Herpes: Symptoms, causes, and treatment

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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), around 67% of people under age 50 globally have an HSV-1 infection, and 13% under age 50 have an HSV-2 infection.

In this article, we describe the symptoms of genital and oral herpes, how to treat them, and how to prevent these infections.

Genital herpes is a common sexually transmitted infection (STI), with roughly 572,000 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% 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.

Learn more about genital herpes here.

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.

Learn more about cold sore stages here.

The following images can help with identifying forms of herpes:

Learn more about how to visually identify herpes here.

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.

Research 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 days, 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.

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 risk 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 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 of 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 of developing inflammation of the brain, eyes, esophagus, lungs, or liver, as well as widespread infection.

Learn more about HIV here.

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.

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.

The following are common questions and answers about herpes:

Can I still have sex if I have herpes?

A person with herpes should tell their partners that they have the infection before they have sex. Use a condom at all times, even if a person does not seem to have symptoms.

Learn safe sex tips here.

Prescription antiviral medication can reduce the likelihood of someone with herpes spreading it to their uninfected partner.

Is there a link between genital herpes and HIV?

It is easier for a person with genital herpes to get or transmit HIV infection.

If a person with a herpes infection is genitally exposed to HIV, their risk of acquiring HIV is 2-4 times higher than someone without genital herpes. This is because genital herpes can cause breaks in the skin and make a person more vulnerable to HIV infection.

A person with HIV and genital herpes is more likely to transmit HIV to sex partners.

Learn about at-home HIV tests here.

Can herpes go away?

Herpes does not go away. There are no treatments that can clear the herpes virus from the body. However, prescription medications can make outbreaks shorter and less severe. Over-the-counter products can provide some relief for symptoms.

Learn why there isn’t a herpes cure here.

How do I know if I have herpes?

If a person has an active herpes outbreak with visible sores, a physician or specialist such as a dermatologist can make a diagnosis based on a physical examination. If the physical symptoms alone are not enough, a doctor may take a swab of the sore and send it to a lab for analysis.

If a person does not have physical sores but is concerned, blood tests are available.

People can also take at-home herpes tests, though they should seek a consultation with a doctor to confirm a diagnosis and seek treatment.

Herpes is a viral infection that can cause blisters or sores to develop around the mouth or genitals, though some people never develop symptoms.

Herpes spreads through physical contact with moist areas of the skin, particularly through sexual activity. People can prevent the spread of herpes by practicing safe sex and personal hygiene, such as washing hands during an outbreak.

If a person has an HSV infection, they will have it for the rest of their life. There are currently no medications to cure herpes. However, there are medications to prevent or shorten outbreaks, help manage symptoms, and make it less likely that a person passes genital herpes on to a partner.

A person who suspects they may have herpes should speak to a doctor about diagnosis and treatment.

Read the article in Spanish.

Herpes simplex virus infection – Symptoms, diagnosis and treatment

Herpes simplex virus infection is common and has multiple clinical manifestations.

The classic clinical presentation of vesicles progressing to painful ulcers is unusual; atypical and mild symptoms are common, and most people have unrecognized disease.

Symptoms of oral herpes (herpes labialis) include tingling and burning followed by development of vesicular then ulcerative lesions involving the oropharynx and perioral mucosa.

Symptoms of genital herpes range from asymptomatic to tingling and burning without lesions, to recurrent genital ulcerations.

Acyclovir, famciclovir, and valacyclovir are effective at shortening the duration and severity of an outbreak.

Daily suppressive therapy reduces recurrences by 80% and reduces transmission risk by approximately 50%.

Glycoprotein G-based type-specific serology testing is used to diagnose infection with or without lesions and distinguish between type 1 and 2.

Definition

The major clinical manifestations of infection with herpes simplex virus (HSV) type 1 (HSV-1) or HSV type 2 (HSV-2) are oral, genital, and ocular ulcers. Less commonly, primary or recurrent HSV infections may also present at other sites with neurologic, hepatic, or respiratory complications. The primary episode occurs during initial infection with HSV, in which the host lacks an antibody response.

Herpes labialis is an infection of the mouth area and lips, most commonly with HSV-1.

Genital herpes is caused by infection with either HSV-1 or HSV-2. The first clinical episode of genital ulceration may represent either new acquisition of the virus or newly recognized disease with remote acquisition of the virus.

For both HSV-1 and HSV-2, asymptomatic shedding and transmission of the virus may occur in the absence of lesions. HSV establishes latency in neuronal ganglia and periodically reactivates. Most reactivations are asymptomatic but can result in transmission of the virus.

