Herpes Simplex

Overview

What is herpes simplex?

Herpes simplex is a virus that causes skin infections. The infection lasts your lifetime, and it causes painful or itchy sores and blisters that come and go. Herpes simplex virus typically doesn’t cause severe problems. But it can be dangerous in infants and people with weakened immune systems. There are two types of herpes simplex:

  • Herpes simplex 1 (HSV-1, commonly known as oral herpes) tends to affect your mouth or face. It causes cold sores. HSV-1 spreads through contact with saliva (spit).
  • Herpes simplex 2 (HSV-2, commonly known as genital herpes) is a sexually transmitted disease (STD). It causes sores on skin that comes in contact with the genitals of an infected person.

Sometimes a herpes infection can affect other parts of your body, such as your eyes or other parts of your skin.

What is the difference between HSV-1 and HSV-2?

HSV-1 spreads through contact with the virus in saliva or skin. It usually affects your mouth and face. HSV-2 spreads through sexual contact and usually affects your genitals. Either form of HSV can show up on any area of skin that comes into contact with the virus.

Who might get herpes simplex?

People of any age can contract herpes simplex. You are more likely to get the virus if you:

  • Were assigned female at birth.
  • Have had multiple sex partners.
  • Started having sex at a young age.
  • Have a history of any sexually transmitted infection (STI).
  • Have a weakened immune system.
  • Don’t use condoms for intercourse and dental dams for oral sex.

Who gets HSV-1, commonly known as oral herpes?

Anyone can get HSV-1. Most people contract HSV-1 during childhood. It spreads when an adult who has the virus has close contact with a child, such as when a family member kisses a child.

Who gets HSV-2, commonly known as genital herpes?

Genital herpes affects sexually active teens and adults of all genders and races. It can spread if you have multiple sexual partners and don’t use condoms or dental dams.

People assigned female at birth (AFAB) are more at risk. Delicate vaginal tissue can tear, making it easier for the infection to get in. Black people who were AFAB are especially vulnerable, with an estimated 1 in 2 people AFAB between the ages of 14 and 49 infected with HSV-2.

How common is herpes simplex?

Herpes simplex is widespread around the world. About 2 in 3 people worldwide (and up to 80% of Americans) contract HSV-1 by age 50. About 15% of 15- to 49-year-olds contract HSV-2.

Symptoms and Causes

How does herpes simplex spread?

Herpes spreads through close contact with a person who has the infection. The virus can be found in skin and saliva. If you have herpes simplex, you are most likely to pass the virus to another person when you have sores. But you can infect someone else even if you have no symptoms. Healthcare providers call this asymptomatic viral shedding.

People may get HSV-1 through

  • Kissing.
  • Touching a person’s skin near the mouth.
  • Sharing food utensils, lip balm or razors.
  • If you receive oral sex from someone who has a cold sore, it may spread a herpes infection to your genitals.

People may get HSV-2 through

  • Intercourse, including anal, vaginal-penile and vaginal-vaginal.
  • Oral sex (giving or receiving) with someone who’s infected.
  • Skin-to-skin contact without ejaculation.
  • Touching open sores, including while breastfeeding.
  • Childbirth by a mother or gestational parent who has an active infection.

You can’t get genital herpes from objects like toilet seats. But you could pass genital herpes through shared sex toys. (To stay safe, wash sex toys before and after using them, and don’t share them. If you do, protect them with a condom.)

What are the symptoms of herpes simplex?

Many people with the infection never experience any herpes symptoms. If you do notice symptoms, you’ll experience them differently depending on whether you’re having your first herpes outbreak or a repeat outbreak. Recurring symptoms are usually milder than the first outbreak. Symptoms don’t last as long with later outbreaks. Some people may only have one or two outbreaks during their lifetime. Others may have as many as four or five outbreaks a year.

