Herpes results from infection with the herpes simplex virus (HSV). It causes sores or blisters in or around the mouth or genitals, alongside other symptoms.
There are two types of HSV:
herpes simplex virus type 1 (HSV-1) causes oral herpes, which usually affects the mouth and surrounding skin but can also affect the genital region.
herpes simplex virus type 2 (HSV-2) typically causes genital herpes, usually sexually transmitted.
There is no cure for herpes, but treatment can help manage symptoms and reduce the likelihood of outbreaks recurring and transmission to partners.
HSV is a common virus. According to the World Health Organization (WHO)Trusted Source, around 67% of people under age 50 globally have an HSV-1 infection, and 13% under age 50 have an HSV-2 infection.
What is genital herpes?
Genital herpes is a common sexually transmitted infection (STI), with roughly 572,000Trusted Source new infections developing each year, according to the Centers for Disease Control and Prevention (CDC).
However, a person with genital herpes might not have symptoms or have only mild symptoms. Most people may not know they have it. Approximately 87.4%Trusted Source of 14-49 year-olds who have genital herpes do not have a clinical diagnosis.
The characteristic symptoms of genital herpes are small blistering lesions, also called cold sores when on the face, usually found around the genitals, rectum, or mouth. The fluid-filled blisters burst and then turn into small, painful sores that can last for two-to-four weeks after they break open.
Learn more about cold sores here.
Sometimes, particularly with their first outbreak of genital herpes, people can have additional symptoms which affect their whole bodies, such as:
fever
headache
body aches
swollen lymph nodes
painful urination
eye infection
After a person has an initial outbreak of genital herpes, they are likely to have more because herpes never goes away entirely. Later outbreaks of herpes are generally milder than the first.
Genital herpes is primarily caused by HSV-2 but it can also be caused by HSV-1.
HSV-2 infection is usually spread only by genital contact with someone who has a genital HSV-2 infection. A person can also get a genital HSV-1 infection by having oral sex with someone who has an oral HSV-1 infection.
The genital herpes virus cannot spread through general contact with objects, such as toilets, doorknobs, or towels.
What is oral herpes?
More than half of American adults have oral herpes. Some estimates say up to 80% of American adults have oral herpes.
Oral herpes is primarily caused by HSV-1, although it is also possible to have an HSV-2 infection around the mouth.
A person with an oral herpes outbreak may first feel itching, burning, or tingling around the mouth, lips, or tongue. Later, cold sores or small blisters may develop in these areas or anywhere on the skin.
Roughly four to six days after these cold sores start leaking, they start healing by forming a crust. Outbreaks of oral herpes can last for two to three weeks, which can be shorter than the two to six weeks of a genital herpes outbreak.
Herpes symptoms
People who develop symptoms of herpes may first experience tingling, itching, or burning, then notice sores or blisters forming around the mouth or genitals.
Symptoms tend to develop 2–20 days after exposure to the virus.
Oral herpes symptoms
Oral herpes causes blisters, sometimes called fever sores or cold sores, to develop in or around the lips and mouth.
Sometimes these blisters form elsewhere on the face or tongue, and more rarely on other areas of skin.
The sores usually last 2–3 weeks at a time before clearing up.
Genital herpes symptoms
These sores tend to develop on the penis, around or inside the vagina, on the buttocks, or on the anus, though they can form on other areas of skin.
Herpes can also cause pain when urinating, and changes in vaginal discharge.
The first time a person develops the sores, they may last 2–6 weeks before clearing up.
Soon after this initial outbreak, symptoms may recur frequently. Over time, outbreaks may occur less often and the symptoms typically become less severe.
Initial episode symptoms
These occur when a person first develops the infection.
Alongside sores or blisters, herpes may cause:
pain and itching
swollen lymph nodes
a fever
fatigue and a general feeling of being unwell
In most cases, the lesions heal without long-term scarring.
Recurring symptoms
Symptoms that reappear are similar to the initial symptoms. However, they tend to be less severe and last for shorter periods.
ResearchTrusted Source suggests that around 33% of people with oral herpes and 50% of those with genital herpes experience recurring symptoms.
During each recurrence, symptoms of oral herpes tend to last 8–10 days, according to the American Sexual Health Association.
Symptoms of a genital herpes recurrence also last 8–10 daysTrusted Source, and there will be fewer sores than in the initial phase. A person can pass on genital herpes for 2–5 days during a recurrence.
