Reviewed By: Dr. Kurt Kloss, MD
Last Reviewed Date: Sep 25, 2018
Last Modified Date: Sep 25, 2018
Published Date: Jul 30, 2018
Herpes refers to a group of viral diseases that affect the skin or nervous system. Since herpes is a long-term condition, it's important for those who have herpes to understand what it is and how to manage it. Symptoms can be infrequent, if they occur at all, so it's best if patients can identify them at the first outbreak and take appropriate action to further manage the disease.
There's no cure for herpes, so those who are infected will have the disease for life. Herpes is incredibly common. Roughly one American in six has genital herpes and over half of Americans have oral herpes. Herpes is manageable when you know what to do about the symptoms when they appear.
The Initial Genital Herpes Episode
Image via Flickr by a.drian
Genital herpes can occur with both the HSV1 and HSV2 viruses. The HSV2 virus is more commonly associated with genital herpes. Patients with this virus have roughly four or five outbreaks of genital herpes each year. Patients with HSV1 typically experience oral symptoms, but they may exhibit genital herpes as well. Outbreaks with HSV1 tend to occur about once or twice a year and are less severe than those associated with HSV2.
After coming into contact with the virus, people typically have their first outbreak within two weeks. Most will experience symptoms within 24 hours. However, not everyone will experience their initial outbreak this quickly. Some patients don't have an outbreak for years, though they're carrying the virus unknowingly.
The initial herpes outbreak is usually the most severe. It can be quite alarming for a newly infected patient to discover the infection through this potentially painful outbreak. Around the affected area, the patient may feel itching, swelling, tingling, and pain. Other symptoms are flu-like and include:
- Loss of appetite
- Swollen lymph nodes
- Generalized aches and pains
These symptoms may last for a few hours or a few days. Once this period has passed, the individual will often see the genital blisters that are characteristic of the disease. These lesions are red and inflamed, often appearing in clusters. After several days, the blisters crust over and heal. They don't leave permanent scars.
Genital herpes lesions typically appear around the vagina in women. They may also occur in the cervix, where they're less noticeable. Men tend to experience lesions on the shaft of the penis. The sores can also appear on the thighs, buttocks, and anus for both men and women.
Herpes lesions can continue to form over a period of roughly 10 days. These lesions last longer during the first outbreak than they will in later outbreaks, and may persist anywhere from two to six weeks. Some patients mistake genital herpes lesions for jock itch, insect bites, an allergic reaction, or a yeast infection. If you suspect that you might have herpes symptoms, you should speak with your doctor as soon as possible for a conclusive diagnosis.
Recurrent Genital Herpes Episodes
Though later outbreaks of genital herpes are usually less severe, they still come with several symptoms. It's important to identify these symptoms and be aware of the possibility of outbreaks at any time. If you did not identify the virus with the first outbreak, these subsequent outbreaks can help you recognize the presence of genital herpes so you can begin getting the care that you need.
Compared to the initial outbreak, subsequent genital herpes outbreaks are usually much less severe. These outbreaks last about half as long as the first outbreak, rarely lasting longer than 10 days. The lesions are often small enough to be mistaken for razor burn, pimples, or ingrown hairs. Patients are unaware that the virus is active in about a third of their outbreaks.
Herpes, along with other STDs, can cause an inflamed cervix in women, known as cervicitis. Patients may notice an unusual discharge, spotting between periods, or discomfort during intercourse. The condition can be quite uncomfortable but will clear when the underlying infection receives treatment.
Genital herpes may also reactivate without any lesions at all. This is known as asymptomatic reactivation.
Symptoms of Prodrome
Prodrome is a warning that can alert you to a pending herpes outbreak. Not all patients experience prodrome, but those that do can prepare for an outbreak appropriately by paying attention to this sensation. Prodrome can occur hours or days before the herpes outbreak. Patients typically notice a peculiar sensation of tingling, itching, or general discomfort in the genital area.
Prodrome symptoms may include:
- Nerve pain in the legs
- Tender muscles
- Shooting pains in the legs, buttocks, or groin
- A pinching or stinging sensation in the genital area
Prodrome is more common in the first few outbreaks. As the body builds more immunity to the virus, these symptoms are less noticeable. Patients should pay close attention to sensations that may indicate prodrome so they can enjoy the benefits of a little advance warning before a genital herpes outbreak. Prodrome can alert you to an active period in which the virus is shedding, even when lesions never occur.
If you believe that you're experiencing prodrome, you should take precautions to avoid spreading the herpes virus. Avoid sexual intercourse, even if your partner also has herpes. Sexual activity may worsen the symptoms of your outbreak. If you've been provided with antiviral medication, prodrome is a key indicator that it's time to start taking it.
Many people have triggers that will spur on an outbreak of genital herpes. If you're experiencing prodrome, you may want to consider your diet and activities over the last few days to see if you can identify anything that may be causing your herpes outbreaks.
