Herpes simplex: After clearing, herpes simplex sores can return. When the sores return, the outbreak tends to be milder than the first outbreak.
Herpes simplex is a common viral infection. If you’ve ever had a cold sore or fever blister, you picked up the herpes simplex virus. Most cold sores are caused by herpes simplex virus type 1 (HSV-1). Other names for cold sores caused by HSV-1 are:
- Oral herpes.
- Mouth herpes.
- Herpes simplex labialis.
Herpes simplex viruses are contagious, even when you do not see sores.
A closely related herpes simplex virus, HSV-2, causes most cases of genital herpes. But either HSV-1 or HSV-2 can cause a herpes sore on the face or genitals.
Signs and symptoms
Herpes simplex: If a person has HSV-1, a bad sunburn can trigger a herpes simplex outbreak.
Herpes simplex: Outbreaks usually develop around the mouth or on the genitals, but the sores can appear almost anywhere on the skin.
Many people who get the virus that causes herpes never see or feel anything. If signs (what you see) or symptoms (what you feel) occur, a person may experience:
- Tingling, itching, or burning: Before the blisters appear, the skin may tingle, itch, or burn for a day or so.
- Sores: One or more painful, fluid-filled blisters may appear. Blisters break open and often ooze fluid and form a crust, before healing. The first time sores appear, they will show up between 2 and 20 days after a person has contact with an infected person. The sores can last from 7 to 10 days. Where the sores appear often varies with type:
- Oral herpes (HSV-1): Most blisters appear on the lips or around the mouth. Sometimes blisters form on the face or on the tongue. Although these are the most common places to find oral herpes, the sores can appear anywhere on the skin.
- Genital herpes (HSV-2): Sores typically occur on the penis, vagina, buttocks, or anus. Women can have sores inside the vagina. Like oral herpes, these sores can appear anywhere on the skin.
- Flu-like symptoms. Fever, muscle aches, or swollen lymph nodes (glands) in the neck (oral herpes) or groin (genital herpes) are possible.
- Problems urinating. People (most often women) with genital herpes may have trouble urinating or have a burning feeling while urinating.
- An eye infection (herpes keratitis). Sometimes the herpes simplex virus can spread to one or both eyes. If this happens, you can have pain, light sensitivity, discharge, and a gritty feeling in the eye. Without prompt treatment, scarring of the eye may result. Scarring can lead to cloudy vision and even loss of vision.
If you develop signs and symptoms of herpes simplex, you can expect to have these for as long as listed below:
- Oral (mouth) herpes: 2 to 3 weeks
- Genital herpes: 2 to 6 weeks (the first outbreak)
How do dermatologists diagnose herpes simplex?
During an outbreak, a dermatologist often can diagnose herpes simplex by looking at the sores. To confirm that a patient has herpes simplex, a dermatologist may take a swab from a sore and send this swab to a laboratory.
When sores are not present, other medical tests, such as blood tests, can find the herpes simplex virus.
How do dermatologists treat herpes simplex?
There is no cure for herpes simplex. The good news is that sores often clear without treatment. Many people choose to treat herpes simplex because treatment can relieve symptoms and shorten an outbreak.
Most people are treated with an antiviral medicine. An antiviral cream or ointment can relieve the burning, itching, or tingling. An antiviral medicine that is oral (pills) or intravenous (shot) can shorten an outbreak of herpes.
Prescription antiviral medicines approved for the treatment of both types of herpes simplex include:
Taken daily, these medicines can lessen the severity and frequency of outbreaks. They also can help prevent infected people from spreading the virus.
The first (primary) outbreak of herpes simplex is often the worst. Not all first outbreaks are severe, though. Some are so mild that a person does not notice. When the first outbreak of genital herpes is mild and another outbreak happens years later, the person can mistake it for a first outbreak.
Some people have 1 outbreak. For others, the virus becomes active again. When they have another outbreak, it is called a recurrence. These tend to be more common during the first year of infection. Over time, the outbreaks tend to become less frequent and milder. This is because the body makes antibodies (defenses) to the virus.
Serious complications rarely occur in healthy people with herpes simplex. They occur most often in unborn babies, newborns, and people who have a long-term illness or weak immune system. If you have cancer or HIV/AIDS, or you had an organ transplant, seek medical help right away if you have signs or symptoms of a herpes infection.