The esophagus is a muscular tube that carries food and drink from your mouth to your stomach.

Herpes esophagitis is a viral infection of the esophagus. It’s caused by the herpes simplex virus. Type 1 and type 2 can both cause herpes esophagitis, although herpes type 1 is more common.

Still, herpes esophagitis isn’t very common in healthy people. People who have weakened immune systems, such as from autoimmune conditions, cancer, HIV, or AIDS, are at an increased risk.

Herpes esophagitis can cause:

  • inflammation
  • damage to the esophagus
  • throat tissues
  • painful or difficult swallowing
  • chest pain

If you have the condition, your doctor will watch you very closely and check for other illnesses or health problems.

There are two types of the herpes simplex virus.

HSV-1

Herpes simplex virus type 1 (HSV-1) is the cause of most cases of herpes esophagitis.

It’s the same virus type that causes cold sores. It’s generally passed through mouth-to-mouth contact as well as through saliva containing the contagious agent.

You can develop a throat condition through close contact with someone who has mouth ulcers, cold sores, or eye infections.

If you’ve acquired HSV-1, it’s important that you wash your hands with soap and warm water to help prevent transmitting the virus to others. You should avoid contact with people who have an active outbreak.

If you know or suspect that you’ve acquired HSV-1, contact your doctor immediately and inform anyone whom you’ve had close contact with. HSV-1 can also be transmitted to the genitals during oral sex.

HSV-2

Herpes simplex virus type 2 (HSV-2) is another form of the virus. It’s often considered a sexually transmitted infection (STI). HSV-2 is transmitted through skin-to-skin contact and causes genital herpes.

HSV-2 rarely causes herpes esophagitis, but engaging in oral sex with someone who has an active herpes HSV-2 outbreak could lead to some people developing herpes esophagitis.

If you’re having a herpes outbreak, make sure to practice safer sex by using a condom or other barrier method. And always inform your partner.

The key to preventing herpes from being transmitted is early detection and starting treatment immediately.

Most people with strong immune systems won’t develop herpes esophagitis, even after acquiring the herpes virus.

Your risk increases if you have:

  • HIV or AIDS
  • leukemia or other cancers
  • an organ transplant
  • diabetes
  • any illness that compromises your immune system
  • treatment of an autoimmune disease such as rheumatoid arthritis or lupus
  • treatment with high-dose corticosteroids like prednisone

People who have alcohol use disorder or take long-term antibiotics are also at greater risk. Taking certain oral medications or using steroid inhalers can affect your esophageal lining, which increases your risk.

Symptoms of herpes esophagitis involve the mouth and other areas of the body. The primary symptoms include open sores in the mouth and painful or difficult swallowing.

Swallowing may be painful due to the inflammation and ulceration of throat or esophageal tissues. The mouth sores are called herpes labialis.

Other signs of the condition may include:

  • joint pain
  • chills
  • fever
  • general malaise (not feeling well)

Your doctor will ask you about your medical history. They may also look into your esophagus with a small, lighted camera called an endoscope.

Bacteria, fungi, and a range of other viruses can also cause esophagitis. Other conditions such as strep throat or hand, foot, and mouth disease may mimic the symptoms of herpes esophagitis.

Your doctor can use diagnostic tools to confirm that you have herpes esophagitis. These tests include:

  • throat and mouth swabs (viral culture or molecular tests)
  • urine molecular tests (genital herpes only)

These tests can help your doctor identify the source of the condition. Your doctor will know that you have herpes esophagitis if they find the herpes virus specifically.

Antibody tests are only useful to identify a previous infection, not a current one.

Medication can help treat esophagitis caused by the herpes virus. Over-the-counter pain relievers may help ease the pain. Your healthcare provider will also likely prescribe one of three antiviral drugs:

  • acyclovir (Zovirax)
  • famciclovir (Famvir)
  • valacyclovir (Valtrex)

If your pain is severe, you may need prescription pain medication. Your doctor might also prescribe the antiviral medication on a long-term basis to prevent you from developing recurring outbreaks.

Recovery times vary depending on your health.

People with healthy immune systems usually respond quickly to treatment and improve within a few days. People who have certain medical conditions may need more time to heal.

Scarring from the inflammation can sometimes make it difficult to swallow. A more serious, life threatening complication is esophageal perforation, which is a medical emergency.

Herpes esophagitis rarely causes esophageal perforation, though. Most people with herpes esophagitis won’t develop any serious, long-term health issues.