Frequency of Genital Herpes Symptoms
As mentioned previously, genital herpes can occur with both HSV1 and HSV2. As much as 30 percent of genital herpes is caused by HSV1, yet only 2 to 5 percent of these infections result in recurring genital outbreaks. Patients with genital herpes caused by HSV1 may experience few outbreaks if any. On average, these outbreaks occur about once a year. HSV2 outbreaks can occur as much as 10 times more often than HSV1 outbreaks.
Though these averages can give you a general idea of what to expect with genital herpes, there are many variables that will impact how often you have symptoms. You're more likely to experience a genital herpes outbreak if you have a compromised immune system. This may occur as the result of HIV, cancer, or a severe burn. Patients taking immunosuppressant medications are more likely to experience genital herpes outbreaks. The longer you have genital herpes, the less frequent your outbreaks will be.
Genital Herpes Triggers
Certain conditions often trigger genital herpes outbreaks. Understanding these conditions can help patients take steps to avoid any unnecessary outbreaks. Tracking your outbreaks can help you identify common personal triggers. These vary from one person to the next, so it's important to pay attention to what happens to your body.
Some common triggers of genital herpes include:
- Illness which compromises the immune system
- One's menstrual cycle
- Hormonal changes
- Periods of stress
- Sexual intercourse
Your dietary choices may trigger genital herpes outbreaks as well. Foods high in arginine, such as chocolate and nuts, are common triggers. Beverages high in caffeine can also be problematic. Red wine causes outbreaks in some people, too. While you should strive for a healthy diet to help keep your genital herpes under control, you should not engage in an overly restrictive eating plan.
If you're struggling with frequent genital herpes outbreaks, try keeping a journal of your diet and activities. Examining this information over a period of time, you might notice commonalities such as a higher number of outbreaks at a certain point in your menstrual cycle, after high-stress work presentations, or when you're drinking more often. Herpes is different for everyone, so you should take the time to examine what the virus looks like for you.
Genital Herpes Infection and Risk Factors
Patients with genital herpes don't always experience a noticeable outbreak. Many infected individuals carry the virus for a long time before realizing that they have it. Understanding the risk factors for genital herpes will help you avoid the disease when possible and take the appropriate actions if you've been in a situation in which you might have been exposed to the virus.
Genital herpes caused by HSV1 is spread through oral sex. HSV2 is typically spread through sexual intercourse. The herpes virus doesn't survive long on non-living surfaces, so you can't get it from somewhere like a toilet seat.
If you have unprotected sex, you're at a higher risk for contracting genital herpes. You should speak with your partner about his or her sexual history, but do keep in mind that many people with herpes are unaware of it. If your partner has engaged in high-risk sexual behavior, you may discuss getting tested for herpes and other STDs.
Condoms can help prevent the spread of genital herpes, though they're not 100 percent effective since herpes can exist on other parts of the body beyond the genitals. Avoid having physical contact when a genital herpes outbreak is active. If you have been diagnosed with genital herpes, speak with your doctor about herpes medications that can reduce your risk of spreading the virus.
Managing Genital Herpes
Genital herpes outbreaks can be uncomfortable, but there are several things that you can do to minimize your symptoms and get through an outbreak with little disruption to your daily life.
Taking an antiviral medication such as acyclovir (Zovirax), famciclovir (Famvir), and valacyclovir (Valtrex) can reduce the severity of an outbreak if taken at the first sign of symptoms. You can also reduce the frequency of your outbreaks by taking these medications daily. Speak with your doctor to determine which schedule is best for your case.
During a herpes outbreak, you should keep the infected area clean using soap and water. Use a separate towel to clean the area and launder this immediately after use. Avoid antibiotic ointments, which ultimately hinder airflow to the sores. Avoid restrictive clothing, which may cause chafing. Choose breathable, loose-fitting cotton.
A warm bath, cool compress, or cool air from a blow dryer can ease some of the discomfort of herpes sores if they're particularly severe. Ibuprofen, acetaminophen, and aspirin can help relieve pain.
When to Get Tested for Genital Herpes
Testing for genital herpes isn't recommended for individuals who do not have symptoms. False positive results are possible, so this STD isn't screened for as regularly as others. However, there are some specific cases in which herpes testing is recommended.
If you or your partner has had any symptoms that may be associated with genital herpes, you should speak to your doctor about getting tested. Individuals who have had multiple sexual partners may also request a test.
If you have active lesions that you believe may be from genital herpes, your health care provider can take a sample of the cells from these sores to determine whether they are from genital herpes. A PCR blood test can also determine if you have genital herpes. You may get a false negative if you were infected too recently to form antibodies in the blood, or if your provider swabs sores that have already begun to heal.
Oral Herpes Symptoms
Oral herpes is most commonly caused by the HSV1 virus. The lesions associated with oral herpes are often referred to as fever blisters or cold sores. Some people may refer to herpes blisters as canker sores, but this is inaccurate. Canker sores are not contagious. They are caused by an irritation of the mouth.
Herpes sores typically appear on the lips or around the mouth. In some cases, patients might experience sores on the chin, on the cheek, at the back of the throat, or inside the nose.