People who do have herpes symptoms may experience:

  • Cold sores around their lips, mouth or tongue. They may look crusty or like fluid-filled blisters.
  • Sores on their genitals or around their anus.
  • Tingling, itching or burning.
  • Fever, swollen lymph nodes or muscle aches.
  • Pain while urinating.

How long do sores from herpes simplex last?

If you’re infected with HSV-1, commonly known as oral herpes, you may notice tingling or burning around your mouth in the days before a cold sore appears. These blisters break open and ooze fluid before forming a crust. Usually, sores last for seven to 10 days.

If you’re infected with HSV-2, commonly known as genital herpes, your first outbreak may last between two to four weeks. Recurrent outbreaks usually last between three to seven days.

What triggers a herpes outbreak?

Once you have the herpes virus, it stays in your nerve cells forever — even if you never have symptoms. It is usually dormant (inactive).

A trigger may activate the virus. This activation, called an outbreak, causes symptoms, such as sores.

Common outbreak triggers include:

Diagnosis and Tests

How is herpes simplex diagnosed?

Healthcare providers may diagnose herpes simplex based on how the sores look. Your provider may take a sample from the sore. Laboratory analysis of the sample can confirm or rule out the herpes virus.

If you don’t have sores, your healthcare provider can use a blood test to check for HSV-1 and HSV-2 antibody, a marker showing you’ve been exposed to the virus. The blood test doesn’t show an active infection (especially in the absence of open sores or lesions). But it informs your provider whether you’ve been exposed to the herpes virus in the past. If this is your first infection, you may not test positive for herpes if there hasn’t been enough time for your body to develop antibodies. The HSV-1and HSV-2 antibody test may be repeated in eight to 12 weeks.

Management and Treatment

How is herpes simplex treated?

Some people have few to no herpes outbreaks and choose not to have treatment. But many people prefer to use medications that shorten outbreaks and reduce symptoms.

During an outbreak, you may use an antiviral ointment or cream to help lessen your symptoms and help them go away faster, but it only works if you start it soon after you start an outbreak. Many people with HSV-2 take daily oral medications to keep outbreaks at bay.

Your provider may prescribe a topical (applied to the skin) medication or oral medication such as:

  • Acyclovir (Sitavig®, Zovirax®).
  • Famciclovir (Famvir®).
  • Valacyclovir (Valtrex®).

Can I treat herpes simplex at home?

Avoiding known triggers, such as illness or stress, can help reduce how often you have herpes outbreaks.

How can I ease my symptoms during an outbreak of HSV-1 (oral herpes)?

How can I ease my symptoms during an outbreak of HSV-2 (genital herpes)?

  • Apply an ice pack to your genitals. Wrap the ice pack in a washcloth or apply it over your underwear.
  • Keep your genitals dry. Wear cotton or other nonsynthetic underpants and avoid tight-fitting clothes. Moist sores take longer to heal.
  • Soak in a warm bath.
  • Take nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve pain.
  • Topical 1% or 2% lidocaine may be used as a topical analgesic.

What are the complications of genital herpes (HSV-2)?

People who have open sores from genital herpes are twice as likely to get HIV compared to people without herpes. This risk is yet another reason why it’s important to use condoms.

Prevention

How can I reduce my risk of herpes simplex?

Preventing HSV-1 (commonly known as oral herpes)

You can reduce your risk of contracting HSV-1 by avoiding physical contact with someone who has a cold sore. People can still spread HSV-1 when cold sores aren’t present, but it’s less likely.

If someone has an active HSV-1 infection, avoid:

  • Kissing.
  • Oral sex.
  • Sharing utensils, cups, lip balms or other personal care products.
  • Touching the skin near their mouth.

Preventing HSV-2 (commonly known as genital herpes)

If you’re sexually active, you can take these steps to protect yourself and others from the herpes virus and other STIs:

  • Be monogamous with one sexual partner or limit your number of partners.
  • Get tested for STIs and complete any prescribed treatment.
  • Tell your sexual partners if you have genital herpes so they can get tested.
  • Use condoms during intercourse and dental dams during oral sex.

