Herpes Simplex

Herpes simplex is a very common viral infection caused by two types of the virus: HSV-1 (typically causes cold sores around the mouth) and HSV-2 (typically causes genital herpes). Either type can infect either site through direct contact. Many infected people have no symptoms and don't know they carry the virus.

How it spreads

• Direct skin-to-skin contact, including kissing
• Oral, vaginal, or anal sex
• Contact with a cold sore or an active genital lesion
• Virus can spread even when there are no visible lesions (asymptomatic shedding)
• Sharing utensils, lip balm, razors — less common routes
• From mother to baby during childbirth (rare but serious for the newborn)

Symptoms

Many infections are silent. When symptoms occur:

• Tingling or itching before blisters appear
• Small, painful, fluid-filled blisters that break into open sores and then crust over
• Cold sores around the mouth (HSV-1) — lips, chin, sometimes inside the mouth
• Genital sores (HSV-2 or HSV-1)
• Fever, swollen glands, body aches — more common with the first outbreak
• Painful urination if genital lesions are near the urethra
• Recurrences — milder, shorter episodes triggered by stress, illness, fever, sun, menstruation

Diagnosis

Usually clinical — a doctor recognises typical lesions. Swabs from a fresh lesion can confirm the specific virus. Blood tests for antibodies are sometimes used but are less useful for clinical decisions.

Treatment

Herpes is not curable, but antiviral medicines effectively manage it:

• Antivirals — taken during an outbreak to speed healing, or daily to reduce the frequency of recurrences (suppressive therapy) for those with frequent outbreaks or to lower transmission risk to partners
• Pain relief — paracetamol and cold compresses for sore lesions
• Keep lesions clean and dry
• Avoid triggers — stress, sun exposure (use sunblock on lips if cold sores triggered by UV)

Prevention and living with herpes

• Don't kiss or share utensils during an active cold sore
• Condoms reduce but don't eliminate genital-herpes transmission risk
• Avoid sexual contact during active genital outbreaks
• Suppressive antivirals lower transmission risk between partners
• Tell a new partner — being open matters
• In pregnancy — tell your doctor so the risk of passing to the baby can be managed

Herpes is very common, usually mild, and does not affect long-term health for most people. The stigma attached to it is much bigger than its medical significance.