Herpes

Herpes is one of the most common sexually transmitted infections in the U.S. It’s an infection caused by two different but closely related viruses, called Herpes Simplex Virus Type 1 (HSV-1) and Herpes Simplex Virus Type 2 (HSV-2).

• HSV-1 is usually transmitted by touching and kissing but it can also be transmitted by sexual contact. Infections with HSV-1 may cause cold sores, and/or fever blisters on the lips, sores around the teeth and gums or no symptoms. HSV-1 is also spread by oral sexual contact and can cause genital herpes.
• HSV-2 is almost always spread by sexual contact and can cause genital herpes with painful lesions around the vulva, cervix, anus, and penis.

How common is herpes?

Almost 90 percent of Americans will have oral herpes (“cold sores”) caused by Herpes Simplex Virus type 1 (HSV-1) at some time in their life. In the United States, 1 out of every 6 people per year are diagnosed with new genital herpes caused by HSV-1 or HSV-2. However, many people don’t know they are infected because they have never had or noticed the symptoms. Genital herpes is more common among women than men.

How is herpes spread?

Herpes is spread through contact with infected skin or mucosa, secretions from vagina, penis, or anus, or oral fluid of someone who is infected with the virus. This includes touching, kissing, and sexual contact (vaginal, anal, penile, and oral). Moist areas of the mouth, throat, anus, vulva, vagina, and eyes are very easily infected. Herpes can be passed from one partner to another or from one part of your own body to another part. If one partner has oral cold sores, they can pass on the virus during oral sex and cause genital herpes. Herpes is most easily spread when there are open sores, but it can also be spread before the blisters actually form or even from people with no symptoms. It’s very unlikely that herpes is spread by toilet seats, swimming pools, bathtubs, whirlpools, or moist towels. An infected mother can pass the virus to her baby during or after childbirth. Pregnant individuals who get infected for the first time close to the time of delivery are particularly likely to pass the virus to their baby. Pregnant individuals should always let their doctor know if they have had herpes or been exposed to herpes.

What are the symptoms of oral herpes?

The first oral contact with herpes often causes no symptoms, but it may cause sores in the mouth around the teeth and gums (“gingivostomatitis”). Typically the infection shows up later as small blisters on the lips (“cold sores” or “fever blisters”), a flare-up of an earlier infection. The flare-ups are more common during colds, fevers, and sun exposure. Oral herpes can be spread through contact such as kissing, or through oral sex. Direct contact for a short amount of time is enough to spread the virus. Cold sores can cause genital herpes through oral sex. If you have oral herpes, you should avoid contact with newborn babies.

What are the symptoms of genital herpes?

Genital infection with herpes may not cause any symptoms and the person may not know they have the virus until they pass it on to another person or get symptoms when the virus is “reactivated.” If symptoms are present, they often include painful bumps or sores (also called vesicles). These bumps or sores can be mistaken for other rashes (such as a pimple or ingrown hair). The first outbreak is usually the worst and most painful and occurs within 2-20 days after contact with the virus. The sores usually will go away within 2-3 weeks.

The first time a person becomes infected with the virus is called “primary herpes.”

Symptoms may include:

• Tingling in the genital area at first
• Small, painful red bumps that turn into small blisters in about 24-72 hours. They can appear on the labia, clitoris, vagina, vulva, cervix, anus, thighs, or buttocks in girls and penis, scrotum, anus, or buttocks in boys.

Other symptoms of primary herpes infection can include:

• Burning, painful feeling if urine passes over the sores; unable to urinate (pee) if the vulva is swollen (because of the many sores)
• Swollen, tender lymph glands in the groin, neck, and under the arms (can remain swollen for up to 6 weeks)
• Muscle aches
• Headache
• Fever
• Nausea
• Headache
• “Run-down” feeling
• Achy, flu-like feeling

Symptoms usually go away within 2-3 weeks; even faster if you are treated with medication. The sores usually scab over and heal without scars. But after going away, the virus stays in the body, even with treatment. The infection can flare up and cause sores again days, weeks, months, or even years later (“outbreaks”). Symptoms are usually worse during primary herpes, and are milder with “outbreaks”.

How is herpes diagnosed?

Your health care provider (HCP) can diagnose herpes by looking at the sores during a physical exam and by testing fluid taken from the sores to see if you have HSV-1 or HSV-2. There are also specific blood tests, which can be helpful in some patients to figure out which virus type caused the symptoms or to figure out if one partner has been infected by herpes. Testing for herpes may or may not be included when your health care provider tests for other sexually transmitted infections (STIs) because the Centers for Disease Control and Prevention (CDC) doesn’t recommend routine screening. If you think you have symptoms of herpes or have a partner with genital herpes, see your health care provider right away and ask if you need testing and treatment.

Is there treatment for herpes?

