An Overview of Herpes

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Herpes is a general term used to describe both oral herpes (also known as herpes labialis) and genital herpes. While these conditions may go by this same name in casual conversation and have some similarities, each is caused by a different type of the herpes simplex virus (HSV). HSV-1, or type 1, is responsible for herpes infections that result in lesions in or around the mouth, otherwise known as cold sores. HSV-2, or type 2, causes genital sores. In both cases, these lesions are open, have a tendency to recur, are spread by skin-to-skin contact, and can be managed with (though not cured by) antiviral therapy. Though the sores can be quite profound, some people with these infections may exhibit no symptoms at all.

Symptoms

HSV types 1 and 2 both cause blistery, red sores, but the two infections have some differences.

An initial infection of HSV-1 can be widespread, with several sores on the lips or inside the mouth.

It can take a day to 26 days (median six to eight days) from first exposure to the virus for sores to begin to appear. They may be:

  • Slightly raised, reddish areas
  • A group of small, fluid-filled blisters appearing on a red area of skin
  • Blisters that quickly develop a crust on them

These are different from canker sores, which generally have a whitish central area.

It may hurt to eat, drink, or talk, depending on the location and severity of a cold sore. Children may develop a mild fever and swollen glands in their neck when they are first exposed to the HSV type 1 virus.

Most recurrences of cold sores involve only one or two sores. You may feel some pain, burning, or itching at the location of the cold sore before it appears, and these sensations generally improve once a sore appears, but may remain until it heals.

HSV type 2, on the other hand, does not always cause symptoms, particularly in men. When it does, symptoms typically include pain in or around the vagina or penis. The pain may be more noticeable when urinating or during sexual activity. Sores may appear red, fluid-filled, or crusty, and they may appear, resolve, and recur for years unless they are treated. 

Causes

The viruses that cause herpes are highly contagious and transmitted by direct contact. Generally, after the initial infection, the viruses remain dormant, meaning inactive, and can be reactivated at a later time. 

HSV type 1 is spread by contact such as kissing or sharing cups, which makes it difficult to identify where you might have acquired the infection. Because of the mode of transmission, it's easy for people of all ages to acquire the infection. About 85 percent of the population is infected with HSV type 1 at some time.

HSV type 2 is sexually transmitted, so only those who engage in sexual contact with someone who has the virus are at risk. HSV-2 is less common, though many people who have it do not know that they are infected—and potentially passing it along to others. Pregnant women can also transmit HSV type 2 to their babies during birth, sometimes with serious consequences.

While the above is true for most cases of herpes, it is possible to have an HSV type 2 infection of the mouth or an HSV type 1 infection of the genital area. This can occur with transmission through oral sex. In these instances, it is not possible to distinguish which virus you have based on your symptoms, as they are very similar. 

Reactivation

Cold sores are also known as "fever blisters" as they often recur when you have an infection or a fever. Generally, an illness, emotional stress, or physical trauma can cause reactivation of HSV type 1. If your immune system is impaired, whether due to illness or medication, you also have a greater chance or reactivation of HSV type 1 or 2.

Some people, particularly children, get cold sores repeatedly, often on the same spot on their face or lip. Genital sores, similarly, tend to recur in the same location. However, the virus can cause new sores in a different, nearby, location when a recurrence happens. This can occur with HSV 1 or 2. 

Diagnosis

Because of the location and look of cold sores, HSV type 1 lesions are often recognized by patients themselves (or, in the case of children, parents or teachers). Doctors can make a diagnosis based on the same signs and symptoms.

You can also recognize HSV type 2 by its appearance. However, because many people do not have symptoms, testing may be needed to confirm a diagnosis of genital herpes.

Tests, which can distinguish between HSV-1 and HSV-2, include:

  • Viral cultures: A sample is collected by brushing a swab on a sore (if you have one) and the material is grown in a lab to look for viral activity.
  • Antibody test: If you do not have any lesions, you may still have the virus. This blood test can look for proteins your body creates in response to infection with either type of HSV. That said, dormant infections, rather than just active ones, can deliver a positive result.
  • Blood test for the virus: You can also have a blood test that identifies the virus itself. However, this type of test, unlike the antibody test, is not very sensitive and may come back negative even when having the infection. 

Treatment

Herpes simplex virus infections generally do not completely go away, although the sores appear and resolve periodically. Treatment for both types is generally focused on comfort, though that of HSV-2 is also centered on reducing the spread to sexual partners and preventing the transmission of the infection to newborns (if applicable). 

Treatment of Cold Sores

Untreated cold sores usually go away in seven to 10 days. Cold sores can be treated with either topical or oral (by mouth) antiviral medications. 

Medications aren't always needed, but they can help the sores heal more rapidly and decrease pain, if necessary. Initial infections are often treated with oral antiviral medications, whereas recurrences are often treated with topical antivirals. Topical medications are not thought to be as effective in treating cold sores if symptoms are severe.

Medications currently available for cold sore treatment include: Zovirax (acyclovir), Famvir (famciclovir), Valtrex (valacyclovir), and Abreva (benzalkonium).

Treatment of Genital Herpes

Genital herpes is treated with antiviral therapy, and treatment is recommended for people who are experiencing a first outbreak or recurrent ones.

Treatment may involve Zovirax (acyclovir), Famvir (famciclovir), or Valtrex (valacyclovir), and dosing will depend on your treatment needs as determined by your doctor.

Prevention

Preventing oral and genital herpes requires different strategies. 

For oral herpes prevention, it's important to avoid skin-to-skin contact and sharing items with someone you know to be infected with the virus. Likewise, if you know that you're a carrier, be mindful of the contact you have with others (especially young babies and others who are immunocompromised) and items that you leave around, including towels. Frequent hand washing is also important, especially after you touch a cold sore.

To prevent reactivation of oral herpes, do your best to stay otherwise healthy (fever or skin irritation, particularly in children, can "wake up" a dormant herpes infection). Manage your stress and avoid chapped lips and sunburn.

When cold sores are recurrent, suppressive therapy—daily medication to prevent lesions from occurring—may also be considered.

The only way to prevent the spread of genital herpes is with safe sex precautions, particularly by using condoms. It is important to communicate with sexual partners about the possibility of sexually transmitted diseases, including herpes. 

A Word From Verywell

Typically, among those with healthy immune systems, neither of these infections causes serious complications. If you have recurrent cold sores, you generally do not need treatment unless the sores become severe, recur more than six times per year, or cause intense pain. If you have genital herpes, you should be treated, because you can spread it to sexual partners, and there are real risks to babies of mothers with HSV type 2. Understanding your condition can help you know when to seek medical treatment to avoid the few serious potential consequences. 

Over time, you will learn to recognize your triggers if you experience recurrences. You will also get a good handle on whether or not you need to take medication for your recurrences, and which medications work best for you. A diagnosis of herpes infection, even if it sounds alarming, is manageable. 

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