For details of management of ophthalmic HSV infection, please refer to the Uveitis and Keratitis topics. For details of management of suspected HSV encephalitis, please refer to the Encephalitis topic.

Key diagnostic factors

• dysuria (in women)
• lymphadenopathy
• genital ulcer
• oral ulcer
• fever

More key diagnostic factors

Other diagnostic factors

• tingling sensation
• headache/aseptic meningitis

Other diagnostic factors

Risk factors

• HIV infection (risk factor for clinical disease)
• immunosuppressive medications (risk factor for clinical disease)
• female sex (risk factor for seropositivity)
• black race (risk factor for seropositivity)
• increasing age (risk factor for seropositivity)
• high-risk sexual behavior (risk factor for seropositivity)
• lack of condom use (risk factor for seropositivity)

More risk factors

1st investigations to order

• HSV polymerase chain reaction (PCR)
• viral culture
• Glycoprotein G-based type-specific serology (gG1 and gG2)

More 1st investigations to order

disseminated visceral involvement: pneumonitis, hepatitis, or CNS involvement (meningitis or encephalitis)

genital disease: first episode, immunocompetent

genital disease: first episode, immunocompromised

genital disease: recurrent episode, immunocompetent

genital disease: recurrent episode, immunocompromised

genital disease: pregnant (36 weeks of gestation)

oral disease: first episode, immunocompetent

oral disease: first episode, immunocompromised

oral disease: recurrent episode, immunocompetent

oral disease: recurrent episode, immunocompromised

ONGOING

genital disease: sexually active or frequent severe recurrences, immunocompetent

genital disease: sexually active or frequent severe recurrences, immunocompromised

oral disease: frequent severe recurrences, immunocompetent

oral disease: frequent severe recurrences, immunocompromised

Contributors

Authors

Herpes simplex virus type 1 and 2 (HSV 1/2), oropharyngeal DNA qualitative determination; separable blisters and erosive and ulcerative lesions, as well as from the cerebrospinal fluid

PCR can detect even a small amount of viral particles in biological material. It allows you to identify herpes viruses, regardless of the duration of infection, even at a time when antibodies have not yet formed.

The most common are the 1st and 2nd types of herpes. Both are contagious and contribute to the appearance of small bubbles (vesicles) on the mucous membranes, which burst, forming open sores. In HSV-1, blisters appear around the mouth and in the oral cavity, while HSV-2 usually affects areas in the genital area.

Herpes simplex virus can be transmitted through skin contact when there are vesicles on the skin, and sometimes when there are no visible lesions on the skin. HSV-2 is often referred to as a sexually transmitted disease, but HSV-1 herpes infection can also occur, for example, through oral sex. According to WHO, from 50% to 80% of the adult population of developed countries is infected with herpes type 1 and about 20% – type 2. Because type 2 symptoms are subtle, 90% of those infected with it may be unaware of their infection.

In the case of a primary infection, painful blisters usually develop at the infection site after two weeks, which usually disappear after four weeks. They appear on the genitals, around the anus, on the buttocks or on the thighs, after which they can burst. You may also experience flu-like symptoms, such as chills and a sore throat.

However, herpes vesicles do not always form. Sometimes the manifestations of the disease are so mild that they go unnoticed or are mistaken for something else, such as insect bites or allergies. After the infection enters the body and spreads, the herpes virus is in a latent form. With stress or other diseases that lead to a decrease in immunity, it can be activated again. In most cases, herpes simplex is not dangerous to health, but it can cause serious illnesses: neonatal herpes (if a child becomes infected during childbirth from a mother infected with genital herpes) and encephalitis. They can lead to serious incurable neurological diseases and even death. The following factors increase the risk of contracting herpes:

diseases that suppress the immune system (eg HIV/AIDS),
organ transplant.
Currently, there is no cure for herpes, however, there are antiviral drugs that suppress its spread, as well as shorten the duration of the acute phase of a viral infection and alleviate the symptoms of the disease.

What is research used for?

To detect genital herpes infection in men and women and monitor its treatment.
To test a woman for herpes before and during pregnancy (if there is a risk of infection).
When is the test scheduled?

If necessary, confirm or deny the fact of genital herpes infection.

An important place is occupied by the preparation for the study. To make the result of the analysis as reliable as possible, a smear from the oropharynx is taken under the following conditions:

On an empty stomach (or not earlier than 2-3 hours after a meal).
Before rinsing, mucosal irrigation, drops or lozenges.
Before the appointment of antibacterial drugs (or not earlier than three days after their cancellation).
With the exception of brushing teeth, chewing gum, drinking water, intensive blowing your nose and using hygiene products (creams, ointments).
The physician takes the discharge of blisters and erosive and ulcerative lesions, cerebrospinal fluid.

