Herpes: Signs, Symptoms, & Treatment

By Zina Semenovskaya, MD
Medically reviewed checkmarkMedically reviewed
May 1, 2020

Herpes is a common, lifelong infection that afflicts over 3 billion people worldwide. It primarily affects the mouth, genitals, anal region, mucosal tissues, 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, 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 never experience herpes symptoms.

What Is Herpes?

Herpes is a very common viral infection that affects roughly half of American adults under 50. 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 – most infected individuals do not develop symptoms at all.

Once you contract 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 at any time 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), and Kaposi’s sarcoma. Among the family of viruses, there are two that cause the 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 herpes simplex viruses, primarily causing oral herpes. HSV-1 is highly contagious and afflicts roughly 67% of the world’s population. Many people with HSV-1 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’re 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 the inside of your cheeks. Occasionally, you may develop herpes blisters on your chin or cheeks, a condition that doctors refer to as facial herpes.

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. HSV-2 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 are asymptomatic.

Among those that do develop symptoms, men with HSV-2 can develop herpes blisters on their penis, scrotum, anus, buttocks, and inner thighs. Women 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. You can get HSV-1 by coming into contact with saliva, sores, or surfaces in and around the mouth of a person with the disease. Many patients contract it by kissing or sharing objects such as razors and lip balm which have been in direct contact with infected areas. HSV-1 can also be passed through oral sex, and more rarely, between mother and infant during delivery.

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, or by touching someone’s genitals 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 infant during delivery.

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

  • Small red bumps or white blisters, sores, or open ulcers on the mouth, face, genitals, anus, 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
  • Fever
  • Fatigue or a general feeling of being run down
  • Headaches or body aches
  • Lack of appetite or nausea
  • For women, unusual vaginal discharge

Both men and women who contract herpes in their mucosal eye tissues may experience eye pain, discharge or a “gritty” feeling in their eye.

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 years for any signs of infection to show, and for others, they may never experience 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 family doctor, an OB-GYN, or a nearby public health clinic to get tested.

During your exam, your doctor or other 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 for your doctor to swab, you may be asked to undergo a blood test 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 you are diagnosed with herpes, your doctor may prescribe antiviral medications like acyclovir, famciclovir or valacyclovir to decrease the duration of the acute outbreak and active symptoms. Medications 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 medication.

Herpes Prevention

Herpes, particularly HSV-1, is so widespread it’s nearly impossible to completely insulate yourself from acquiring it. There are, however, some steps that you can take to reduce your chances of contracting herpes whenever you are sexually active, and especially when you are coming into close contact with someone with a known infection. For example, you should:

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

If you have concerns about your sexual health or if you have herpes and are worried about transmitting the 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.

When to See a Doctor

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 your family doctor, an OB-GYN, or a nearby public health clinic to get tested.

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How K Health Can Help

If you think you may have herpes, 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.

Zina Semenovskaya, MD

Dr. Semenovskaya specializes in emergency medicine, and received her medical degree from Weill Cornell Medical College. She is currently the medical director at Remote Emergency Medicine Consulting, LLC and splits her time working clinically as an emergency medicine attending in California and Alaska. She is the first of our doctors to be fluent in Russian.