Understanding Herpes: Types, Treatments, and Prevention
Herpes often causes painful, fluid-filled sores or blisters in and around the mouth or genital region. However, some people never get symptoms from the infection.
Herpes is not currently curable, but it is preventable and controllable. Treatment with antiviral drugs can help reduce symptoms and reduce the risk of transmitting the infection. Practicing safe sex by using barrier methods such as condoms may also prevent herpes.
This article looks at herpes in more detail, including types, stages, symptoms, treatment options, and typical durations.
HSV-1 and HSV-2 are closely related viruses. They belong to a larger family of herpes viruses that can cause a variety of other diseases. Other common types of herpes viruses include:
- herpes zoster, which causes chickenpox and shingles
- Epstein-Barr, which causes mononucleosis and other infections
Herpes is very contagious. The virus spreads through intimate contact. You can contract and transmit it by coming into direct contact with herpes sores or blisters or affected skin, saliva, or mucous membranes in the genital or oral areas. Mucous membranes are the linings of body cavities, such as the mouth, vagina, and anus.
You can transmit herpes to other areas of your skin by touching a sore and then another area. Pregnant people can also pass HSV to their newborns during vaginal delivery.
Once you have the virus, it stays in your body forever. After your body handles the initial infection, the virus lies dormant in a group of nerve cells.
Herpes can reactivate periodically with certain triggers and cause a herpes outbreak. An outbreak refers to lesions erupting in the oral or genital area. Examples of triggers include stress, fever, and menstruation.
Recurrences tend to be milder than the initial infection and decrease over time. Recurrences of HSV-2 genital herpes typically occur more frequently than recurrences of HSV-1 genital herpes. Some people with frequent recurrences require daily antiviral medication.
Seek prompt medical care if you are pregnant, have a disease or condition that suppresses your immune system, and may have had exposure to herpes. Also, seek prompt medical care if you are pregnant and have herpes symptoms.
There are two types of HSV infections: genital herpes and oral herpes.
Genital herpes is a common sexually transmitted infection (STI). It causes outbreaks of blisters and lesions in the genital area. HSV-2 is the most common cause of genital herpes.
According to the Centers for Disease Control and Prevention (CDC), about 1 in 8 people ages 14–49 years have genital herpes from an HSV-2 infection.
It is highly contagious even when sores are not present. HSV-1 can also cause genital herpes through oral sex.
Oral herpes is also very common. The CDC estimates that nearly 50% of all adults in the United States have oral herpes. Oral herpes causes small, painful cold sores and blisters on the mouth, lips, or gums.
HSV-1 is the most common cause of oral herpes. In some cases, HSV-2 may be responsible for oral herpes through oral sex.
Once they have the virus, a person will experience different stages of infection.
The primary stage occurs during the initial infection, whereas the other three stages can occur in any order throughout a person’s lifetime. In some cases, these stages can overlap. For example, a person can shed the virus at any point, including during the primary stage.
During the initial infection, you may or may not have symptoms. If symptoms develop, they typically occur between 2 days and 2 weeks after exposure.
The sores and other herpes symptoms can last for 2–4 weeks. The virus is contagious during this time. This first outbreak is usually the worst.
Once your body controls the infection, there are no active sores or symptoms. During this time, the virus travels to groups of nerves called ganglia. There, the virus lies dormant until a trigger activates a recurrence.
In genital herpes, the ganglia are in the lower back. In oral herpes, they are behind the cheekbone.
As the virus lives in your body, it periodically goes through a shedding stage. During this time, it replicates, infects bodily fluids, and is contagious.
The shedding stage does not cause symptoms. This is how the virus can spread even if you do not have an active outbreak. Shedding can also occur during a recurrence, with or without symptoms.
Recurrences can happen periodically after the initial infection. In a recurrence, you may have a symptomatic outbreak, or you may have no symptoms at all.
If you have a symptomatic outbreak, you may experience a prodrome before sores appear. During the prodrome, you may feel itching, tingling, or pain. This usually lasts a day or two before the sores develop.
The sores start as small bumps or blisters, progress to an ulcer, and then crust over and heal. Recurrences tend to be less severe than the initial infection. They also become less frequent with time.
Several things can trigger a recurrence. Triggers include fatigue, fever, sickness, and stress. For oral herpes, sun exposure, wind exposure, or tissue injury can trigger an outbreak. In females, menstruation and other hormonal changes may activate a recurrence.
Recurrences are generally milder and do not last as long as the initial outbreak. Herpes recurrences appear at the same location on the body.
Symptoms of oral herpes
Symptoms of oral herpes may include:
- itching, discomfort, or pain, which may appear days before the arrival of blisters and sores
- small blisters filled with a clear yellowish fluid, often on top of raised, red, painful skin areas
- a sore throat
- swollen lymph nodes in the neck
If small blisters appear, they may break, ooze, and merge into a larger blister. Eventually, a yellow crust forms on the blisters. When the crust falls away, pink, healing skin appears.
After a period of time, blisters, sores, or lesions can reappear due to a reactivation of the virus. Illness, stress, or exposure to sun or wind can trigger another outbreak.
Symptoms of genital herpes
Symptoms of genital herpes can include:
- blisters in the genital region, possibly affecting the genitals, thighs, buttocks, anus, vagina, or cervix
- painful lesions or sores from broken blisters
- decreased appetite
- difficulty urinating or burning when urinating
- fever and chills
- fatigue or malaise
- muscle aches
- pain, sensitivity, or itching on or near the penis, vulva, or rectum
- swollen lymph glands
- unusual vaginal discharge
Both HSV-1 and HSV-2 can cause genital and oral herpes.
