Herpes

What Is Herpes?

The herpes simplex virus (HSV), or simply herpes, is a viral infection that can cause small, fluid-filled blisters or lesions on various body parts, including the mouth and the genitals.

There are two main types of HSV:

• Herpes simplex virus type 1 (HSV-1). According to the World Health Organization (WHO), HSV-1 mostly spreads by oral contact and causes outbreaks in or around the mouth (oral herpes or cold sores). It can also cause genital herpes outbreaks. Most adults are infected with this type of herpes.

• Herpes simplex virus type 2 (HSV-2). HSV-2, sometimes called genital HSV, spreads by sexual contact and causes genital herpes. It can also cause oral herpes.

If you’ve just been diagnosed with herpes, you probably have a ton of questions about how it’ll affect your health and your sex life, like: How often will I have symptoms? or Will I have herpes forever?

We’ll get to those questions and many more in this guide, but you should know that there are many misconceptions about this virus, which has been highly stigmatized for far too long.

For one, it’s more common than you think. The WHO reports that herpes affects several billion people worldwide.

Secondly, though many think of herpes solely as a sexually transmitted infection (STI), the virus can also be spread in other ways. A parent can pass herpes to their child during birth (called neonatal herpes); you can catch herpes through kissing; and, in rare cases, you can even get herpes by coming into direct contact with infected surfaces.

There is no cure for herpes, but very effective treatments are available that can reduce the symptoms, prevent outbreaks, and decrease transmission risk. Keep reading to explore those treatments, get tips on how to prevent herpes, and find out when to see a healthcare provider.

How Common Is Herpes?

We already mentioned that billions of people have herpes worldwide. But let’s get into specifics.

• HSV-1. According to the WHO, around 3.8 billion people under age 50 worldwide have an HSV-1 infection, the leading cause of oral herpes.

• HSV-2. Fewer people have HSV-2, but it’s no small number: Approximately 520 million people ages 15 to 49 globally have an HSV-2 infection, the leading cause of genital herpes.

According to the Centers for Disease Control and Prevention (CDC), nearly 50 percent of Americans under age 50 have HSV-1, and around 12 percent have HSV-2. In 2018 alone, there were an estimated 572,000 new genital herpes infections in the U.S. within this age group.

Symptoms of Herpes

Most people with herpes have mild symptoms or are asymptomatic. This makes it very easy to pass the infection to others.

When you first get herpes, you may feel like you have the flu — fever, aches, and swollen glands — along with painful or tingling sores. These sores can appear around your mouth or genitals 1-2 weeks after contracting the virus, and often take a few weeks to heal. The first outbreak is usually the most severe and long-lasting (around two to four weeks), after which the virus settles into your nerve cells, where it remains dormant until a future outbreak.

Herpes sores are the most common symptom of the HSV-1 and HSV-2 virus, emerging as red bumps or blisters that eventually crust over. Oral herpes symptoms include blisters or ulcers in or around the mouth or lips, while genital herpes symptoms include bumps or open sores around the genitals or anus.

Common symptoms of HSV include:

• Small bumps or blisters

• Fever

• Body aches

• Swollen lymph nodes near the infection site

• Fatigue

Symptoms of Oral Herpes

In addition to the symptoms listed above, oral herpes can cause:

• Cold sores or open sores (ulcers) that appear in or around the mouth

• Infected hair follicles in the beard area that look like inflamed, red bumps

• Red and swollen gums

Symptoms of Genital Herpes

Herpes that affects the genital area can cause:

• Tingling or itching in the genital or anal area

• Painful blisters or sores, which may break open and form ulcers.

• Burning or stinging sensation when urinating if sores are present.

• Swollen, tender lymph nodes in the groin area.

• Red bumps or open sores on or around the genitals, anus, thighs, or buttocks 

• Painful urination

How Often Will I Have Herpes Outbreaks?

It’s fairly common to have recurrent outbreaks, especially during the first year of infection with herpes. You’ll usually notice signs before your outbreaks, like itching, tingling, or burning at the site of infection.

Remember, the first episode is typically the worst. Subsequent outbreaks tend to be shorter and have milder symptoms. Many people stop having outbreaks altogether over time.

Herpes Complications

Having herpes may increase your risk of other STIs, including HIV infection. Sores in the genital area create a cellular environment conducive to an HIV infection, even if you’ve successfully treated your sores and no current lesions are present.

Other rare complications associated with the herpes simplex virus include:

• Encephalitis: This inflammation of the brain and its surrounding tissues can be caused by either HSV-1 or HSV-2.

• Keratitis: An eye infection that affects the cornea, keratitis can be caused by HSV-1 and, if left untreated, can lead to serious complications, like scarring of the eye and blindness.

Causes of the Herpes Virus Infections

HSV-1 and HSV-2 are spread through direct or indirect contact with the bodily secretions of someone who already has the virus.

According to the American Academy of Dermatology, most people with HSV-1 are infected as children via skin-to-skin contact with an adult carrier. An adult doesn’t have to have sores present to spread the virus to their child.

HSV-2, on the other hand, is typically spread through sexual contact.

While touching a sore is one way to be infected with the virus, most people get herpes from someone who does not have lesions due to asymptomatic viral shedding.

How People Get Oral Herpes

You can get oral herpes by:

• Kissing someone with herpes

• Sharing items like razors, lip balm, drinkware, or utensils

• Oral sex

How People Get Genital Herpes

Genital herpes can be caused by either HSV-1 or HSV-2, but it’s more commonly caused by HSV-2.

You can get genital herpes by having sexual contact (vaginal, oral, or anal sex) with someone with herpes, especially if you don’t use a condom (although condoms do not reduce transmission risk to zero). Remember, you can be infected with herpes whether sores are visible or not. 

