What is herpes?

Herpes refers to infections caused by the herpes simplex viruses: HSV-1 and HSV-2. These viruses infect skin and mucous membranes and establish lifelong latency in nerve cells. Periodically, the virus can reactivate and cause symptoms or be shed without symptoms. Herpes infections are very common worldwide; many people carry HSV without realizing it because they have mild or no symptoms.

HSV-1 vs HSV-2 — what’s the difference?

Both viruses are closely related but tend to affect different areas:

• HSV-1 is the main cause of oral herpes (cold sores, fever blisters). It is commonly acquired in childhood through nonsexual contact, but it can also cause genital infections through oral-genital contact.
• HSV-2 most commonly causes genital herpes and is usually transmitted through sexual contact. HSV-2 genital infections are less likely to be acquired in childhood.

Both types can cause symptoms at either site, and lab testing (PCR or type-specific antibody testing) distinguishes them when necessary.

How common is herpes?

Herpes infections are widespread. Estimates vary by country and age group, but seroprevalence studies indicate that a large portion of the global population has been exposed to HSV-1, and a substantial proportion of sexually active adults carry HSV-2. Because many infections are asymptomatic, testing is the only way to know for sure.

How does herpes spread?

HSV spreads through direct contact with infected skin, mucous membranes, or bodily fluids. Transmission modes include:

• Oral contact: Kissing or sharing items like lip balm or utensils can transmit HSV-1.
• Sexual contact: Genital contact, oral-genital contact, and genital-to-genital contact can transmit HSV-1 or HSV-2 to genital areas.
• Skin-to-skin contact: Transmission can happen when there are visible sores, but also during asymptomatic viral shedding (no visible symptoms).

HSV does not survive long on surfaces, so indirect transmission via inanimate objects is uncommon. Using protection and avoiding contact during outbreaks reduces transmission risk.

Typical signs and symptoms

Many people with HSV are asymptomatic. When symptoms occur, they often follow a pattern:

Prodrome

Many people feel early warning signs 12–48 hours before a lesion appears: tingling, burning, itching, or local discomfort.

Lesion stage

Small, grouped blisters form on a red base and later break open, producing shallow ulcers that crust and heal without scarring within 1–3 weeks. For oral herpes this commonly appears on or around the lips; for genital herpes on the vulva, penis, perineum, or perianal area.

Systemic symptoms

The first outbreak is often the most severe and can include fever, muscle aches, swollen lymph nodes, and uncomfortable urination (in genital infections). Recurrent outbreaks are usually milder and shorter.

How is herpes diagnosed?

Diagnosis combines clinical exam with laboratory testing when needed:

• Viral detection (PCR or culture): Swabbing an active lesion to detect viral DNA (PCR) or grow the virus. PCR is sensitive and preferred.
• Type-specific antibody tests: Blood tests can detect antibodies to HSV-1 or HSV-2. Antibodies may take weeks to develop after initial infection, so early tests can be negative.
• Clinical diagnosis: Experienced clinicians often diagnose based on lesion appearance and history; testing confirms the type or rules out other causes.

Treatment options

There is no cure for HSV, but effective treatments exist to shorten outbreaks, reduce symptom severity, and lower transmission risk.

Antiviral medications

Common antiviral drugs include acyclovir, valacyclovir, and famciclovir. They may be used in two main approaches:

• Episodic therapy: Taken at the first sign of an outbreak to shorten duration and severity.
• Suppressive therapy: Daily antiviral medication to reduce frequency of recurrences and lower the chance of transmitting the virus to partners. Suppressive therapy is particularly useful for people with frequent outbreaks or those who want to minimize transmission risk.

Local care and symptom relief

• Keep the area clean and dry.
• Avoid touching lesions; wash hands after care.
• Over-the-counter pain relievers may ease discomfort.
• Topical analgesics or protective barriers (as recommended by clinicians) can relieve pain for some people.

