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Herpes results from infection with the herpes simplex virus (HSV). It causes sores or blisters to form in or around the mouth or genitals, as well as other symptoms.
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.
There is no cure for herpes, but treatment can help manage symptoms and reduce the likelihood of them recurring.
HSV is a common virus. According to the World Health Organization (WHO), around 67% of people, globally, have an HSV-1 infection, and 11% 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.
The following images can help with identifying forms of herpes:
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 the 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.
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. During a recurrence, a person can pass on genital herpes for 2–5 days.
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 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 anda 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.
There are several treatment options for both oral and genital herpes.
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 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.
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, which are often creams, can help manage tingling, itching, and pain.
To significantly lessen the duration 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 remains a possibility.
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.