Does your partner have herpes? Or are you worried about passing herpes to your future partners? Check out this resource on dating someone with herpes.

Risk Factors for Herpes

Though anyone can get herpes, regardless of age or gender, some people have a higher risk of being infected. For example, having a weak immune system and not using condoms regularly both increase your risk. Having a partner who has HSV-1 or HSV-2 also increases your risk.

Unique risk factors for HSV-1, according to one study, include:

• Being older

• Being female

• Having obesity

• Smoking

Another review found women are also more likely to have genital herpes. Other genital herpes risk factors include having a higher number of lifetime sexual partners and having another STI.

Triggers for Recurrence

Once you have the virus and get over the initial outbreak, some factors can trigger a repeat outbreak.

Risk factors for recurrent herpes outbreaks include:

• Stress

• Exposure to sunlight

• Fever

• Surgical procedures

You’re also more likely to have another outbreak if you’re a man and if your first outbreak lasted longer than 34 days.

Diagnosing Herpes

Most people with herpes don’t know they have the virus because they haven’t had any symptoms. The CDC does not recommend testing people for herpes who don’t have symptoms, so herpes testing is not always part of a routine STI screening.

If you do see some bumps or sores in or around your mouth or genitals, you should see a healthcare provider to confirm if you have herpes.

Some tests that help to diagnose herpes include:

• Physical examination. If you have sores, your provider may examine them. They should be able to distinguish between a herpes sore and another type of blemish, like an ingrown hair or a pimple. 

• HSV swab test. If your sores are not crusted or healing, your provider may use a swab to collect fluid and send it to a lab to check for HSV in either a polymerase chain reaction (PCR) test or viral culture.

• Blood test. If you have no sores but suspect you’ve been exposed to the virus, your provider may order a blood test to check for herpes antibodies. Testing positive for antibodies, though, just confirms that you were exposed to the HSV virus sometime in your lifetime. It does not distinguish between oral and genital herpes, and often cannot distinguish between new and old infections.

Is There a Cure for Herpes?

Wondering how to get rid of herpes? Unfortunately, there’s no cure yet, but there are many ways to manage herpes outbreaks.

Infectious disease researchers are also working to find a cure for herpes using gene therapy. In one animal study, gene editing eliminated 90 percent of latent HSV DNA in mice with oral infections and up to 97 percent in those with genital infections. However, this work is experimental and ongoing.

Until more studies are completed on human subjects, your best course of action is to explore treatments to manage your condition.

What Are Herpes Treatments?

The main treatments for herpes symptoms include antiviral medication and pain-management techniques.

Antiviral Medications

Antiviral medications can be used in two different ways.

• Shorten current episodes: Antivirals can reduce symptoms when present and shorten the duration of an outbreak by around two days.

• Suppress future episodes: They can also be used as daily suppressive therapy to prevent future flare-ups. Suppressive therapy has been shown to reduce the frequency of genital herpes recurrences by 70 to 80 percent among people who get outbreaks often.

The most common antiviral medications for herpes include acyclovir, valacyclovir, and famciclovir. Although all of these medications appear to be equally effective in reducing symptoms, the medication valacyclovir has some notable advantages.

Valacyclovir for Oral Herpes

When you take valacyclovir for oral herpes, it stops the herpes virus from spreading to healthy cells, thereby reducing the effects of the virus. As a fast-acting medication, valacyclovir starts working almost immediately, which means you may be able to take less than other medications. In a study comparing valacyclovir to acyclovir for oral herpes, a single day of treatment with valacyclovir (two doses) reduced the time it took for sores to heal.

Valacyclovir for Genital Herpes

Using antiviral drugs like valacyclovir for genital herpes is a bit different. For your first episode, treatment lasts 10 days. For recurrent episodes, treatments typically last three days. However, you should always follow your provider’s advice regarding treatment plans and dosing.

Antivirals should always be taken at the first sign of symptoms to stop a herpes outbreak and shorten the duration of the illness.

Learn more about valacyclovir and its side effects.

Topical Antivirals

Antiviral medications like acyclovir and penciclovir can also be found in topical formulations. Like oral antivirals, these drugs speed up the healing process, but they are applied directly to the lesions themselves at the first sign of symptoms. Studies show that topical antiviral medication is less effective than oral antivirals in preventing new lesions and carries the risk of causing skin irritation when applied.

Pain Management

To manage pain associated with herpes, try the following:

• Over-the-counter pain relievers: Medications like ibuprofen and aspirin can help reduce the pain of open sores and associated symptoms like fever and body aches.

• Cold compresses: Applying a cold compress to sores can relieve swelling, pain, and itching.

• Sitz bath: A sitz bath is a shallow bath of warm water that you sit in to relieve pain and itching of your genitals or anal area. This can be especially helpful if you’re experiencing pain when you pee.

Herpes Prevention Tips

To prevent herpes infections and recurrent outbreaks, do the following:

• Get tested if you have any herpes symptoms

• Avoid contact with genital and oral sores (no sex or kissing during outbreaks)

• Ask about your partner’s STI status and share your own

• Use condoms during sexual activity, especially with new partners

• Use dental dams during oral-vaginal and oral-anal sex

• Wash up after sex and keep your genitals clean and dry

• Avoid sharing razors, towels, utensils, drinks, lip balm, and other items that may come into contact with infected areas of the body

• Keep your immune system strong through healthy lifestyle habits

• See a therapist if you deal with chronic stress

If you’re infected with HSV-1 or HSV-2 and want to shorten the duration of your outbreaks or learn how to prevent them, reach out to a healthcare provider to figure out the next steps. You can schedule an online consultation right now to see if prescription medication is right for you.

Want more tips on how to have an empowered sex life with HSV? Check out this guide to having sex with herpes, find out the rules on kissing and cold sores, and explore other sexual health products here.