HSV-1 is the most common cause of oral herpes. HSV-2 is the most common cause of genital herpes.
Herpes viruses spread from one person to another during contact that involves touching the mouth or genitals, typically during vaginal or anal sex. Oral sex can spread genital herpes to the mouth or transmit oral herpes to the genitals.
Oral herpes can also spread through kissing and engaging in other activities that involve exposure to the mucous membranes or saliva of a person with oral herpes.
Anyone who engages in sexual activity can contract and pass on a herpes infection. It is important to know that herpes can spread between people even when no blisters or other symptoms are present.
If your doctor diagnoses herpes, you should notify any sexual partners so that they can get appropriate treatment.
HSV can also pass from a pregnant person to a newborn during vaginal delivery. This type of infection travels to the nervous system and can have devastating consequences for the newborn, such as blindness or brain damage.
Certain factors increase the risk of infection with herpes. These can include:
- having a compromised immune system due to medication use, chemotherapy, or conditions such as HIV
- having direct exposure to the saliva or mucous membranes of a person with oral herpes
- being female, though males are also at risk
- having a history of another STI
- having sex — including vaginal, oral, and anal sex — without using a barrier method such as a condom
A newborn is at risk of herpes when their birthing parent has active genital herpes during pregnancy or delivery.
Herpes is preventable. The virus can spread even if a person has no symptoms. However, it is most contagious during an outbreak, when blisters or lesions are present.
These tips can help you lower your risk of infection or help prevent the spread of infection:
- Avoid kissing and engaging in sexual activity until all blisters and lesions have completely healed.
- Engage in sexual activities only within a mutually monogamous relationship.
- Do not share items exposed to the mouth, such as drinking glasses, silverware, toothbrushes, or mouth guards.
- Seek medical care as soon as possible after potential exposure to herpes or after a high risk sexual activity.
- Seek prenatal care early and regularly during pregnancy.
- Use barrier methods properly.
- Practice proper hygiene, such as frequent handwashing.
To diagnose herpes, your doctor will take a medical history, perform an exam, and possibly order testing.
Questions your doctor may ask include:
- What symptoms are you experiencing?
- When did your symptoms start?
- Have you ever had symptoms like this in the past?
- Have you had direct contact with anyone who has herpes?
- What other medical conditions do you have?
- What medications do you take?
- Are you pregnant, or is there a chance you could be pregnant?
- Are you sexually active? Have you had a new partner recently?
Usually, doctors can diagnose cold sores by examining them. The same may be true with genital herpes. In either case, your doctor may order testing to confirm the diagnosis.
Tests for herpes may include:
- blood tests to look for herpes antibodies, which can be present even if the infection happened in the past
- polymerase chain reaction tests to look for viral DNA within fluid from a sore
- viral culture of fluid from a sore
There is currently no cure for herpes. However, prompt diagnosis and treatment can help reduce or delay the onset of serious complications, improve quality of life, and prevent the spread of the infection to others.
You can best manage herpes by following your treatment plan, which generally involves taking antiviral medications and practicing self-care.
Antiviral medications for herpes
Antiviral medications can control herpes to various degrees. These drugs do not cure herpes, but they can help speed the healing of blisters and reduce the amount of time in which the infection is most contagious. These medications are most effective if you take them before sores appear.
- acyclovir (Zovirax), which is available as a pill for genital and possibly oral herpes and as a cream for both genital and oral herpes
- docosanol (Abreva), which is a cream for oral herpes
- famciclovir (Famvir), which is a pill for genital and possibly oral herpes
- penciclovir cream (Denavir), which is a cream for oral herpes
- valacyclovir (Valtrex), which is a pill for genital and possibly oral herpes
Self-care for herpes
Try these self-care measures to help treat symptoms and prevent the transmission of herpes:
- Take over-the-counter pain medication, such as aspirin, ibuprofen, or acetaminophen.
- Apply sunblock or lip balm containing zinc oxide to protect the lips when outdoors.
- Apply cold or warm packs to affected areas to reduce pain.
- Avoid touching affected areas during outbreaks.
- Wash the hands thoroughly with soap and water if you do touch an affected area.
- Keep the affected areas clean and dry.
- Do not share personal items that touch an affected area.
Complications of herpes can be serious in some cases. People at risk of serious complications include those with impaired immune systems due to conditions such as HIV or treatments such as chemotherapy.
Treatment can help minimize the risk of complications.
Serious complications of herpes
Serious complications of herpes can include:
- an increased risk of contracting other STIs, including HIV
- severe, recurrent outbreaks and symptoms
- skin infections
- the spread of herpes through the bloodstream into other organs and tissues of the body
Life threatening complications of herpes in newborns
Newborns whose birthing parents have genital herpes are at risk of life threatening complications. Exposure to the herpes virus is dangerous because a newborn’s immune system is immature. The risk is highest with active genital herpes during pregnancy or vaginal delivery.
Complications in newborns can include:
- liver or lung infection
If you are pregnant and have genital herpes, or if you have exposure to herpes while pregnant, notify your doctor. They may prescribe an antiviral medication to lower the likelihood of an outbreak around delivery time. If herpes is active at the time of delivery, your doctor may recommend a cesarean delivery.
Both HSV-1 and HSV-2 are common. Once you have herpes, the virus stays in your body. You may not always have symptoms, but you can still pass the infection to others.
People who get symptomatic recurrences often have a prodrome, wherein symptoms occur before sores appear. Starting treatment before the sores appear is often most effective at speeding recovery.