Preventing transmission

Prevention strategies reduce but do not eliminate transmission risk:

• Avoid physical contact during outbreaks: Do not kiss or have sexual contact when sores are present.
• Use condoms or dental dams: Consistent use reduces risk for genital HSV transmission but does not fully protect when sores are outside covered areas.
• Suppressive antiviral therapy: Daily medication reduces asymptomatic shedding and lowers transmission risk to sexual partners.
• Open communication: Discuss HSV status with partners so both can make informed decisions about risk and protection.
• Avoid sharing personal items: Items contacting the mouth (lip balm, utensils) should not be shared during active oral outbreaks.

Herpes, pregnancy and newborns

HSV in pregnancy requires special attention because neonatal herpes — rare but serious — can occur if an infant is exposed during delivery. Key points:

• If a pregnant person has a history of genital herpes, notify the prenatal care team early so risks can be managed.
• Women with active genital lesions at the time of labor are often offered cesarean delivery to reduce the newborn’s exposure risk.
• Suppressive antiviral therapy starting late in pregnancy (often around 36 weeks) may reduce recurrence at delivery.
• Newborns exposed to HSV may require immediate evaluation and treatment; symptoms in infants can be subtle and progress rapidly, so prompt medical care is essential.

Living with herpes — emotional and practical support

Learning to live with herpes includes both medical management and emotional wellbeing. Practical suggestions:

• Educate yourself: Understand how HSV behaves, triggers for outbreaks (stress, illness, sun exposure, hormonal changes), and treatment options.
• Talk with partners: Honest conversations about risks, testing, and prevention help maintain trust.
• Build a care plan: Work with your clinician to decide between episodic and suppressive therapy and craft a tailored plan for outbreaks and prevention.
• Find support: Support groups, counseling, or trusted friends can help reduce shame and anxiety. Herpes is medically common and manageable; many people lead healthy relationships and lives.

When to see a clinician

Seek medical care if:

• You suspect you have been exposed to HSV (recent sexual contact or oral contact with a symptomatic person).
• You develop painful blisters, ulcers, or new genital or oral sores.
• You have severe systemic symptoms (fever, widespread lesions, or signs of secondary infection).
• You are pregnant and have a history of herpes or develop genital lesions.
• You have a weakened immune system (e.g., due to medications, cancer, or HIV), as HSV infections can be more severe.

Common myths and facts

• Myth: Herpes means poor hygiene. Fact: HSV is a virus spread primarily by contact; hygiene does not determine infection risk in normal circumstances.
• Myth: You can tell if someone has herpes by looking. Fact: Many people have no visible symptoms, and sores are sometimes absent even when the virus is shed.
• Myth: Herpes always causes frequent painful outbreaks. Fact: Outbreak frequency varies widely; many people have infrequent or mild recurrences.

Diagnosis and testing — what the numbers mean

Serologic (antibody) tests indicate past exposure but do not indicate when infection occurred. PCR tests detect active viral DNA from lesions and are the best test during an outbreak. Discuss results with your clinician to interpret what they mean for your health and relationships.

Special considerations: immunocompromised people

People with weakened immune systems may experience more frequent, prolonged or severe HSV infections, and may require more aggressive antiviral therapy and specialist follow-up. If you or a partner are immunocompromised, mention this to your clinician so care can be tailored.

Frequently asked questions (FAQs)

Practical next steps and resources

1. If you suspect an active infection, seek care promptly for evaluation and possible antiviral treatment.
2. If you have recurrent outbreaks or worry about transmission, discuss suppressive therapy and strategies with your clinician.
3. Use reliable sources for further information: national health agencies, sexual health clinics, and accredited medical organizations.

Final notes

Herpes is a common viral infection that is manageable with modern medical care and common-sense prevention. Education, compassionate care, and clear communication reduce stigma and help people live full, healthy lives. If you have specific concerns or complex medical needs, consult your healthcare provider for personalized guidance.