Wash your hands often if you have an outbreak or are around someone with symptoms.

If your sexual partner has genital herpes, these actions can lower your risk of getting the virus:

  • Don’t have sex when your partner has active symptoms. Condoms may not cover all sores, so you may still get the virus.
  • Make sure your partner takes antiviral medication as prescribed.
  • Wait to have sex until scabs fall off active lesions.

Outlook / Prognosis

Is there a cure for herpes simplex?

There is no cure for herpes simplex. Once you have the virus, it’s a lifelong infection.

What is the outlook for people with herpes simplex?

For many people, the first herpes outbreak is the most severe. Many outbreaks are less frequent and milder after the first year of infection. Some people may have only one outbreak and never have another again.

Herpes infection doesn’t usually pose a serious health risk. The risk of a health complication due to herpes is higher in infants and if you have HIV/AIDS, cancer or an organ transplant.

Living With

What can I do if I have herpes simplex 2 (commonly known as genital herpes)?

Many people who find out they have herpes feel depressed knowing they'll always have the virus and can give it to others. But you aren’t alone. Herpes is one of the most common STIs, both in the U.S. and worldwide. If you have herpes, you should:

  • Learn all you can about it. Information will help you to manage your disease and feel better about yourself.
  • Talk about your illness with your doctor.

If you have herpes, you can still:

  • Have sex if you use a condom or dental dam (and/or have your partner use a condom/dental dam), and you tell your partner about your illness. Some couples, who have sexual relations only with each other, may choose not to use condoms even though one partner has herpes. Because each situation is different, you should ask your doctor if this is the right choice for you in your relationship.
  • Have children. People with herpes can still give birth to healthy babies. If you have herpes and plan to have children, discuss your illness with your healthcare provider.

If you have herpes, you should also get checked for HIV (AIDS) and other STIs (such as syphilis, gonorrhea and chlamydia).

How can I best learn to cope with herpes simplex?

Some people feel distressed or embarrassed about their herpes simplex infection. It’s important to understand that the herpes virus is common. For most people, herpes doesn’t significantly interfere with daily life.

To cope with negative feelings, you may consider:

  • Connecting with others through support groups or online forums.
  • Sharing your feelings with a trusted friend or loved one.
  • Speaking with a therapist.

When should I call the doctor?

You should call your healthcare provider if you experience:

  • Genital irritation or itching.
  • Genital or anal blisters.
  • Painful intercourse (dyspareunia).
  • Painful urination (dysuria).
  • Unusual or foul-smelling penile or vaginal discharge.
  • Vaginal or penile redness, soreness or swelling.

What questions should I ask my doctor?

You may want to ask your healthcare provider:

  • What is the best treatment for me?
  • What happens if I don’t treat a cold sore?
  • What are the side effects of antiviral medications?
  • How can I reduce the risk of future outbreaks?
  • What’s the best way to prevent getting another STI?
  • How can I protect my partner from getting genital herpes?
  • Should I lookout for signs of complications?

Frequently Asked Questions

How does genital herpes affect pregnancy?

Herpes simplex virus doesn’t affect fertility or your ability to conceive. Pregnant women diagnosed with HSV-2 (commonly known as genital herpes) should start a daily antiviral at 36 weeks of pregnancy as prescribed, to prevent outbreaks during delivery. If you have an active infection at the time of childbirth, you can pass the herpes virus to your baby. Neonatal (at birth) herpes puts a baby at risk for blindness, brain damage, skin infections and death. Your healthcare provider will perform a cesarean section to lower this risk.

What is neonatal herpes?

Neonatal herpes can be a very serious infection. Babies generally contract the virus from their birthing parent during childbirth even if the parent doesn’t have active lesions. They may also get HSV-1 if an adult with an active cold sore kisses them. Breastfeeding (chestfeeding) babies can also get HSV-1 from the breast if there are lesions present. But babies can’t get herpes from breast milk, so it’s safe to pump and feed.

