Herpes Infections: causes, symptoms, diagnosis & treatment

What is herpes?

Herpes is an infection caused by the herpes simplex or herpes zoster viruses. The three most common types are:

Herpes simplex-1 (HSV-1) is the oral type, commonly causing sores (cold sores or fever blisters) around the mouth and lips. It’s contagious with skin-to-skin contact like kissing. HSV-1 can cause herpes sores in the genital area also, but the majority of genital sores are caused by herpes simplex-2. HSV-1 can also be spread to the genital area during oral sex. HSV-1 recurs much less frequently than HSV-2 infections.
Herpes simplex-2 (HSV-2) is the genital type and causes sores usually located below the waist, specifically the genitals or rectum. It can be transmitted though anal, genital or oral sex with an infected person, even if that person has no visible sores or symptoms. HSV-2 is common, infecting as many as 20-30% of American adults. Although highly contagious with skin-to-skin contact, HSV-2 cannot live outside the body. This makes it almost impossible to get from toilets, towels or other things touched by the infected person.
Herpes zoster is caused by the virus that causes chickenpox (varicella). After chickenpox heals, the virus remains inactive (dormant) in the body’s nerve roots. If it’s reactivated; it causes shingles, an infection that causes very painful blisters. It’s contagious if you have contact with fluid from the blisters.

Why should I worry about herpes?

Although there are a number of diseases and illnesses associated with herpes viruses, getting a prompt diagnosis from your doctor provides the best chance for a positive response to treatment with medications. Treatment depends on the type of herpes virus you have. But for other types of herpes infections, even if they’re dormant and not causing symptoms, there is no known cure. Medications help manage symptoms. A majority of all adults will test positive for HSV-1 and or HSV-2 on antibody testing, regardless of active or historical symptomology.

How do you get exposed to herpes simplex-1 and 2?

You can get HSV-1 and 2 primarily through contact by saliva, such as kissing or touching someone, or using their personal items while they have an active outbreak. Some people with HSV-1 and 2 were infected as children. After initial exposure, the virus can lie dormant in the body. However, it can become active again at any time during one’s life in the body’s response to stress, another illness, certain immuno-suppressive medications, and even a serious sunburn.

Genital herpes results from sexual exposure, either as anal, oral or vaginal sex with an infected partner. After the initial infection, individuals can have recurrent episodes of flare-ups. There are treatments for genital herpes viral infection and even if appropriate, long term suppressive therapy.

What are the symptoms of HSV-1?

HSV-1 first causes a blister on the lips, around the mouth or inside the mouth. The blister becomes a fluid-filled blister that crusts over during the healing process. Individuals have to be aware that the clear liquid in the blister is ladened with active virus and can be infectious. The classical signs of a herpes blister is a clear vesicle on a red, irritated base. Infection can cause fatigue, slight fever, and tingling or pain at the infection site. Individuals can have frequent episodes of re-activation throughout their lives. An exposed or infected individual should seek medical attention and advice.

How painful is herpes?

A herpes infection can be painful. When an outbreak or infection occurs, the pain is due to a reaction or reactivation in nerves. The degree and duration of pain varies among individuals and the location of the infection. It is common for doctors to prescribe pain medication along with an antiviral medication. Prompt treatment can assist in pain control as well as the duration of pain. Unfortunately with serious infection, pain can be persistent for a prolonged period of time. While symptoms can recur for years, they often become less frequent, and the sores heal more quickly as time passes. This happens because the body is producing antibodies to fight herpes.

What’s a herpes outbreak or reactivation?

An outbreak or reactivation of a herpes infection means the dormant virus has become active and the symptoms of the illness reoccur. The first outbreak of HSV-1 or HSV-2 can be significant and an individual should seek prompt medical attention. The frequency of outbreaks or reactivation varies from person to person, based on their underlying health condition, stress levels, and other medications they’re taking for other medical issues. With any outbreak or reactivation illness, it is important to seek medical attention.

With genital herpes, an outbreak can cause these symptoms:

Aches and pain in the genital area, burning pain and difficulty urinating
Pain in the lower back, buttocks and legs
Discharge from the genitals
Itchy, tingling, burning and tenderness around the genital area, lasting until the infection clears and the outbreak ends
Painful small blisters (may be red or white) develop into sores that ooze or bleed

Complications from genital herpes can occur and can be worse if the patient is immunocompromised. If the infection is not treated or not treated promptly, the chances of complications increase. A herpes uro-genital infection during pregnancy can lead to serious complications for both the fetus and the mother. Always tell your doctor immediately about outbreaks. Complications of herpes infection can affect many organ systems including, but not limited to, the uro-genital tract, the brain causing meningitis or encephalitis, and the gastrointestinal tract. Due to the inflammatory response that accompanies herpes genital infection, individuals can be at increased risk for other sexually transmitted infections such as HIV.

How is herpes diagnosed?

An experienced health care provider can diagnose herpes infection based on a physical exam and symptomatology. To confirm diagnosis, your doctor will collect a sample of the blister fluid for analysis. A blood test only documents exposure, and does not play a role in diagnosis.

How are herpes infections treated?

Treatments are based on the type of herpes virus, HHV1-8, and the illness that the infection is causing. Specific antiviral medications are used to treat the different herpes viruses. It’s important to prevent the spreading of herpes to others via the clear blister fluid. If you touch the fluid you must wash your hands immediately. The fluid can be transmitted by touching another part of your body or other common objects such as door handles or other surfaces.

Keep dishes and eating utensils separate from other family members and wash well after each use.
Keep washcloths and towels separate from others and wash after each use.
Avoid close contact with others and don’t kiss anyone until the cold sores completely heal.
Wash your hands frequently, especially after touching a cold sore.
Apply medication to the sores with a cotton ball to reduce your contact with sores.

Mayo Clinic (Oct. 2020). Genital Herpes. Retrieved 8-23-21, {https://www.mayoclinic.org/diseases-conditions/genital-herpes/symptoms-causes/syc-20356161}

WebMD. (n.d.). Herpes Simplex Virus: HSV-1 & HSV-2. Retrieved 8-23-21, {https://www.webmd.com/genital-herpes/pain-management-herpes#1}

Nemours. (Feb. 2019). Cold Sores HSV-1. Teens Health from Nemours. Retrieved 8-23-21, {https://kidshealth.org/en/teens/cold-sores.html}

Healthline. (July 2018). Herpes Simplex. Retrieved 8-23-21, {https://www.healthline.com/health/herpes-simplex#causes}

Medically reviewed by:

Dr. Javeed Siddiqui, MD, MPH

Dr. Siddiqui is the Chief Medical Officer at TeleMed2U responsible for clinical and technical program development as well as maintaining a thriving telemedicine practice in infectious diseases which includes specialized care of Hepatitis and HIV.

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