The first outbreak of oral herpes is the worst. This usually occurs two to 12 days after the initial contact with the virus. The outbreak may begin with itching, burning, or tingling before the sores erupt. Individuals typically experience fluid-filled blisters that may appear singly or in clusters. These lesions have a red base around small gray ulcers. If you're not familiar with the symptoms of oral herpes, you might mistake these sores for insect bites, pimples, or even chapped lips.
As the lesions heal, they will crust or scab over. At this point, the sores take on a dry, yellowish appearance. During this outbreak, you may experience flu-like symptoms such as fatigue, fever, enlarged lymph nodes, and muscle aches.
Recurrent oral herpes outbreaks are less severe than the initial outbreak. Patients will notice similar symptoms, but the sores will typically clear faster, and the outbreak may be smaller and less noticeable.
Frequency of Oral Herpes Outbreaks
The frequency of oral herpes outbreaks varies from one person to another. The longer you've had the virus, the less frequent your outbreaks will typically be. Since many people contract HSV1 as children, they may have few to no outbreaks as adults. Individuals who contract an oral case of HSV2 usually see no outbreaks at all. HSV2 is more commonly associated with genital herpes, but you can get it orally through oral sex.
Those with a strong immune system will have fewer outbreaks, while individuals with a compromised immune system will typically see oral herpes appear more frequently. There are many other triggers that can increase the frequency of oral herpes outbreaks, as discussed in the next section.
Oral herpes outbreaks usually last between eight and 10 days. If your symptoms last two weeks or longer, you should see your health care provider. There may be an underlying infection that's preventing your herpes outbreak from clearing as it should.
Oral Herpes Triggers
Understanding the triggers that might cause your oral herpes to flare up can help you avoid outbreaks as much as possible. Individual triggers vary from person to person so you may want to track your diet and other activities to determine what is causing your outbreaks, particularly if you have oral herpes outbreaks often.
Sunlight is a common trigger for oral herpes outbreaks that patients might easily overlook. Pay attention to your outbreaks and note whether they occur after prolonged exposure to the sun. Avoiding these UV rays can help limit herpes outbreaks, particularly in the summer months when you're likely to have more exposure.
Illnesses such as colds weaken the immune system and may trigger an outbreak. If you have a fever, immune depression, or experience trauma to a nerve region where you've had a previous outbreak, you're at a higher risk for getting fever blisters.
Stress and fatigue may trigger herpes outbreaks. Though these aren't always easy to control, taking measures to keep stress levels under control and getting adequate sleep at night will help protect you from getting fever blisters.
Women may notice that herpes outbreaks occur at a particular time in their menstrual cycles. Hormonal changes can trigger these sores. Tracking your cycle might help you better predict when an outbreak is likely to occur.
Oral Herpes Infection and Risk Factors
Oral herpes is easy to transmit via contact with the skin or saliva. It's not an uncommon virus, and the infection rate is much higher than many people realize.
Oral herpes is transmitted through contact with the herpes simplex virus when the contagious area comes into contact with broken skin or mucous membrane tissues around the mouth and genitals. Oral herpes is often passed through something as simple as a kiss on the face. Many patients contract herpes this way when they're children. An individual can transmit oral herpes even when sores are not present.
You can minimize your risk of contracting oral herpes by avoiding contact with those who have an active outbreak. However, it's important to understand that oral herpes is incredibly prevalent. In the Americas, nearly half of all women and almost 40 percent of men carry HSV1. Contracting oral herpes is not always as disruptive to one's life as you might imagine.
Managing Oral Herpes Symptoms
No cure exists for oral herpes, so it's valuable for patients to know how to handle outbreaks when they occur. You can take several steps to ease the discomfort of oral herpes and aid the healing process. Antiviral pills can speed the healing process when taken at the start of a herpes outbreak. Prescription medications can decrease pain at the lesion site and reduce the length of a herpes outbreak by roughly half a day.
If you're dealing with a significant amount of pain, you can use a topical anesthetic to speed healing and reduce discomfort. Something as simple as a cold, moist compress can help with pain as well. Aloe vera gel offers a similar effect by cooling the area.
You can limit the spread of a herpes outbreak by boosting your vitamin C intake so your body is more able to fight the infection. Applying a warm tea bag to the sores for about 15 minutes, three to four times a day, may minimize the spread of the outbreak as well.
When to Get Tested for Oral Herpes
Many doctors can diagnose oral herpes with a visual examination during an active outbreak. To confirm the diagnosis, your physician might perform a viral cultural analysis, PCR test, or staining test.
If you believe that you may have oral herpes, speak with your doctor as soon as possible, whether you have an active outbreak or not. Your physician can speak with you about prescription medications that may help you better control outbreaks so you'll suffer less from the uncomfortable sores associated with this virus.
While no cure for herpes exists, patients can manage it and live comfortably. Knowing that you have herpes is the first step in taking better control of the disease. It's important to speak with your doctor if you've had symptoms of either genital or oral herpes so you can get tested and take the proper steps going forward. A few smart precautions can minimize your outbreaks and help prevent the spread of the virus to others.