Can genital herpes caused by the herpes simplex virus (HSV) completely disappear from the skin?

Genital Herpes Lesions Do Disappear from the Skin Surface but the Virus Remains Latent

Yes, genital herpes lesions will completely disappear from the skin surface, but the virus remains dormant in the body and can reactivate periodically. 1

Natural Course of Genital Herpes Lesions

Genital herpes lesions follow a predictable pattern of appearance and resolution:

1. Initial appearance: Begins with a patch of redness at the site
2. Progression: Develops into papules, then vesicles (fluid-filled blisters)
3. Rupture: Vesicles burst, forming shallow ulcers or erosions
4. Healing: Lesions crust over and heal completely without scarring 1

The complete episode typically lasts less than 10 days, though it may be prolonged by secondary bacterial infection or in immunocompromised individuals 1.

Important Distinction: Surface Healing vs. Viral Clearance

• Surface healing: The visible lesions completely disappear from the skin with proper healing
• Viral persistence: Despite the disappearance of lesions, HSV establishes lifelong latent infection 2, 3

Mechanism of Latency and Recurrence

After initial infection, HSV:

1. Travels along sensory nerve pathways to establish latency in:

   • Sacral ganglia (for genital herpes) 1
   • Cervical ganglia (for oral herpes) 1

2. Remains dormant in a non-multiplying episomal form within neuronal nuclei 1

3. Can reactivate periodically, causing:

   • Recurrent symptomatic outbreaks
   • Asymptomatic viral shedding 3

Frequency and Pattern of Recurrences

• Recurrences vary greatly between individuals:

  • Some experience outbreaks once every few years
  • Others have several recurrences per month 1

• Recurrent lesions typically appear at the same location as the primary infection 1

Clinical Implications

1. Lifelong infection: Both HSV-1 and HSV-2 establish permanent infection 1, 4

2. Transmission risk: Even when no visible lesions are present, asymptomatic viral shedding can lead to transmission 5, 6

3. Treatment considerations:

   • Antiviral medications (valacyclovir, famciclovir) can reduce outbreak duration and frequency but do not eliminate the virus 5, 6
   • Treatment should be initiated at the earliest signs of recurrence for maximum effectiveness 5, 6

Important Caveats and Pitfalls

• Misunderstanding cure vs. control: Patients should understand that while lesions disappear, the infection is not cured 5, 6

• Transmission misconceptions: Many patients incorrectly believe they can only transmit the virus when lesions are present 7

• Diagnostic challenges: 80-90% of genital herpes infections progress subclinically, meaning many infected individuals are unaware of their status 1

• Pregnancy considerations: Special precautions are needed during pregnancy due to risk of neonatal transmission 2

In summary, while genital herpes lesions completely disappear from the skin surface during periods of remission, the virus remains dormant in the body and can reactivate to cause future outbreaks or asymptomatic viral shedding.