Yes. Your HCP can prescribe medications that quicken healing, make symptoms less painful, and lower the risk of getting outbreaks. These medications don’t kill the virus and don’t prevent you from getting outbreaks in the future. Even when you don’t have any symptoms, the virus is in the body and can flare up. However, the flare ups and outbreaks of sores usually become fewer and less severe as time goes on. Outbreaks can be prevented or treated early with anti-viral medication to lessen symptoms.

Does treatment cure herpes?

No. Although herpes cannot be cured, it can be treated! For oral herpes, using a sun block on and around the borders of the lips and a hat can lessen the chance of cold sores from sun exposure. Oral medications, prescribed by your health care provider, can be used to treat herpes infections, prevent genital herpes recurrences, and decrease the chance of passing the infection to partners.

Is there anything I can do to relieve my symptoms for genital herpes?

• Keep sores clean and dry
• Don’t touch the sores. If you do, wash your hands well with soap and water
• Wear loose, cotton underwear and clothes to keep your clothes from rubbing against the sores
• Take warm or cool baths
• Try holding cool compresses or ice packs to the sores for a few minutes several times a day
• Drink plenty of water
• Get plenty of rest
• Take acetaminophen or ibuprofen to help with pain and fever
• If urination (peeing) is painful, you can urinate sitting backwards on the toilet so the urine doesn’t touch the lesions or urinate (pee) in a warm bath or shower. You can also use both hands to separate the lips of your vulva, so that urine doesn’t touch the sores. It’s important to wash your hands right after touching your vulva so the virus isn’t spread to your fingers or face.
• Don’t touch or rub your eyes; don’t wet contact lenses with saliva
• Wash your hands before touching a contact lens

You may have some early warning signs that an outbreak is coming. These signs include: tingling, burning, and itching where you had sores before. These signs could start a few hours or days before the outbreak.

How often do outbreaks occur?

Half of the people who have herpes don’t have any more outbreaks after the first occurrence of symptoms. This is especially true if the infecting herpes was HSV-1. Some people only get a few outbreaks, while others get many. People can have many outbreaks in a row and then go months or years without one. People with illnesses that weaken the immune system such as leukemia and HIV are more likely to get more outbreaks and have symptoms that are more painful and last longer.

What causes an outbreak?

It is not clear what causes outbreaks. Some ideas are: other infections, physical or emotional stress, fever, surgery, menstruation, sexual intercourse, skin irritation (sunburn or sun exposure), trauma, alcohol, or problems with your immune system.

Is there anything I can do to prevent outbreaks?

Make sure that are you are eating a healthy diet, getting enough rest, exercising, and finding ways to relieve stress. If you have frequent or severe outbreaks, talk to your health care provider about taking a medication to prevent outbreaks or to treat them early.

How can I prevent spreading herpes?

• If you are having a herpes outbreak, you should NOT have any sexual contact until all sores have healed, the scabs have fallen off, and the skin is normal again.
• Using condoms lessens the chance of getting herpes but does not completely protect against spreading the disease because the condom does not cover all areas of the body where there may be herpes infection. Touching sores can also spread herpes to other parts of the body or to your partner.
• If your skin has become normal again and you have no symptoms of herpes, you can have sexual contact again but herpes can still be spread when there are no symptoms. You should always use condoms whenever you have oral, vaginal, or anal sex.
• If you get any of the typical warning signs that an outbreak may occur-tingling, burning, and itching where sores were before-you should stop having sexual contact until the outbreak is over. These signs can start a few hours or a day before the sores show up.
• Talk to your health care provider about whether you should take medication to lessen your chance of transmitting herpes to your partner. It is helpful for your partner to get a blood test for herpes type specific antibodies so he/she knows if they have already had the infection. If he/she has a positive test for the herpes type you have had, then you don’t need to take medication to prevent transmission. Pregnant women should particularly avoid getting a herpes infection and let their doctor know if they have ever had symptoms of genital herpes.

Does herpes cause cervical cancer?

No. Cervical cancer is caused by infection with certain human papilloma viruses, not by herpes. However, you can talk to your health care provider about getting a Pap test when you are 21.

Is there a connection between herpes and HIV infection?

People with herpes or other sexually transmitted infections that cause genital sores are more likely to get HIV. The sores provide a place for the HIV virus to enter and start spreading. If a person with HIV also gets genital herpes, the herpes infection is likely to be more severe.

Our health guides are developed through a systematic, rigorous process to ensure accuracy, reliability, and trustworthiness. Written and reviewed by experienced healthcare clinicians from Boston Children's Hospital, a Harvard Medical School teaching hospital and consistently ranked as a top hospital by Newsweek and U.S. News & World Report, these guides combine clinical expertise, specialized knowledge, and evidence-based medicine. We also incorporate research and best practices from authoritative sources such as the CDC, NIH, PubMed, top medical journals, and UpToDate.com. Clinical specialists and subject matter experts review and edit each guide, reinforcing our commitment to high-quality, factual, scientifically accurate health information for young people.