Herpes is one of the most common viral infections in the world. The World Health Organization estimates that around two-thirds of people under 50 carry HSV-1, the type that usually causes cold sores. Most never know, and many who do get sores feel embarrassed about something that is simply a common infection. Clear information helps.
What causes it?
Herpes is caused by the herpes simplex virus, which comes in two types:
- HSV-1 usually causes cold sores (fever blisters) on and around the lips.
- HSV-2 usually causes genital herpes.
Either type can infect either area. After the first infection, the virus travels along a nerve and stays there, inactive, for life. From time to time it can reactivate and travel back to the skin, causing a new outbreak in the same place.
What an outbreak looks like
- Tingling, itching or burning in one spot, often a day before anything shows.
- A small cluster of fluid-filled blisters.
- The blisters burst and crust over.
- The crust heals, usually within one to two weeks, without a scar.
The first infection can be more severe, sometimes with fever, swollen glands and painful sores inside the mouth (especially in children) or in the genital area. Later outbreaks tend to be milder and shorter.
How it spreads
Herpes spreads through direct skin contact with the affected area: kissing for cold sores, sexual contact (including oral sex) for genital herpes. It is most infectious when sores or tingling are present, but can also spread when there are no visible sores. Sharing lip balm, cups or towels during an outbreak can pass on HSV-1.
To lower the risk:
- avoid kissing and oral contact while a cold sore is present, and do not touch the sore;
- avoid sexual contact during outbreaks, and use condoms at other times;
- do not share lip products, razors or towels during an outbreak;
- wash hands after applying cream to a sore.
Common triggers
Not everyone has triggers, but these are commonly reported:
- illness and fever, such as a cold or flu;
- stress and lack of sleep;
- strong sun on the lips;
- hormonal changes, for example around periods;
- injury to the skin, including dental work and some cosmetic procedures such as lasers and peels near the lips.
If you get cold sores and are planning a laser, peel or filler around the mouth, tell your doctor. A short course of antiviral tablets before the procedure can prevent a flare.
Diagnosis
A doctor can usually recognise herpes by looking at the sores. If there is doubt, a swab from a fresh blister can confirm the virus. Blood tests show past exposure but cannot say where or when the infection happened, so they are used selectively.
Treatment
There is no medicine that removes the virus from the body, but treatment works well:
- Antiviral tablets such as aciclovir, valaciclovir or famciclovir shorten an outbreak and ease symptoms, especially when started at the first tingle.
- People with frequent outbreaks can take a longer daily course to reduce how often they happen and lower the chance of passing the virus on.
- Antiviral creams have a modest effect on cold sores.
- Simple measures help comfort: cool compresses, pain relief, keeping the area clean, and lip sunscreen to prevent sun-triggered flares.
Antivirals need a prescription. Please see a doctor rather than using leftover tablets.
When to see a doctor quickly
- A sore near the eye, or a red, painful eye.
- Herpes in a newborn baby or in pregnancy, especially late pregnancy.
- Widespread blisters on skin with eczema.
- A weakened immune system (for example from cancer treatment or high-dose steroids).
- Outbreaks that are very frequent, very severe or not healing after two weeks.
Living with herpes
Herpes is common, manageable and does not define anyone. Most people have fewer and milder outbreaks as time goes on. If outbreaks affect your confidence or relationships, a frank conversation with a doctor about treatment and with partners about risk usually makes a big difference.
At OrnaSkin, herpes and other skin infections are part of a routine dermatology consultation, handled privately and without judgement.
