While both oral and genital herpes are characteristically "nuisance infections" that are not life-threatening, cold sores (on the face) can cause rare severe or fatal disease if they travel to the eyes or brain. This is of particular concern in the case of newborns infected by genital herpes during passage through the birth canal (the risk of this occurring is by far higher when the mother has a primary infection just prior to birth and lacks protective antibodies that would otherwise reduce viable virus shedding). HSV-1 genital herpes has been shown to be more infectious in primary episodes than HSV-2. Both oral and genital herpes infections have periods of active cold sore disease lasting 2-10 days and then remission when the cold sores disappear. The majority of cases however are asymptomatic, but asymptomatic shedding has been shown to occur. Over time, periods of remission generally increase in length, and the duration of cold sores decrease, until the person rarely has active disease. At the same time, virual shedding also decreases. The frequence of recurrences is regulated by specific immunity developed by the patient against the virus. A previous HSV-1 infection tends to ameliorate the symptoms of a subsequent HSV-2 infection. All the viruses in the 'herpes family' are life-long. Recurrences can be triggered in some individuals by specific events, such as sunburn, ultraviolet light, wind, trauma, surgery, stress or other infections. Being that the virus is present but held in check by antibodies in an immunocompetent person, the weakening of the immune system in HIV or transplant patients can trigger serious HSV infections such as keratitis in people with facial infection.
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The ways in which herpes simplex infections manifest themselves vary tremendously among individuals. The following are general descriptions of the courses outbreaks may take in the oral and genital regions.
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