Herpes of the throat, also known as herpes esophagitis, is a severe viral infection of the esophagus that can lead to significant pain and discomfort. The esophagus carries food from your mouth down to your stomach. Herpes esophagitis is rare in healthy individuals and is most common among men less than 40 years old, but can be a common infection in people with weakened immune systems. While this infection will heal on its own, antiviral medications can be helpful to speed healing time and reduce the frequency of outbreaks.
Does Everyone Have HSV?
Herpes esophagitis is a viral infection caused by the herpes simplex virus (HSV). This condition is most commonly caused by HSV-1, the same virus that causes cold sores, but may be linked to HSV-2, which causes genital herpes. Not everyone has HSV, but it is very common. The National Institutes of Health indicate HSV-1 is usually transmitted during childhood.
Most individuals who have HSV-1 may not know they have it, or may never show symptoms. The virus can stay dormant for a long period of time and re-emerge without warning. There is no way of knowing how long after exposure to herpes, when your symptoms may appear. Usually a tingling sensation is the first sign that herpes may be making a comeback.
This virus is spread through direct contact with infected individuals, and is transmitted via infected saliva or by contact with open sores in the mouth or genitals. HSV infections are lifelong, but there are steps you can take to reduce outbreaks and treat active infections early — before they cause a lot of pain and discomfort. HSV-1 and HSV-2 infections are confirmed through a blood test. Some estimates indicate that approximately 90 percent of individuals worldwide have a type of herpes simplex virus.
What Can Trigger Herpes Outbreaks?
Herpes esophagitis is rare in people with healthy immune systems. Herpes outbreaks -- and the spread of this infection into the throat and esophagus -- are more common in people with weakened immune systems.
Herpes of the throat is more likely to occur in people who have kidney failure, cancer, human immunodeficiency virus (HIV) or AIDS, in organ transplant recipients, or in people who are undergoing treatment that suppresses the immune system, according to the journal Medicine. Herpes esophagitis is often seen in tandem with a primary HSV outbreak, according to doctors at Up To Date.
Herpes of all kinds can be triggered by hormonal fluctuations. A 2017 study published in the Journal of Virology indicated that persistent, long term stress is often a trigger for symptoms of both HSV-1 and HSV-2. Epinephrine and cortisol, the two major stress hormones in the body can suppress the immune system and allow the virus to replicate. This may impact the severity of the outbreak and the chance for reoccurrence.
Symptoms of Herpes Esophagitis
If you have ever had a cold sore, you know the discomfort of an HSV infection. When these sores extend to the throat and esophagus, they can lead to a great deal of pain. Research published in American College of Gastroenterology Case Reports Journal indicates people with herpes esophagitis often complain of difficult and painful swallowing, throat pain, chest pain, and fever. Sometimes this infection causes esophageal tearing, which can cause chest pain and gastrointestinal bleeding. In addition, herpes symptoms include body aches and swollen lymph nodes.
Get a Diagnosis of HSV
Esophagitis is not always caused by the herpes virus. According to the U.S. National Library of Medicine, esophagitis can also be caused by other infectious bacteria such as human papillomavirus (HPV), Candida albicans, or tuberculosis bacteria. In order to diagnose herpes esophagitis, your doctor will use an endoscope to visually inspect the throat and esophagus, and may also perform a throat swab or other laboratory tests.
This infection can heal without medication therapy. People with healthy immune systems tend to heal quickly, while those with weak immune systems often have a longer recovery time with more severe symptoms. Rarely, after an outbreak, the esophagus develops a hole, which can lead to bleeding, worsening of chest pain, or shortness of breath. Seek urgent medical attention of this occurs.
Treating Herpes Esophagitis
The first herpes outbreak is usually the most worst, according to The National Institutes of Health. Antiviral medications work by halting the replication of the virus, and can be used to reduce the frequency and severity of HSV infections. These medicines do not remove the HSV from the body, however.
Common antivirals include acyclovir (Zovirax), famciclovir (Famvir), and valacyclovir (Valtrex). These drugs are most effective when taken at the first sign of an outbreak, such as the tingling, itching or burning sensation, although your doctor may prescribe an antiviral on a long-term basis to prevent outbreaks. Research published in The American Journal of Medicine indicate that symptoms can resolve in as little as three days on medication.
Over-the-counter pain relievers may also help counter the associated pain and discomfort. If there is painful and difficulty with swallowing, it may be helpful to modify the diet. A soft diet can help ease the discomfort associated with the inflammation with foods such as smoothies, mashed potatoes, pudding, applesauce, yogurt, steamed fruits and vegetables, cream soups and broths can. Foods to avoid would be raw fruits and vegetables, crackers, nuts, and hard-to-swallow foods.
Reduce Your Chances of Contacting HSV
HSV is most contagious during an outbreak, but can be transmitted when no obvious symptoms are present. People with active symptoms, such as blisters or open sores, should avoid direct contact with others — including kissing, oral sex, and any other direct contact that can spread the virus via touching or saliva.
If you have been in recent contact with someone or accidentally touched an open area of someone with the virus, wash your hands immediately. If you think you are infected with the herpes simplex virus, see your doctor to discuss an appropriate management plan.
Is There a Herpes Cure?
There is currently no cure for HSV and there is no reason to feel shame or guilt if you have the herpes simplex virus. The National Institutes of Health indicate researchers are currently working on two different vaccines for herpes. One vaccine would be for those who have not yet been infected and the other vaccine would help boost the immune response to reduce the amount of recurrences of herpes.
How to Reduce Your Chance of a Herpes Outbreak?
The nature of HSV-1 and HSV-2 do not afford you a warning when herpes is about to strike. The best course of action to prevent an outbreak is to keep your immune system strong. Take charge of your nutrition and fitness and get your body into fighting shape.
Speak with your primary health team if you would like to start a fitness program and speak with a registered dietitian on how to get your nutrition in check. Add probiotics and prebiotics to your diet to help keep your gut healthy. Get enough sleep and reduce your stress levels on a daily basis using a method that works for you such as deep breathing, yoga, walking, or meditation.
Reviewed by Kay Peck, MPH RD
- The Canadian Journal of Infectious Diseases: Herpes Simplex Esophagitis in Immunocompetent Hosts
- World Health Organization: Herpes Simplex Virus
- ACG Case Reports Journal: Acute Herpes Simplex Viral Esophagitis Occurring in 5 Immunocompetent Individuals With Eosinophilic Esophagitis
- Medicine: Clinical Characteristics and Manifestation of Herpes Esophagitis
- The American Journal of Medicine: Not so Obvious: Acute Herpes Esophagitis
- NIH News in Health: Herpes Can Happen To Anyone
- Up To Date: Simplex Virus Infection of the Esophagus
- MedLine Plus: Esophagitis
- Journal of Virology: Stress Hormones Epinephrine and Corticosterone Selectively Modulate Herpes Simplex Virus 1 (HSV-1) and HSV-2 Productive Infections in Adult Sympathetic, but Not Sensory, Neurons
- NIH Herpes: Persistence in the population: epidemiology, transmission