Infection with herpes simplex virus, commonly known as herpes, can be due to either herpes simplex virus type 1 (HSV-1) or herpes simplex virus type 2 (HSV-2). HSV-1 is mainly transmitted by oral-to-oral contact to cause infection in or around the mouth (oral herpes). However, HSV-1 can also be transmitted through oral-genital contact to cause infection in or around the genital area (genital herpes). HSV-2 is almost exclusively transmitted through genital-to-genital contact during sex, causing infection in the genital or anal area (genital herpes).
Both oral herpes infections and genital herpes infections are mostly asymptomatic or unrecognized but can cause symptoms of painful blisters or ulcers at the site of infection, ranging from mild to severe.
There are two types of HSV:
- HSV-1 causes oral herpes, which usually affects the mouth and surrounding skin.
- HSV-2 causes genital herpes, which is usually sexually transmitted.
If a person has an HSV infection, they will have it for the rest of their life, though some people never develop symptoms. If symptoms occur, they reflect the type of HSV.
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 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 on the tongue, and more rarely on other areas of skin. The sores usually last 2–3 weeks at a time.
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 sores, they may last 2–6 weeks. Soon after this initial outbreak, symptoms may recur frequently. Over time, outbreaks may occur less often and the symptoms tend to become less severe.
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.
Symptoms that reappear are similar to the initial symptoms, though they tend to be less severe and last for shorter periods.
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 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 the time when symptoms first appear and when they heal. Less commonly, a person can transmit the virus when symptoms are not present. If a woman 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 risk of contracting and passing on HIV, as sores in the skin can facilitate HIV’s passing into and out of the body. HSV-2 increases the number of CD4 cells in the genital lining, which can raise the risk of infection if a person is exposed to HIV. Also, people with HIV have weakened immune systems, and this increases 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 of developing keratitis, a type of eye inflammation, or encephalitis, inflammation of the brain. If a person has a weakened immune system and genital herpes, there is, rarely, a higher risk of developing inflammation of the brain, eyes, esophagus, lungs, or liver, as well as widespread infection.
Who is at risk of developing herpes simplex infections?
Anyone can be infected with HSV, regardless of age. Your risk is based almost entirely on exposure to the infection. In cases of sexually transmitted HSV, people are more at risk when they have sex not protected by condoms or other barrier methods. Other risk factors for HSV-2 include:
- having multiple sex partners
- having sex at a younger age
- being female
- having another sexually transmitted infection (STI)
- having a weakened immune system
If a pregnant woman is having an outbreak of genital herpes at the time of childbirth, it can expose the baby to both types of HSV and may put them at risk for serious complications.
Recognizing the signs of herpes simplex
It’s important to understand that someone may not have visible sores or symptoms and still be infected by the virus. They may also transmit the virus to others. Some of the symptoms associated with this virus include:
You may also experience symptoms that are similar to the flu. These symptoms can include:
HSV can also spread to the eyes, causing a condition called herpes keratitis. This can cause symptoms such as eye pain, discharge, and a gritty feeling in the eye.
What is the long-term outlook for herpes simplex?
People who become infected with HSV will have the virus for the rest of their lives. Even if it does not manifest symptoms, the virus will continue to live in an infected person’s nerve cells.
Some people may experience regular outbreaks. Others will only experience one outbreak after they have been infected and then the virus may become dormant. Even if a virus is dormant, certain stimuli can trigger an outbreak. These include:
It’s believed that outbreaks may become less intense over time because the body starts creating antibodies. If a generally healthy person is infected with the virus, there are usually no complications.
Preventing the spread of herpes simplex infections
Although there is no cure for herpes, you can take measures to avoid contracting the virus or to prevent transmitting HSV to another person. If you’re experiencing an outbreak of HSV-1, consider taking a few preventive steps:
- Try to avoid direct physical contact with other people.
- Don’t share any items that can pass the virus around, such as cups, towels, silverware, clothing, makeup, or lip balm.
- Don’t participate in oral sex, kissing, or any other type of sexual activity during an outbreak.
- Wash your hands thoroughly and apply medication with cotton swabs to reduce contact with sores.
People with HSV-2 should avoid any type of sexual activity with other people during an outbreak. If the person is not experiencing symptoms but has been diagnosed with the virus, a condom should be used during intercourse. But even when using a condom, the virus can still be passed to a partner from uncovered skin.
Women who are pregnant and infected may have to take medication to prevent the virus from infecting their unborn babies.
There are several treatment options for both oral and genital herpes. Antivirals, such as acyclovir, famciclovir, and valacyclovir are the most effective medications available for people infected with HSV. These can help to reduce the severity and frequency of symptoms, but cannot cure the infection.
The following could help relieve herpes symptoms for some people:
- dabbing cornstarch onto the affected area
- squirting water from a bottle onto blisters to ease the pain while urinating
- applying aloe vera gel to sores
However, no research indicates that these remedies work.
A person might also try:
- taking pain relief medication, such as acetaminophen or ibuprofen
- bathing in lightly salted water or soaking in a warm sitz bath
- 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. Never apply ice directly to the skin wrap it in a cloth first.
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
Abstinence remains the best protection against STIs.