (lesions) inside the mouth, such as cold sores (fever blisters), or infection of the eye (especially the conjunctiva and cornea). It can also lead to infection of the lining of the brain (meningoencephalitis). It is transmitted by contact with infected saliva. By adulthood, 30 - 90% of people will have antibodies to HSV-1. The likelihood of childhood infection is higher among those with lower socioeconomic status.
• Herpes simplex virus 2 (HSV-2) is usually, but not always, sexually transmitted. Symptoms include genital ulcers or sores. However, some people with HSV-2 have no symptoms. Up to 30% of adults in the U.S. have antibodies against HSV-2. Cross-infection of type 1 and 2 viruses may occur from oral-genital contact. That is, you can get genital herpes on your mouth, and oral herpes on your genital area.

A finger infection, called herpetic whitlow, is another form of HSV infection. It usually affects health care providers who are exposed to saliva during procedures. Sometimes, young children also can get the disease.

HSV can infect a fetus and cause abnormalities. A mother who is infected with HSV may transmit the virus to her newborn during vaginal delivery, especially if the mother has an active infection at the time of delivery. However, 60 - 80% of HSV infections acquired by newborns occur in women who do NOT have symptoms of HSV infection or a history of genital HSV infection.

It's possible for the virus to be transmitted even when there are no symptoms or visible sores. Two-thirds of people with genital HSV infection have recurrences of their symptoms, and one-third have three or more recurrences (outbreaks) per year.

HSV is never eliminated from the body, but stays dormant and can reactivate, causing symptoms.

• Blisters or ulcers -- most often on the mouth, lips and gums, or genitals
• Enlarged lymph nodes in the neck or groin (usually only at the time of the initial infection)
• Fever blisters
• Fever -- especially during the first episode
• Genital lesions-- there may first be a burning or tingling sensation
• Mouth sores

Many times, doctors can tell whether you have an HSV infection simply by looking at the sores. However, certain tests may be ordered to be sure of the diagnosis. These tests include:

• Blood test for antibodies of HSV (serology)
• Direct fluorescent antibody (DFA) test of cells taken from a lesion
• Viral culture of the lesion

Some cases are mild and may not need treatment.

People who have severe or prolonged outbreaks (especially if it is the first episode), people with immune system problems, or those with frequent recurrences will benefit from antiviral medications such as acyclovir (Zovirax), famciclovir (Famvir), and valacyclovir (Valtrex).

People who have frequent or severe recurrences of oral or genital herpes may choose to continue taking antiviral medications to reduce the frequency and severity of recurrences.

Support groups and dating services are available for people with genital herpes.

The oral or genital lesions usually heal on their own in 7 to 10 days. The infection may be more severe and last longer in people who have a condition that weakens the immune system.

Once an infection occurs, the virus spreads to nerve cells and stays in the body for the rest of a person's life. It may come back from time to time and cause symptoms, or flares. Recurrences may be triggered by excess sunlight, fever, stress, acute illness, and medications or conditions that weaken the immune system (such as cancer, HIV/AIDS, or the use of corticosteroids).

• Eczema herpetiform (widespread herpes across the skin)
• Encephalitis
• Infection of the eye -- keratoconjunctivitis
• Infection of the trachea
• Meningitis
• Pneumonia
• Prolonged, severe infection in immunosuppressedindividuals

Call your health care provider if you develop symptoms that resemble a herpes infection. There are many different conditions that can cause similar lesions (especially in the genital area).

If you have a history of herpes infection and develop similar lesions, tell your health care provider if they do not get better after 7 to 10 days, or if you have a condition that weakens your immune system.

Preventing HSV infection is difficult because people can spread the virus even when they don't have any symptoms of an active outbreak.

Avoiding direct contact with an open lesion will lower the risk of infection.

People with genital herpes should avoid sexual contact when they have active lesions. Safer sex behaviors, including the use of condoms, may also lower the risk of infection.

People with active HSV lesions should also avoid contact with newborns, children with eczema, or people with suppressed immune systems, because these groups are at higher risk for more severe disease.

To decrease the risk of infecting newborns, a cesarean delivery (C-section) is recommended for pregnant women who have an active HSV infection at the time of delivery.

Whitley RJ. Herpes simplex virus infections. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier. 2007: chap 397.