Herpes is a common condition caused by an infection with the herpes simplex virus (HSV). About one in seven Canadians have herpes, and most of them are not aware. An individual with a herpes infection will have the condition for a lifetime. While most patients do not develop symptoms, it may result in sores or blisters if present.

There are two types of HSV: HSV-1 or oral herpes and HSV-2 or genital herpes. So, if symptoms are present, it depends on the type of HSV infection.

According to the World Health Organization (WHO), around 67% of people have HSV-1 infection, and 11% have HSV-2 infection globally. Although there is no cure for herpes, fortunately, treatment can help you manage symptoms and prevent their recurrence risk. This article details about herpes, its causes, symptoms, diagnosis, precautions, and management.

What is Herpes?

Herpes is a common infection caused by the herpes simplex virus (HSV). This infection can infect any body part but is mainly seen in and around the mouth and genitals.

Based on the affected location, HSV is classified into the following two main types:

• HSV-1: Primarily affects the mouth and results in fever, blisters, and cold sores around the mouth and on the face.
• HSV-2: Mainly causes genital herpes and is responsible for genital sores and blisters, which are generally sexually transmitted.

Causes

The HSV is a contagious virus and can be easily transmitted from one person to another through direct contact. Children mainly catch HSV-1 from early contact with an infected adult. When the virus is present on the skin, it can be transmitted through contact with the wet skin of the genitals and mouth.

However, the virus cannot be transmitted through contact with an infected object such as a washbasin or towel.

Causes include:

HSV-1

HSV-1 can be contracted from general contacts such as:

• Sharing lip balm
• Eating from the same utensils
• Kissing

The spread of the virus is quicker if the affected individual is experiencing an outbreak. It is seen that 67% of people under the age of 49 are positive for HSV-1 despite never experiencing an outbreak.

Besides, it is also possible to get genital sores from HSV-1 if an individual who performed oral sex had herpes sores at that time.

HSV-2

HSV-2 mainly transmits through sexual contact with an infected person. It is seen that about 20% of sexually active couples have HSV-2.

HSV-2 infections spread through contact with a herpes sore, but HSV-1 mainly transmits from asymptomatic patients or patients who do not have sores.

It can transfer through:

• Having anal or vaginal sex with barrier protection such as a condom
• Sharing sex toys

If an infected woman has genital sores during delivery, the virus can infect the baby.

Risk Factors

HSV can infect anyone regardless of age. The risk depends on your exposure to the virus.

In the case of HSV-2, sex without using barrier methods increases the risk. Other risk factors include:

• Having sex at a younger age
• Have a weakened immune system
• Being female
• Having multiple sex partners
• Having other sexually transmitted infection

HSV and HIV

It is seen that individuals with genital herpes have an increased risk of passing and contracting HIV. This is because the sores support the entry of HIV into and out of the body.

Besides, HSV-2 increases the CD4 cells in the genital lining, increasing the risk of infection if exposed to HIV. People with HIV also have a weakened immune system that increases the risk of complications. For instance, an individual with HSV-1 and a weakened immune system has a high risk of inflammation of the eye and brain.

On the other hand, people with HSV-2 and a weakened immune system are at a higher risk of inflammatory conditions affecting the eyes, brain, lungs, esophagus, or liver.

Symptoms

As discussed before, the majority of the patients do not have symptoms and are not aware of the infection. When present, initial symptoms may be itching, tingling, or burning, followed by blisters or sores around the mouth or genitals. Symptoms develop between 2-20 days after being exposed to the virus.

Some common symptoms include:

Oral herpes (HSV-1)

• Blisters, known as cold sores or fever sores around the mouth and lips
• These blisters may also be present on the tongue and face
• Rarely, the blisters can be found on other areas of the skin

These sores last for about two to three weeks.

Genital herpes (HSV-2)

• Sores on the buttocks, penis, inside and around the vagina, or on the anus
• Changes in vaginal discharge
• Pain when urinating

These sores last for about two to six weeks when it occurs for the first time. After this initial outbreak, symptoms may appear more frequently. Gradually, outbreaks occur less often, and symptoms become less severe. 

Primary Symptoms

Symptoms that occur at the time of the outbreak include:

• Blisters and sores
• A fever
• Swollen lymph nodes
• Itching and pain
• A general feeling of being unwell
• Lack of appetite
• Swollen lymph nodes

In most cases, the blisters heal without scarring.

Recurring symptoms

Recurring symptoms are similar to the initial symptoms, but they are less severe and last for shorter periods. It is seen that about 33% of people with HSV-1 and 50% of those with HSV-2 get recurring symptoms.

According to the American Sexual Health Association, during recurrence, symptoms of both oral and genital herpes last for eight to ten days. And during the recurrence phase, people with genital herpes can pass infection between two to five days.

Diagnosis

Your doctor may generally diagnose this condition with a physical check. They will examine your body for sores and ask about the symptoms.

They may also advise HSV testing, known as a herpes culture. This test confirms the diagnosis if you have genital sores. During the test, the expert will take a swab sample of the fluid from the blister or sores and send it to a laboratory for testing.

The antibody test for HSV-1 and HSV-2, a type of blood test, can also diagnose these infections. These tests are essential when there are no sores present.

Precautions

Some strategies that lower the risk of getting or passing the herpes infection are:

• Avoiding oral sex or kissing if oral sores are present
• Avoiding sex if symptoms are present
• Washing hands thoroughly with soap and water, especially after touching the infected area during an outbreak
• Using barrier method of protection during sex, such as condoms

For many individuals, being tired, skin friction, sunbathing, illness, and stress may trigger the symptom’s recurrence. It is best to identify triggering factors and avoid them, reducing the recurrence of outbreaks.

Treatment

While there is no permanent cure for herpes and the patients have the infection for the rest of their lives, the good news is that there are various treatment options to manage the symptoms.

Home Remedies

You can try the following at home:

• Squirting water on the blisters to reduce the pain while urinating
• Applying cream on the urethra before urinating, such as those with lidocaine
• Apply aloe vera gel to the sores
• Applying cornstarch to the affected part
• Having a sitz bath
• Bathing in slightly salted water
• Pain reliever medicines such as ibuprofen or acetaminophen
• Dabbing petroleum jelly to the sores
• Avoiding tight clothes to prevent friction with the sores
• Applying an ice pack wrapped in a cloth. Never apply ice directly to the affected area

Medication

The current treatment approach involves managing the symptoms and limiting the number of outbreaks. In many cases, the sores and other symptoms may subside without treatment. But your physician will determine if you need medicine. If required, you may be prescribed one of the following medications:

• Famciclovir
• Acyclovir
• Valacyclovir

These medicines lower the risk of you transmitting the infection to others. They also reduce the frequency and intensity of symptoms and outbreaks. The mentioned medicines are available as creams or pills. For severe infections, they can also be administered by injection.

Initiating treatment within 24 hours significantly lowers the duration of the outbreak. 

Final Thoughts

Herpes is a common infection, and infected individuals have the virus in their bodies throughout their life. Although they might not have symptoms, the virus will live in their nerve cells.

But some people may have symptoms and experience regular outbreaks. However, others may experience only one outbreak. While there is no cure for herpes, many treatment options are available to manage the symptoms and prevent their recurrence. Antiviral medicines may also lower the risk of infecting other individuals.

Gradually, your body starts producing antibodies, and thus the outbreaks become less intense and less often. 

If treated within the initial 24 hours, the duration of the outbreak is significantly reduced. So, if you have initial symptoms of burning or tingling and feel you may have a herpes infection, it is best to consult your doctor.