Herpes: Signs, Symptoms, & Treatment

By Terez Malka, MD
Medically reviewed checkmarkMedically reviewed
June 3, 2022

Herpes is a common, lifelong infection that affects over 3 billion people worldwide.

It primarily affects the mouth, genitals, anal region, and skin.

Herpes is highly contagious and is considered a sexually transmitted infection that spreads between individuals through close, direct, or intimate personal contact.

Herpes is caused by two types of herpes simplex viruses: herpes simplex virus-1 (HSV-1), the strain that is primarily responsible for oral herpes (cold sores), and herpes simplex virus-2 (HSV-2), the strain that mostly causes genital herpes.

If you contract either strain, you could develop a herpes outbreak, which may present as painful sores, blisters, or other, less specific symptoms such as pain during urination and fatigue. 

Many people, however, remain asymptomatic, meaning that even if you’re infected, you will never experience herpes symptoms.

Also, many people have a recurrence of the infection after the first episode of genital herpes.

What Is Herpes?

Herpes is a very common viral infection that affects roughly half of American adults under 50. It is caused by the herpes simplex virus.

It is highly contagious and is spread through close, direct, and intimate contact between individuals.

While herpes can cause painful and unsightly sores, blisters, and lesions around the area of infection – most often on the mouth and genitals – many infected individuals do not develop symptoms at all.

Once you have the first outbreak of herpes, the infection is lifelong. Initially, you will go through an acute phase, which is the most common time to develop symptoms.

After that, the virus will move from your skin cells and into your nervous system, where it will lay dormant until it is reactivated.

This can happen when you have a weakened immune system, including during illness or surgery, pregnancy, high sun exposure, or other periods of physical or emotional stress.

While there is no cure for herpes, it is rarely a dangerous or life-threatening condition, and its symptoms can be managed relatively easily.

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Types of Herpes

The herpes virus group includes a large cluster of viruses that cause a variety of conditions, from herpes zoster (shingles) to Epstein-Barr (the primary cause of mononucleosis) to Kaposi’s sarcoma.

Among the family of viruses, there are two types of herpes simplex virus that cause cold sores and genital blisters, which we commonly associate with herpes.

Herpes simplex virus-1 (HSV-1)

Herpes simplex virus-1 (HSV-1) is the more common of the two types of herpes simplex viruses, primarily causing oral herpes (cold sores).

This herpes simplex virus type is highly contagious. It is a common virus that afflicts roughly 67% of the world’s population. 

Many people with HSV-1 infection do not experience symptoms and don’t realize that they are carrying or transmitting the virus.

In fact, it’s common to contract HSV-1 as a child and be unaware that you’ve been carrying the disease your entire life.

If you do show symptoms of the disease, you may experience painful or annoying sores and lesions on the mucosal tissues in your mouth, eyes, and nose.

Herpes on lips and gums are often referred to as cold sores or fever blisters, but HSV-1 can also develop on tongue tissue, on the roof of your mouth, and on the inside of your cheeks.

Occasionally, you may develop herpes blisters on your chin or cheeks, a condition known as as facial herpes, or on the skin of other parts of your body.

Herpes simplex virus-2 (HSV-2)

Herpes simplex virus-2 (HSV-2) is the strain most often responsible for genital herpes.

It affects roughly 20% of sexually active adults in the United States.

This herpes simplex virus type is primarily spread through sexual contact and can cause sores or lesions on the genital and anal regions.

Just as with HSV-1, many infected people don’t show symptoms for genital herpes infections. 

Among those that do develop symptoms, people with penises with HSV-2 can develop herpes blisters on their penis, scrotum, anus, buttocks, and inner thighs.

People with vaginas who have contracted the virus can develop vulval, labial, cervical, and vaginal herpes sores, as well blisters around their anus, buttocks, and inner thighs.

While HSV-1 most commonly infects the mouth and face and HSV-2 infects the genitals, the viruses are not limited to just those areas.

A person who receives oral sex from a person with HSV-1 can develop HSV-1 on their genitals, and a person who gives oral sex to someone who has HSV-2 can develop HSV-2 on their face.

Ultimately, without specific testing, there is no way to know for sure which type of HSV someone has based solely on the location of the blisters.

How Do You Get Herpes?

Patients contract herpes by having close, direct, or intimate personal contact with an individual who already has the virus.

You can’t get herpes from hugging or holding hands, coughing, sneezing, or coming into contact with inanimate objects or surfaces like toilet seats.

Herpes simplex virus-1 can be transmitted in both sexual and non-sexual contexts.

However, it is more commonly contracted from sexual partners via direct skin contact during sexual activity. 

You can get HSV-1 by coming into contact with saliva, sores, genital areas, or surfaces in and around the mouth of a person with the disease. 

For the herpes virus to infect a person, it has to pass through mucous membranes or tiny injuries.

Many patients contract it by kissing or sharing objects such as razors, sex toys, and lip balm which have been in direct contact with infected areas. 

HSV-1 can also be passed through oral sex and extremely rarely, between mother and baby during delivery (also called neonatal herpes).

Even though herpes is not transmitted via breast milk, newborn babies can get infected if they come in contact with a herpes sore or blister on the breast or any other area of skin. 

