What Is Herpes Esophagitis?

A Rare Condition Affecting the Throat

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Herpes esophagitis is an inflammation of the esophagus caused by infection with a herpes simplex virus (HSV). The esophagus is part of the throat, the tube that connects the mouth to the stomach.

There are many possible causes of esophagitis. Herpes esophagitis is caused by HSV-1 or HSV-2, although it rarely occurs in individuals who have a healthy immune system. Herpes esophagitis is more likely to occur in individuals who are immunocompromised, such as because of HIV infection.

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What Is Herpes Esophagitis? 

Esophagitis is the technical term for inflammation and irritation of the esophagus, the tube that connects the mouth to the stomach. The majority of cases of esophagitis are not caused by infection.

In fact, esophagitis is most often caused by gastrointestinal reflux. However, in rare cases, infection with a herpes simplex virus can lead to herpes esophagitis. Most but not all cases of herpes esophagitis are in people who are immunocompromised.

How Common Is Herpes Esophagitis?

Infectious esophagitis is a relatively rare condition. The vast majority of cases of esophagitis are caused by non-infectious conditions, such as gastroesophageal reflux disease (GERD). Infectious esophagitis is so uncommon that scientists don’t make estimates about its prevalence in the general population.

Research suggests that the vast majority of infectious esophagitis cases are caused by Candida species (i.e., yeast). Herpes infection and cytomegalovirus infection make up most of the rest. However, esophagitis can also be caused by other bacterial and viral infections, including HIV.

Symptoms

Symptoms of herpes esophagitis are similar to symptoms of other infections involving the throat. They include:

  • Difficulty swallowing
  • Pain with swallowing
  • Sores in the back of the mouth or throat
  • Fever
  • Generally feeling unwell

Causes

Herpes esophagitis is caused by infection with a herpes simplex virus, either HSV-1 or HSV-2.

HSV-1, sometimes referred to as the oral herpes virus, is transmitted through kissing and other contact with saliva. But HSV-1 isn’t only transmitted through intimate kissing; it’s also often transmitted within families through casual contact. HSV-1 causes most cases of herpes esophagitis.

HSV-2, also referred to as the genital herpes virus, can also cause herpes esophagitis. HSV-2 infections of the throat are thought to be primarily caused by unprotected oral sex. (Unprotected oral sex can also spread HSV-1 from the mouth to the genitals.)

Herpes esophagitis is less common in people with a healthy immune system than those who are immunocompromised, but it can happen. People with a healthy immune system who get herpes esophagitis may have other risk factors. For example, they may have other infections of the esophagus.

Other risk factors include:

  • Eosinophilic esophagitis
  • Burns to the throat
  • Blood cancers
  • Other types of tumor

What Is Eosinophilic Esophagitis?

Eosinophilic esophagitis is caused by chronic, allergic inflammation of the esophagus. It results from an accumulation of eosinophils, a type of white blood cell that takes part in the immune response. In addition to an allergic reaction, this immune response can be caused by acid reflux.

Symptoms of eosinophilic esophagitis are very similar to those for herpes esophagitis. However, people with herpes esophagitis may experience visible sores at the back of the mouth or the throat. Similar sores would not be expected in eosinophilic esophagitis.

Eosinophilic esophagitis can take place in people of any age. It may cause difficulty with eating and failure to thrive. Treatment may involve addressing either the underlying swelling or its causes.

Diagnosis

Diagnosis of herpes esophagitis may be by either a dentist or a medical doctor. In either case, the healthcare professional will generally use an endoscope to look inside your esophagus.

Endoscopy is usually performed under sedation but not general anesthesia. During the procedure, the provider will look for swelling and irritation that is characteristic of esophagitis. They will also take samples from any sores to determine if a herpes virus or other infection is present.

The leading infectious cause of esophagitis is candidiasis. People can be infected with both candida and herpes in their throats.

Treatment

Immunocompromised individuals diagnosed with herpes esophagitis may be treated with an antiviral medication such as acyclovir, famciclovir, or valacyclovir. In individuals with a healthy immune system, the condition will usually go away on its own within one to two weeks. However, acyclovir can still be used for treatment.

Herpes Esophagitis in Children

Herpes esophagitis is rare in children, but it can occur. Furthermore, being diagnosed with herpes esophagitis doesn’t mean there is a problem with the child’s immune system. There have been a number of published case reports of herpes esophagitis in healthy children.

As in adults, herpes esophagitis in children may be self-limiting. It can also be treated with acyclovir. Most cases of esophagitis in children are not caused by herpes. However, any condition that makes it difficult for a young child to take in food should be brought to the attention of a physician.

Herpes infections may be particularly serious in newborn infants. The biggest concern for transmission is in people who are newly infected during pregnancy. Pregnant people experiencing new herpes symptoms should discuss their delivery plans with their doctor.

Neonatal herpes is less of a concern in the infants of people who are infected with herpes before becoming pregnant.

Prevention

Herpes virus infections are incredibly common. In 2015–2016, the Centers for Disease Control and Prevention (CDC) estimated that almost half of the population (47.8%) were infected with HSV-1 and around 12% were infected with HSV-2. Most people infected with herpes will never experience herpes esophagitis.

It is possible to reduce your risk of herpes infection or spreading it to other people. You can:

  • Avoid sharing straws or other objects that touch the mouth during an oral herpes outbreak.
  • Avoid kissing people who have an active cold sore (i.e., oral herpes).
  • Consistently use barrier methods for oral sex.
  • Avoid sexual contact during an active herpes outbreak.
  • Try to avoid touching active herpes sores, and frequently wash your hands.

Taking these steps, however, will not completely eliminate your risk of herpes. While the infection is most contagious when a person has symptoms (such as a cold sore), it can be spread when a person has no symptoms. Scientists believe that the majority of genital herpes infections are transmitted by people with no recognizable symptoms.

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