9 0035

Reference values: negative.

Positive result

The body is affected by the virus.

Genital herpes | Symptoms, treatments

Sexually transmitted venereal viral infection. It affects the mucous membrane of the genital organs. Rashes appear in the affected areas, there is a burning sensation and swelling. Possible low temperature, general weakness of the body.

Genital herpes is an infectious disease caused by the Herpes simplex virus. It is characterized by frequent relapses, and it is especially dangerous during pregnancy, because it poses a threat to the fetus. In exceptional cases, genital herpes can cause infertility. However, even in the absence of complications, this disease can cause a lot of inconvenience.

What causes the disease

Eight types of herpes virus are known, each of which has its own location and symptoms. Genital cause only the first two (herpes simplex virus 1 and 2). Most often, infection occurs in two ways:

• sexual. Genital herpes can be contracted even through oral contact if the virus from the carrier’s lips gets on the partner’s genitals;
• household. The virus remains viable for quite a long time even outside the human body.

If there is a carrier of genital herpes in the family, then children are also at risk.

Symptoms

Each stage of genital herpes is characterized by specific symptoms.

• Initial. In places of future manifestation of specific rashes, discomfort begins to be felt, itching and burning appear. Minor swelling, pain in the perineum, pain and heaviness in the upper thighs, numbness in the pelvic area may also appear. This period can last from two weeks to five months.
• Second. Foci of reddened skin begin to be covered with small numerous bubbles filled with a clear liquid. They are very painful and inconvenient. The main places of their localization are: pubis, external genital area, inner thighs, urethra, cervix, buttocks and anus.
• Third. The resulting bubbles burst, and ulcers form in their place. This occurs simultaneously for about a day, after which the surface of the sores is covered with a crust, under which the damaged tissues regenerate.

FORMS OF GENITAL HERPES

However, genital herpes has several forms, and not all of them are manifested by the symptoms described above.

• Microsymptomatic – symptoms are mild, such as a couple of blisters and slight itching, so they usually do not become a reason to see a doctor.
• Macrosymptomatic – the described symptoms of genital herpes appear, but not all. Sometimes these are only vesicles without any other manifestations, sometimes only pain and itching in the complete absence of the vesicles themselves.
• Asymptomatic – there are no symptoms at all and no external manifestations of genital herpes are observed.

Doctors also distinguish between primary and recurrent genital herpes. Symptoms of the primary on average appear 2-14 days after infection. Recurrent genital herpes aggravates periodically. The number of relapses determines the severity of its course. Depending on this, three degrees of recurrent genital herpes are distinguished:

• mild – exacerbations occur 3-4 times a year;
• moderate – exacerbations of genital herpes occur 4-6 times a year;
• severe – exacerbations occur monthly.

Diagnosis of genital herpes

To detect the virus in the clinic, specialized tests are carried out:

• PCR – identifies and detects genital herpes by its DNA.
• ELISA – a test for the presence of antibodies to the herpes simplex virus allows you to determine the phase of the disease.
• Serological – detects class G antibodies (blood from a vein is used for analysis).
• RIF is a microscopic examination that is effective only at a high concentration of the virus in the blood.

Additional diagnostic measures:

• The culture method is an accurate, but lengthy (takes up to 2 weeks) method for identifying genital herpes.
• Dot hybridization – allows you to identify the DNA of the virus before the onset of symptoms.
• Vulvocolpocervicoscopy – examination of the cervix with a colposcope and taking a smear for cytology.
• Immunogram – a test for the strength of immunity.

TREATMENT OF GENITAL HERPES AND PROGNOSIS

Throughout the entire period of treatment, it is necessary to refrain from sexual contact in any manifestation, bodily contact, even kissing must be excluded.

Completely genital herpes cannot be cured in any clinic, since there is still no effective cure for this virus. However, modern antiviral agents can significantly alleviate the symptoms and the number of relapses. Preparations for oral and external use do not allow the genital herpes virus to develop, but only if they are taken within 72 hours after ulceration.

Most often, doctors prescribe medicines that contain acyclovir to treat genital herpes. Usually therapy lasts 5 days, but it is most effective at the initial stage of the disease. Patients with severe infection are treated intravenously in the clinic.

With frequent exacerbations of genital herpes, prophylaxis is carried out for several months. This reduces the frequency of relapses and reduces the severity of symptoms.