Herpes simplex virus (HSV) causes painful blisters and sores on the mouth or genitals. Treatment decreases outbreaks, but it cannot cure the infection.
There are two types of HSV:
- Herpes simplex virus type 1: (HSV-1): HSV-1 usually causes oral herpes, but it can also cause genital herpes. Cold sores, also known as fever blisters, typically appear on your face, especially around your mouth, but can appear anywhere on your skin. Most adults with the herpes simplex virus have HSV-1.
- Herpes simplex virus type 2: (HSV-2): Blisters typically appear in your genital area but can occur anywhere on your skin. HSV-2 usually spreads through sexual contact, including vaginal, anal, or oral sex.
Genital herpes is a sexually transmitted infection (STI) that can be caused by herpes HSV-2 or HSV-1. It typically spreads through sexual contact and can be transmitted even when someone with the infection has no visible sores.
Genital herpes is the most common ulcerative (characterized by genital sores) STI in industrialized countries like the United States, northern Europe, Japan, Canada, Australia, and New Zealand.
Most people with herpes do not have symptoms. When symptoms occur, they vary depending on the location and severity of the infection.
HSV-1 and HSV-2 cause similar symptoms, including:
- Itching, burning, or tingling: Many people feel burning, tingling, or itching sensations on their skin 1-2 days before small, fluid-filled blisters appear.
- Blisters: One or more small blisters form on or around the mouth, genitals, or other body parts. Blisters are fluid-filled and eventually rupture, forming crusted sores. Blisters and sores usually last from five days to two weeks. First outbreaks generally last longer than recurrences.
- Flu-like symptoms: Swollen lymph nodes in the groin (genital herpes) or neck (oral herpes), fever, headache, and body aches are common, especially during an initial outbreak.
Oral Herpes
Symptoms of oral herpes often appear 2-20 days after exposure to HSV and can last up to three weeks. Once infected with HSV-1, you may have recurrent cold sores that usually appear in the same area as your first outbreak.
Symptoms of oral herpes include:
- Small fluid-filled blisters on your lips, gums, mouth, or throat
- Red, swollen skin around the blisters
- Yellow, crusted sores (ulcers) that eventually scab and heal without leaving scars
- Pain when swallowing, eating, or talking
Genital Herpes
Symptoms of genital herpes usually develop within 2-12 days after exposure to HSV. During the initial outbreak, symptoms can be severe and last up to six weeks. Recurrent outbreaks typically do not last as long.
Symptoms of genital herpes include:
- Small, painful blisters on and around the labia, cervix, penis, scrotum, anus, thighs, buttocks, or inside the vagina
- Shallow, red, painful ulcers that form after blisters break open, crust over, and heal within 1-2 weeks
- Pain when urinating
Less common symptoms include:
Herpes is caused by the herpes simplex virus (HSV)—a highly contagious virus that spreads through close contact with an infected person.
Oral herpes is usually caused by HSV-1, but it can also be caused by HSV-2.
It primarily spreads when you come in direct contact with herpes sores or fluids from a herpes blister. Skin-to-skin contact, like kissing or sharing personal items like utensils, towels, or lip balm, can pass the virus from one person to another.
Most people contract oral herpes during childhood from non-sexual saliva contact. People in the United States usually contract oral herpes by the age of 20.
Genital herpes is usually caused by HSV-2. However, it can also be caused by HSV-1. It primarily spreads through sexual contact with someone who has the herpes simplex virus, including vaginal, anal, or oral sex.
The virus can spread even when someone with the virus has no symptoms. This is known as asymptomatic viral shedding.
Once the virus enters your body, it infects nerve cells near the body part that came into contact with the virus. It remains dormant in those nerve cells—sometimes for weeks, months, or years—until it reactivates.
When the virus reactivates, it travels from the nerve endings to the skin or mucous membranes, causing a recurrent outbreak.
Who’s at Risk?
Anyone can contract herpes. About 67% of people are infected with HSV-1 by age 50, and about 13% are infected with HSV-2 by age 50.
Certain risk factors can increase your chances of contracting herpes.
These include:
- Having unprotected sex (for example, not using condoms, dental dams, or gloves)
- Having multiple or anonymous sexual partners
- A history of having another sexually transmitted infection (STI)
- Being immunocompromised (having a weakened immune system)
- Close contact with someone who has oral or genital herpes
What Increases Your Risk of Recurrence?
Once you have herpes, certain triggers can reactivate the virus and cause an outbreak.
HSV triggers include:
- Stress
- Menstruation
- Illness
- Surgery
- Overexposure to sunlight (can trigger HSV-1)
You may need to get tested for herpes simplex virus if:
- You have symptoms of HSV
- Your sexual partner has HSV
- You are pregnant and you or your sexual partner has symptoms
Herpes is diagnosed based on the appearance of sores or blisters during an outbreak. Lab tests can confirm the diagnosis by swabbing a sore or blister and testing it for the herpes virus.
Diagnostic tests used to diagnose herpes include:
- Swab testing: A doctor uses a swab to gently collect fluid from a herpes blister or sore. The sample is sent to a lab to test for the herpes virus.
