Herpes virus infections

Last updated: April 24, 2023

Summary

Human herpes viruses (HHV) are a large family of DNA viruses that remain dormant in a host following primary infection. An overview of the eight subtypes known to cause various diseases (ranging from asymptomatic to fatal disease courses) in humans is provided below. The specific conditions caused by the various HHVs are discussed in separate articles. Follow the links provided in the overview table below.

Overview

Human herpes viruses (HHV) are members of a large family of DNA viruses, Herpesviridae, that infect humans. Human herpes viruses are classified into three main groups: ^[1]

Alpha herpes viruses
- Include herpes simplex virus 1, herpes simplex virus 2, and varicella zoster virus
- Have a fast replication cycle and a broad host range
- Persist in ganglion cells for the lifespan of the host
Beta herpes viruses
- Include cytomegalovirus, HHV-6, HHV-7
- Have a slow replication cycle and a limited host range
- Persist in granulocytes and lymphocytes
Gamma herpes viruses
- Include Epstein-Barr virus, Kaposi's sarcoma-associated virus
- Have an oncogenic potential and a very restricted host range
- Persist in B-lymphocytes

Overview of human herpes viruses
Human herpes virus	Subtypes	Seroprevalence	Mode of transmission	Characteristics	Disease	Management
HHV-1	Herpes simplex virus 1 (HSV-1)	≥ 50% in adults ^[2]	Saliva Respiratory secretions	After primary infection, the virus remains dormant in nerve ganglia HHV-1: trigeminal HHV-2: sacral VZV: dorsal root, trigeminal	Herpes labialis (cold sores) Herpetic gingivostomatitis Eczema herpeticum Herpetic whitlow Herpes simplex encephalitis HSV keratitis HSV conjunctivitis HSV esophagitis Erythema multiforme	Antivirals may be indicated (see “Acyclovir.”)
HHV-2	Herpes simplex virus 2 (HSV-2)	10–20% in adults ^[2]	Sexual intercourse Perinatal		Genital herpes Eczema herpeticum Congenital herpes simplex, neonatal herpes simplex Viral meningitis (more commonly caused by HSV-2 than by HSV-1) Herpetic whitlow	Antivirals may be indicated (see “Acyclovir.”)
HHV-3	Varicella zoster virus (VZV)	Up to 90% ^[3]	Respiratory secretions Vesicular fluid		Primary infection: chickenpox (varicella) Reactivation: shingles (zoster) Congenital varicella syndrome	Vaccinations are widely used to prevent VZV infections in children.
HHV-4	Epstein-Barr virus (EBV)	65% in children, teens, and young adults between 6 and 19 years old ^[4]	Saliva Respiratory secretions (EBV is also called “kissing disease.”)	Oncogenic potential: can immortalize and transform host B cells Uses CD21 receptor to cause infection in B cells	Infectious mononucleosis (positive monospot test) Oral hairy leukoplakia Burkitt lymphoma Nasopharyngeal carcinoma (especially in adults of Southeast Asian descent) Post-transplant lymphoproliferative disorder	Symptomatic therapy Avoid physical activity that may trigger splenic rupture (e.g., contact sports) for at least 3 weeks
HHV-5	Cytomegalovirus (CMV)	∼ 50% in the US ^[5]	Congenital Sexual intercourse Transfusions, transplants Saliva Urine	Large atypical lymphocytes with intranuclear inclusion bodies that have an owl-eye appearance Uses integrins to cause infection	Cytomegalovirus infection CMV mononucleosis (occurs in immunocompetent individuals) Congenital CMV infection	Antivirals may be indicated. (See “Ganciclovir,” “Foscarnet,” and “Fomivirsen.”) ^[6]
HHV-6		∼ 90% in the US ^[7]	Saliva	Virus spreads early. ^[8]^[9] Reactivation of latent virus or reinfection may occur later in life (especially if individuals become immunocompromised).	Roseola infantum (more commonly caused by HHV-6 than HHV-7)	Self-limiting condition Symptomatic treatment to reduce fever
HHV-7		∼ 90% in the US ^[7]	Saliva		Roseola infantum (more commonly caused by HHV-6 than HHV-7)
HHV-8	Kaposi's sarcoma-associated virus (KSHV)	< 10% in the US Higher in men who have sex with men (MSM) and HIV-positive patients	Sexual intercourse	Has oncogenic potential Infects endothelial cells causing malignant, multifocal, highly vascularized tumor	Kaposi sarcoma	Treatment of the underlying disease (e.g., antiretroviral treatment in patients with HIV)

Herpes labialis Herpetic gingivostomatitis Eczema herpeticum Herpetic whitlow Cutaneous manifestation of HSV infection Herpes simplex keratitis Erythema multiforme Chickenpox Shingles Herpes zoster Infectious mononucleosis Reactive lymphocytes in infectious mononucleosis HIV patient with oral hairy leukoplakia Burkitt lymphoma Owl's eye appearance in cytomegalovirus infection Roseola infantum (three-day fever, exanthem subitum) Intraoral Kaposi sarcoma of the palate Kaposi sarcoma on skin

References

Whitley RJ. Medical Microbiology. Herpesviruses. University of Texas Medical Branch at Galveston ; 1996
Bradley H, Markowitz LE, Gibson T, McQuillan GM. Seroprevalence of Herpes Simplex Virus Types 1 and 2--United States, 1999-2010. J Infect Dis. 2013; 209 (3): p.325-333.doi: 10.1093/infdis/jit458 . | Open in Read by QxMD
Reynolds MA, Kruszon-Moran D, Jumaan A, Schmid DS, McQuillan GM. Varicella Seroprevalence in the U.S.: Data from the National Health and Nutrition Examination Survey, 1999–2004. Public Health Rep. 2010; 125 (6): p.860-869.doi: 10.1177/003335491012500613 . | Open in Read by QxMD
Dowd JB, Palermo T, Brite J, McDade TW, Aiello A. Seroprevalence of Epstein-Barr Virus Infection in U.S. Children Ages 6-19, 2003-2010. PLoS ONE. 2013; 8 (5): p.e64921.doi: 10.1371/journal.pone.0064921 . | Open in Read by QxMD
Bate SL, Dollard SC, Cannon MJ. Cytomegalovirus Seroprevalence in the United States: The National Health and Nutrition Examination Surveys, 1988–2004. Clinical Infectious Diseases. 2010; 50 (11): p.1439-1447.doi: 10.1086/652438 . | Open in Read by QxMD
Cytomegalovirus (CMV) and Congenital CMV Infection. http://www.cdc.gov/cmv/overview.html. Updated: June 17, 2016. Accessed: November 2, 2016.
Caserta MT, McDermott MP, Dewhurst S, et al. Human herpesvirus 6 (HHV6) DNA persistence and reactivation in healthy children. J Pediatr. 2004; 145 (4): p.478-484.doi: 10.1016/j.jpeds.2004.06.016 . | Open in Read by QxMD
Human Herpesvirus 6: An Emerging Pathogen. http://wwwnc.cdc.gov/eid/article/5/3/99-0306_article. Updated: December 10, 2010. Accessed: November 2, 2016.
Vincent C Emery and Duncan A. Clark. HHV-6A, 6B, and 7: persistence in the population, epidemiology and transmission. Cambridge University Press : p. Chapter 49

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