Causes
When HSV is present on the skin, it can easily pass from person to person through contact with the moist skin of the mouth and genitals, including the anus.
The virus may also spread through contact with other areas of the skin and the eyes.
A person cannot contract HSV by generally touching an object or a surface, such as a washbasin or a towel.
Infection can occur in the following ways:
having vaginal or anal sex without using barrier protection, such as a condom
sharing sex toys
having any other oral or genital contact with a person who has herpes
The virus is most contagious between when symptoms first appear and before they heal. Less commonly, a person can transmit the virus when symptoms are not present.
If a person with genital herpes has sores while giving birth, the virus can pass on to the baby.
HSV and HIV
People with genital herpes have a higher riskTrusted Source of contracting and passing on HIV, as sores in the skin can facilitate HIV’s ability to infect the body.
HSV-2 increases the number Trusted Source of CD4 cells in the genital lining where HSV-2 lesions occur, which can raise the risk of infection if a person is exposed to HIV.
Also, people with HIV have weakened immune systems, increasing the risk of more severe complications.
For example, if a person has oral herpes and a weakened immune system, they may have a higher risk Trusted Sourceof developing keratitis, a type of eye inflammation, or encephalitis, which is inflammation of the brain.
If a person has a weakened immune system and genital herpes, there is, rarely, a higher risk Trusted Sourceof developing inflammation of the brain, eyes, esophagus, lungs, or liver, as well as widespread infection.
Learn more about HIV here.
When to see a doctor
Because a person might not have symptoms even if they have herpes, it can be difficult to know when to see a doctor for diagnosis and treatment.
Planned Parenthood recommends that a person see a healthcare professional as soon as they notice sores on or around their genitals. Other STIs, such as syphilis, can have similar symptoms but require different treatment. The American Sexual Health Association also recommends seeing a doctor to get a culture of any lesion or cold sore a person notices.
People may wish to take an at-home STI test before seeing a doctor. However, at-home tests should not replace professional diagnosis and treatment.
Learn about at-home herpes tests here.
Treatment
There are several treatment options for both oral and genital herpes:
Home remedies
People should not try to treat herpes with home remedies without speaking to a doctor first. No research supports the effectiveness of home remedies in treating herpes symptoms.
The following could help relieve sone discomfort from herpes symptoms in some people:
taking pain relief medication, such as acetaminophen or ibuprofen
bathing in lightly salted water or soaking in a warm sitz bath
squirting water from a bottle or bidet onto blisters to ease pain while urinating
applying aloe vera gel to sores
applying petroleum jelly to the affected areas
wearing loose clothing to avoid irritation
refraining from sexual activity, even with protection, until symptoms have gone
applying a cream or lotion to the urethra before urinating, such as one that contains lidocaine
Some people find that using ice packs help. However, never apply ice directly to the skin — wrap it in a cloth first.
Learn more about home remedies for herpes here.
Medication
No drug can get rid of the herpes virus. However, a doctor may prescribe an antiviral medication, such as acyclovir, to prevent the virus from multiplying.
Meanwhile, over-the-counter herpes treatments, often creams, can help manage tingling, itching, and pain.
To significantly lessen the durationTrusted Source of an outbreak, start treatment within 24 hours of initial symptoms, for example, as soon as the tingling begins.
If a person uses antiviral medication, symptoms may resolve 1–2 days more quickly than if they had used no treatment. Medication may also reduce the severity of symptoms.
If a person has fewer than six recurrences of genital herpes per year, a doctor may prescribe an antiviral medication at each recurrence.
If a person experiences recurrences more frequently, a doctor may recommend taking an antiviral for 6–12 months at a time.
Taking these medications every day for longer periods can significantly reduce the risk of passing herpes to a partner, though it still remains a possibility.
Prevention tips
The following strategies can reduce the risk of developing or passing on herpes:
using barrier protection, such as condoms, when having sex
avoiding sex while symptoms are present
avoiding kissing and oral sex when there is a cold sore around the mouth
washing the hands thoroughly, especially after touching the affected area, during an outbreak
Some people also find that stress, being tired, illness, skin friction, and sunbathing can trigger recurrences of symptoms.
Identifying and avoiding these triggers can help reduce the number of outbreaks.