- Blood test: A blood sample is taken from a vein in your arm and sent to the lab to test for antibodies. Antibodies are proteins created by your immune system to fight infection. The presence of antibodies indicates a past or current infection.
There are a few things to keep in mind with HSV testing:
- A negative result does not necessarily mean you do not have the virus: It means the test did not detect enough of it to be positive. You might need to test again at a later date.
- A positive swab test indicates an active infection. Blood tests can tell you whether or not you have HSV, but they cannot determine when you acquired the infection, whether the virus is currently active or dormant (inactive, with no symptoms), or whether you will have future outbreaks.
There is no cure for herpes, but treatment can help decrease the frequency and severity of outbreaks, relieve symptoms, and lower your risk of transmitting the virus to others.
Mild outbreaks typically clear up on their own within a few weeks. Severe or frequent outbreaks usually require treatment.
Medications
Antiviral drugs treat primary (first) and recurrent herpes outbreaks. They are usually taken orally (by mouth).
Antivirals commonly prescribed to treat herpes include:
- Zovirax (acyclovir)
- Valtrex (valacyclovir)
- Famvir (famciclovir)
The dosage and duration of antiviral drug treatment depend on whether you have your first outbreak or a recurrence. Your first episode will likely be treated with a 7-10-day prescription for oral antiviral medications.
Different medication strategies are also used depending on the frequency of your outbreaks:
- Episodic therapy: This type of therapy may be used if you have fewer than six outbreaks per year. You only take medication when you have symptoms. Episodic therapy does not decrease the risk of future outbreaks.
- Suppressive therapy: This type of therapy may be used if you have six or more outbreaks per year or if you have a weakened immune system. You take medication daily, regardless of whether or not you have symptoms. Suppressive therapy decreases the frequency and duration of future outbreaks.
Over-the-counter medications, such as pain relievers and anti-inflammatory drugs, can help relieve pain and discomfort associated with herpes outbreaks.
Home Remedies
Home remedies for herpes may help relieve pain and discomfort while you heal, but they do not help shorten the duration of an outbreak.
If you have an outbreak of oral or genital herpes, these at-home treatments may help you feel more comfortable:
- Cold compresses: Place a cloth-covered ice pack on the sores to soothe the pain. Do not keep the ice on your skin for more than a few minutes.
- Take a warm bath: Warm water can provide temporary relief for sores. If you have pain when urinating, urinating in the water at the end of your bath may help dilute the urine so it does not burn the sores.
- Avoid touching sores: Do not touch, scratch, or rub the sores. This also helps lower the risk of spreading the virus to other areas of your body and other people.
- Keep the affected area clean and dry: This reduces the risk of bacterial infection and promotes healing.
- Lysine supplements: Research suggests they may help reduce recurrent outbreaks and shorten their duration.
Preventing herpes is not always possible since many people acquire the HSV-1 infection during childhood. Not everyone with herpes has symptoms, and many people with oral and genital herpes are unaware they have it.
That said, you can take preventive steps to decrease your risk of getting or spreading the infection.
Preventive strategies include:
- Practice safer sex: Use condoms and dental dams during sexual activity. The virus can spread without active blisters or sores, but using protection decreases the risk.
- Practice abstinence during outbreaks: Avoid close contact (including kissing and sex) with your sexual partner if either of you has an outbreak of oral or genital herpes.
- Do not share personal items: Do not share items such as towels, toothbrushes, utensils, or drinks.
- Get tested: If you are sexually active, get tested regularly for sexually transmitted infections, including genital herpes.
Triggers for herpes outbreaks include fatigue, stress, and overexposure to sunlight. You can take steps to decrease your risk of recurrences by avoiding these triggers.
For example:
- Wear sunscreen and lip balm with high SPF
- Prioritize sleep
- Try stress-management techniques like exercise or meditation
- Eat nutritious foods to strengthen your immune system
Herpes outbreaks usually cause temporary sores and blisters that heal without any complications. However, herpes can infect other parts of your body, including your brain and spinal cord.
This can lead to complications or cause other medical conditions, including:
- Human immunodeficiency virus (HIV): People with HSV-2 have a higher risk of contracting HIV, and HSV-2 is one of the most common infections in people with HIV.
- Bacterial infections: HSV can weaken your immune system. Open sores also allow bacteria to enter your body, increasing your risk of bacterial infections.
- Meningitis: It’s rare, but HSV can cause viral meningitis, which is an infection of the membranes surrounding your brain and spinal cord.
- Encephalitis: The HSV-1 virus can cause encephalitis (brain inflammation). This is also rare.
- Neonatal herpes: If a pregnant person has HSV, they can transmit the virus to the infant during childbirth.
- Other sexually transmitted infections (STIs): People who have HSV are at an increased risk of contracting other STIs, such as chlamydia and gonorrhea.
- Herpes keratitis: HSV can spread to your eye if you touch a lesion on another body part and then touch your eye.
- Hearing loss: HSV-1 and HSV-2 infections have been linked with an increased risk of hearing loss.
