Herpes esophagitis is inflammation and irritation of the esophagus due to a herpes simplex virus (HSV) infection. Herpes esophagitis mostly occurs in people with weakened immune systems.

The esophagus, or food pipe, is part of the digestive system. It is a tube that begins at the back of the throat and carries food and liquids from the mouth to the stomach.

Acid reflux is the most common cause of esophagitis. However, bacterial, viral, or fungal infections can also cause irritation and inflammation.

In this article, we look at the symptoms and causes of herpes esophagitis. We also describe its diagnosis and treatment, as well as who is at risk and how to prevent it.

Adult man drinking a bottle of waterShare on Pinterest
Guido Mieth/Getty Images

People with herpes esophagitis develop inflammation and irritation in the esophagus. As a result, a person might experience:

  • pain or difficulty when swallowing
  • nausea
  • heartburn or chest pain
  • fever
  • sores in the back of the throat
  • sores on or around the mouth

The sores on or near the mouth are called herpes labialis, or cold sores.

Cold sores result from an oral herpes infection — they do not accompany other types of esophagitis. People with oral herpes tend to experience outbreaks of these sores that come and go.

HSV causes herpes esophagitis. There are two main strains of this virus:

  • HSV-1 is the primary cause of oral herpes, but it can cause genital herpes. This virus typically transmits through mouth-to-mouth contact, though it can happen through oral sex.
  • HSV-2 is the primary cause of genital herpes, but it can cause oral herpes. This virus typically transmits through vaginal, anal, or oral sex.

Both types of HSV can cause herpes esophagitis. However, it is rare in immunocompetent people and usually develops in people with weakened immune systems.

This form of esophagitis typically occurs when HSV reactivates in the body and spreads to the esophagus via the vagus nerve or mouth.

A person can contract HSV through direct contact with sores, affected skin, or bodily fluids of someone with the virus. The infection is most contagious during or just before an outbreak of symptoms.

Contracting an HSV infection does not usually lead to herpes esophagitis, however. The main risk factor is having a weakened immune system, which may result from:

Before diagnosing herpes esophagitis, a doctor takes the person’s medical history and evaluates their symptoms. They may also examine the person’s mouth and throat.

Although the condition is rare in immunocompetent people, herpes esophagitis is usually identifiable when the symptoms occur in a person with a weakened immune system.

Further tests can confirm the doctor’s diagnosis and help distinguish the type of esophagitis. These tests may include:

  • blood tests to check for the virus and rule out other conditions
  • an endoscopy, which involves inserting a thin tube containing a light and a camera down the throat to inspect the esophagus for inflammation and ulcers
  • a biopsy, which involves taking a tissue sample from the esophagus and analyzing it under a microscope

A doctor can take the biopsy sample during an endoscopy.

In people with healthy immune systems, HSV esophagitis may resolve without treatment. However, people with weakened immune systems require treatment with an antiviral medication

These treatments may be unsuccessful if a person has a drug-resistant strain of HSV.

In this case, the doctor may prescribe an intravenous antiviral drug called foscarnet (Foscavir). They may also recommend pain-relief medications.

Strategies that can help ease the pain and make swallowing easier include:

  • stopping smoking
  • avoiding foods, drinks, and medications that make the symptoms worse
  • avoiding alcohol and caffeine
  • eating smaller meals
  • keeping the head elevated during sleep, by using more pillows, for example
»More on this:Medications for HSV

HSV infections are highly contagious and common. A person can reduce the chances of the virus passing on by:

  • using barrier methods of protection, such as condoms and dental dams, during sexual activity
  • avoiding mouth-to-mouth contact and oral sex during an oral herpes outbreak
  • not sharing objects that the mouth has touched during an oral herpes outbreak
  • avoiding sexual contact during a genital herpes outbreak
  • not touching any sores during an outbreak

Esophagitis is inflammation and irritation of the esophagus. Herpes esophagitis is a type that results from an HSV infection. It is rare in immunocompetent people.

The condition usually develops in people with weakened immune systems. Treatment involves antiviral medications and avoiding foods and other substances that trigger symptoms.