Herpes simplex can be more dangerous for young babies because they don’t have a fully developed immune system. But most babies with neonatal herpes can recover fully with treatment.

The dangers of neonatal herpes are much higher if the infection spreads to the baby’s organs. If you’re pregnant and have herpes, speak with your healthcare provider about how to lower the risk of passing the infection to your baby.

Is it safe to breastfeed if I have genital herpes?

Yes — as long as there isn’t an open lesion on your chest or breast. If you have an active outbreak while breastfeeding, it’s possible to spread the infection to your nipples through touch. Careful hand-washing can prevent this spread. You shouldn’t nurse from a breast that has herpes sores. You can pump breast milk until the sores heal. Don’t give your baby expressed breast milk if the pump comes into contact with an open sore.

Herpes simplex and the varicella-zoster virus (VZV) are related, but they aren’t the same. VZV causes chickenpox and shingles.

Like HSV-1 and HSV-2, shingles can cause a painful, blistering rash. The shingles rash usually shows up on the back, side, abdomen (belly), neck and face. It is often only on half of your body, following the pattern of your nerves. See your healthcare provider if you have a new rash and suspect you may have shingles.

A note from Cleveland Clinic

Herpes simplex is a virus. Once you have herpes, it’s a lifelong condition. A herpes infection can lead to outbreaks (periods of symptoms), but you’ll also have times when you have no symptoms. The main sign of herpes is sores that appear on the infected skin. Some people choose not to treat herpes, especially if symptoms are mild. Others take antiviral medications to reduce the severity and frequency of outbreaks.

Last reviewed by a Cleveland Clinic medical professional on 05/17/2022.

References

  • American Academy of Dermatology Association. Herpes Simplex: Overview. (https://www.aad.org/public/diseases/a-z/herpes-simplex-overview) Accessed 5/17/2022.
  • American Academy of Family Physicians (AAFP). Herpes. (https://familydoctor.org/condition/herpes/) Accessed 5/17/2022.
  • Centers for Disease Control and Prevention. Genital Herpes Fact Sheet. (https://www.cdc.gov/std/herpes/stdfact-herpes.htm) Accessed 5/17/2022.
  • InformedHealth.org. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Genital herpes: Overview. (https://www.ncbi.nlm.nih.gov/books/NBK525769/) Accessed 5/17/2022.
  • McQuillan G, Kruszon-Moran D, Flagg EW, Paulose-Ram R. Prevalence of herpes simplex virus type 1 and type 2 in persons aged 14–49: United States, 2015–2016 (https://www.cdc.gov/nchs/data/databriefs/db304.pdf) [PDF]. NCHS Data Brief, no 304. Hyattsville, MD: National Center for Health Statistics. 2018. Accessed 5/17/2022.
  • Merck Manual Consumer Version. Herpes Simplex Virus (HSV) Infections. (https://www.merckmanuals.com/home/infections/herpesvirus-infections/herpes-simplex-virus-hsv-infections) Accessed 5/17/2022.
  • National Health Service (NHS) UK. Neonatal herpes (herpes in a baby). (https://www.nhs.uk/conditions/neonatal-herpes/) Accessed 5/17/2022.
  • National Institutes of Health, National Library of Medicine. Herpes Simplex. (https://medlineplus.gov/herpessimplex.html) Accessed 5/17/2022.
  • Planned Parenthood. Oral and Genital Herpes. (https://www.plannedparenthood.org/learn/stds-hiv-safer-sex/herpes) Accessed 5/17/2022.
  • U.S. Department of Health and Human Services (HHS) Office on Women’s Health. Genital Herpes. (https://www.womenshealth.gov/a-z-topics/genital-herpes) Accessed 5/17/2022.
  • World Health Organization. Herpes simplex virus. (https://www.who.int/news-room/fact-sheets/detail/herpes-simplex-virus) Accessed 5/17/2022.

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