What Are the Complications of HSV?

There can be many complications from the Herpes Simplex Virus, including everything from feeling more emotional during an outbreak to experiencing severe symptoms, even death. Complications include the following symptoms and conditions.

• Persistent, localized, or widespread herpes infection across the body (Eczema Herpetiformis)

• Herpetic Keratitis is an eye infection that can lead to corneal scarring and, if left untreated, blindness.

• An infection of the throat.

• An infection of the liver (which can lead to cirrhosis and liver failure)

• Encephalitis (inflammation of the brain) is associated with HSV-1 (cold sores) rather than HSV-2 (genital herpes) because HSV-1 is in closer proximity to the brain. Symptoms are fever, confusion, mental and emotional alterations, and possible coma. 10% of all cases end in death. Survivors often have long-lasting brain damage that causes fatigue, irritability, brain fog, hearing and memory loss, and blindness.

• Genital sores, often called lesions or blisters, can be particularly severe in people with compromised immune systems. 

• Those who are highly sensitive or have chronic pain conditions, such as Fibromyalgia Syndrome (FS), can experience severe herpes pain. It is now understood that the herpes virus can be an indirect cause of FS and worsen symptoms.

• Some individuals who are more sensitive to the Herpes Simplex Virus, or those with overlapping conditions, may experience more frequent and severe outbreaks or a persistent infection without periods of remission.

• Shingles, also called VZV, can cause three types of urinary dysfunction: Cystitis, Neuritis, and Myelitis.

• Herpes creates a higher risk of HIV and AIDS.

• Genital herpes (HSV-2) causes an increased risk of slow fetal growth, miscarriage, and premature labor. It can be transmitted to a baby during the birthing process, even when lesions are not present, and can cause skin lesions, blindness, brain damage, and even the infant's death. Cesarean births are the only safe choice. Mothers can breastfeed as long as there are no visible sores on the breast.

• Genital herpes can also cause aseptic meningitis (Herpes Meningitis), which may present with headache, stiff neck, sensitivity to light, fatigue, loss of appetite, nausea, and occasionally vomiting. These symptoms usually resolve on their own. However, if you have a severe headache (a symptom of encephalitis) or any other symptom you can't handle, please see your doctor or call 911.

• Genital herpes can cause Viral Cystitis (bladder pain).

• Genital herpes (HSV-2) increases the chance of developing certain types of Cancer.

• Prescription drugs often cause allergic Pruritus. Once you've experienced this all-over itching, you may experience it again, whether or not you take medication.

• Frequent herpes infections can overactivate mast cells, potentially leading to Histamine Intolerance.

Emotional Complications of HSV

Contracting HSV can be tough to cope with emotionally. Some individuals have moderate to severe mood changes during viral shedding and outbreaks. Some individuals become extremely impatient or angry, while others may cry a lot or develop brain fog (can't think clearly) and feel emotionally depressed or numb during a bout of herpes. You may feel these emotions daily, hour by hour, and even minute by minute. Feeling over-emotional is normal. Expect it. It may not happen every time, but it's completely normal. Also, see Can Herpes Cause Anxiety or Depression?

Flu-Like Complications of HSV

Flu-like symptoms may include headaches, body aches, fever, and chills. It can be challenging to get up and go to school or work, take care of children, drive around town to appointments or meetings, or get together with friends when you have moderate to severe herpes symptoms. Herpes can also interfere with sleep. If you can afford to, take a day or two off from work.

HSV-1 (cold sores) symptoms include fatigue, headache, facial pain, sore throat or tongue, jaw or neck ache, light sensitivity, and tingling, itching, burning, and pain at the site of the sore. 

HSV-2 (genital herpes) symptoms may also include fatigue, headache, constipation/diarrhea (IBS), urinary retention, buttock, perineal pain, and lower extremity pain, reflecting that the virus has set up housekeeping in the sacral nerve roots. Tingling, itching, burning, and pain are symptoms at the site of the sore.   

Erythema Multiforme &  Disseminated Herpes

Sometimes skin reactions linked to HSV can look similar on the surface, but they come from very different processes in the body.

Erythema multiforme (EM) is not an active herpes infection or a herpes allergy in the skin. Instead, it is an immune system reaction that can be triggered by HSV reactivation elsewhere in the body. In this case, the immune system becomes highly activated, triggering a skin response. The virus itself is usually not actively present in the skin lesions. EM often shows up as distinct "target" or bullseye-shaped spots, commonly on the hands, feet, arms, or legs. For some people, it can come and go in cycles, sometimes appearing after a herpes outbreak or even when the outbreak itself was mild or unnoticed.

Disseminated herpes (HSV), on the other hand, is something different. This is an active viral infection that spreads through the skin and replicates in multiple areas of the body. The lesions usually appear as clusters of blisters or open sores (as in typical outbreaks) rather than target-shaped spots, as in EM. This condition is rare in otherwise healthy adults and more common in newborns or people with weakened immune systems. When it does occur, it requires prompt antiviral treatment.

A simple way to understand the difference is that Erythema multiforme is caused by your immune system reacting to HSV (with no active virus in the lesions). Disseminated Herpes is the virus actively spreading in your body (with contagious lesions). Even though the same virus can cause both, they feel very different in the body: one is an immune response, and the other is an active infection.

Complications from Immune Suppression

While I advocate natural approaches, antiviral medications can be a lifesaver in some cases. For Herpes Simplex Virus, suppressive therapy means taking a low-dose antiviral prescription medication to decrease the frequency and severity of outbreaks. This also helps reduce the chance of transmitting HSV to others. This medication is taken daily. If you experience 5-6 or more outbreaks yearly, take immunosuppressive drugs, or have HIV (human immunodeficiency virus), your doctor will likely recommend suppressive therapy.

Although suppressive therapy is an option, it's still being determined how well it will work, how long therapy should continue, and whether or not frequent outbreaks will continue after therapy is discontinued. Because of these concerns, most doctors recommend taking occasional breaks to assess long-term results. Therapy can always be restarted if and when it becomes necessary. However, if a particular antiviral medication doesn't work the first time, it's unlikely to work at all. Why? Because herpes teaches its "offspring" to become resistant. 

Suppressive therapy is an option if your outbreaks are severe and you fear passing the virus to others. When you experience immune suppression from the following conditions (see below), you're more likely to experience more frequent and severe outbreaks and complications from HSV. You may also have longer periods of viral shedding. Your internal organs may be at risk, and antiviral medications may be less effective.

• HIV or AIDS
• Medications that intentionally suppress the immune system
• Chemotherapy or radiation for Cancer treatment
• Long-term use of high-dose corticosteroids

Age-Related Complications

Contrary to what you may hear, the Herpes Simplex Virus doesn't "get better" as you age. In most cases, herpes outbreaks become more frequent and severe. Why? Because as you age, your immune system doesn't function as well. This can pose problems in your middle years and worsen as you get older. Also see Will Herpes Go Away When I'm Older?