Because the majority of people with HSV-1 do not know they have it, they unwittingly pass it on to those around them.

Most HSV-1 patients contract the disease at some point in their childhood and carry it with them their entire lives.

Herpes simplex virus-2 is primarily transmitted through sexual contact with a person that has an active infection.

You can get HSV-2 through direct skin-to-skin contact with a herpes sore, vaginal sex, anal sex, or by touching someone’s genitals, areas of skin with herpes sores, or bodily fluids even if they don’t show signs of the virus.

In rare cases, HSV-2 can also be transmitted between mother and baby during birth.

Herpes Signs and Symptoms

It’s important to remember that many people who contract HSV-1 or HSV-2 do not develop any herpes symptoms. On the other hand, you may experience flu-like symptoms during your first outbreak.

For those who do show signs of HSV infection, symptoms may include:

  • Small red bumps or white painful blisters, sores, or open ulcers on the mouth, face, genitals, anal area, inner thighs, or buttocks
  • Tingling, itching, or burning for several days before sores develop
  • Pain or burning during urination
  • Tender, enlarged, or swollen lymph nodes
  • Mild symptoms of fever
  • Fatigue or a general feeling of being run down
  • Headaches or aches on different parts of the body 
  • Lack of appetite or nausea
  • For people with vaginas, unusual vaginal discharge

People who contract herpes in their eye may experience eye pain, redness, discharge or a “gritty” feeling in their eyes.

In rare cases, HPV may cause serious complications such as meningoencephalitis (a brain infection), which can lead to brain damage. This is most common in infants and those with a weakened immune system

It can take anywhere from 2-20 days after exposure to herpes for your symptoms—or your initial outbreak— to appear.

For many patients, it could take a long time (years) for any signs of infection to show, and for others, they may never experience mild to severe symptoms.

It’s important to know that even if you don’t show signs of a herpes outbreak, you can still pass the infection to others.

How Is Herpes Diagnosed?

The best way to know if you have herpes or any other STD is to get tested.

If you suspect that you have been exposed to HSV-1 or HSV-2 and are showing symptoms of an infection, it’s important to make an appointment with your primary care provider, an OB-GYN, or a nearby public health clinic for proper diagnosis and to get tested.

During your exam, your health care provider will check your body for any visible sores or blisters and ask you to describe any other symptoms you might be experiencing.

If you are experiencing an outbreak, they may obtain a sample of fluid from any open sores or blisters and send the sample to a laboratory for analysis.

If there are no sores present, you may be asked to undergo a blood test and other laboratory tests to determine whether you have the antibodies that indicate the presence of an HSV-1 or HSV-2 infection.

Herpes Treatment

There is currently no cure or vaccine for either HSV-1 or HSV-2.

If an infected person is diagnosed with herpes, a provider may prescribe antiviral medications like acyclovir, famciclovir or valacyclovir to decrease the duration of the acute outbreak and active symptoms.

Medicines may be taken orally as a pill, applied topically as a cream, or, when necessary, given intravenously. 

Some people are prone to getting frequent herpes outbreaks and may need to be placed on a longer course of antiviral medicine.

For those people with recurrent outbreaks, the CDC suggests they receive antiviral treatments either administered episodically to shorten the duration of lesions or as suppressive therapy taken every day to reduce the frequency of recurrences.

Your primary care provider will know the best treatment options to recommend for you.

Herpes Prevention

Herpes, particularly HSV-1, is so widespread it’s nearly impossible to completely insulate yourself from acquiring it.

People who have multiple sexual partners and indulge in unprotected sex are at high risk of contracting the herpes infection. 

There are, however, some steps that you can take to reduce your chances of contracting herpes whenever you are sexually active, especially when you are coming into close contact with someone with known infection.

For example, you should:

  • Use safe sexual practices, including using condoms and dental dams when engaging in sexual contact with your sex partner.
  • Avoid kissing, sharing utensils, or having sexual contact with someone who is in the midst of an active outbreak.

It is important to practice safe and protected sex as unprotected sex predisposes to STIs like herpes which has been linked to a higher risk of contracting human immunodeficiency virus (HIV infection), according to the Centers for Disease Control and Prevention (CDC).

If you have concerns about your sexual health or if you have herpes and are worried about transmitting the HSV infection to others, talk to your doctor or a public health clinic about the individual steps you can take to reduce the chances of transmitting the virus.

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When to See a Healthcare Provider

If you suspect that you have been exposed to HSV-1 or HSV-2 or are experiencing fever, fatigue, swollen lymph nodes, an unidentifiable rash, or other symptoms, it’s important to make an appointment with a healthcare provider who could be your primary care provider, an OB-GYN, or a nearby public health clinic to get tested.

How K Health Can Help

If you think you may have herpes or have an initial infection, you should talk to a doctor.

 Did you know you can get affordable primary care with the K Health app? Download K to check your symptoms, explore conditions and treatments, and, if needed text with a doctor in minutes. K Health’s AI-powered app is HIPAA compliant and based on 20 years of clinical data.

K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

Terez Malka, MD

Dr. Terez Malka is a board-certified pediatrician and emergency medicine physician.