When And How Are Later Outbreaks Treated
Later outbreaks with only mild symptoms dont necessarily need to be treated. The blisters can then simply heal on their own.
But antiviral medication can also shorten the duration of later outbreaks by an average of about two days. If you decide to have treatment, its important to start it within the first 24 hours of the outbreak ideally, as soon as you notice the first symptoms. So its a good idea to always have a few tablets at home or to take them with you when you travel so they are ready to use. You can get a prescription from your doctor.
In later outbreaks you can take them for a shorter time. The WHO recommends the following:
- aciclovir: 400 mg three times per day or 800 mg two times per day for five days, or 800 mg three times per day for two days,
- famciclovir: 250 mg two times per day for five days, or
- valaciclovir: 500 mg two times per day for three days.
A different dose and treatment duration may be a good idea for people who have immune system disorders, such as an HIV infection.
Pay Attention To What You Eat
ASHA reports that some people believe foods containing the amino acid arginine, such as legumes and whole grains, can contribute to outbreaks. A few older studies, conducted in 1981 and 1987, showed a possible connection, but ASHA states there is no clinical evidence to support these studies. However, because triggers may vary based on the individual, keep track of the foods you eat to determine if there is a connection.
What Are The Different Types Of Herpes
There are two types of herpes simplex virus: HSV I and HSV II. HSV I commonly causes oral herpes, or cold sores. This virus can show up as an upper respiratory tract infection during early childhood. HSV II is the cause of most cases of genital herpes. However, it is possible for HSV I to cause genital herpes and HSV II to cause oral herpes.
Clinicians cannot tell the difference between the two types by physical examination alone, but there are differences between the two viruses. For example, genital herpes caused by HSV II is much more likely to recur. This diagnosis can be helpful in establishing a health care plan.
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Herpes Causes And Risk Factors
Causes of herpes include acquiring the virus through sexual contact, coupled with immune system suppression and sometimes nutritional deficiencies.
HSV-1 is primarily transmitted by oral-oral contact. On the other hand, HSV-2 is considered a sexually transmitted disease and usually passed during oral or vaginal sex.
A scary finding is that more cases of genital herpes than ever before are now being caused by HSV-1 , and about 85 percent of people with genital herpes dont even know it. Studies show that about 50 percent of the new genital herpes infections in young adults are due to HSV-1 and about 40 percent in older adults. The fact that most people dont ever find out theyre infected is one of the reasons that transmission rates are steadily climbing.
Risk factors for acquiring herpes include:
When Should You Call Your Doctor
If you havent been diagnosed with genital herpes, call your doctor if you have any of the following:
- Painful blisters or sores in the genital or pelvic area.
- Burning or pain while urinating, or you are unable to urinate.
- Reason to think youve been exposed to genital herpes.
If you have been diagnosed with genital herpes, call your doctor if you are having frequent outbreaks or you are unable to pass urine or are constipated.
If you are pregnant and have genital herpes, or if you think you have genital herpes, tell your doctor.
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Recurrent Herpes Simplex Labialis
Recurrent herpes simplex labialis, also known as oral herpes, is a condition of the mouth area caused by the herpes simplex virus. Its a common and contagious condition that spreads easily.
According to the World Health Organization , an estimated two out of three adults in the world under age 50 carry this virus.
The condition causes blisters and sores on the lips, mouth, tongue, or gums. After an initial outbreak, the virus stays dormant inside the nerve cells of the face.
Later on in life, the virus can reactivate and result in more sores. These are commonly known as cold sores or fever blisters.
Recurrent herpes simplex labialis usually isnt serious, but relapses are common. Many people choose to treat the recurrent episodes with over-the-counter creams.
The symptoms will usually go away without treatment in a few weeks. A doctor may prescribe medications if relapses occur often.
Easy Herpes Pain Relief Tips
While herpes has no cure, even though there are methods to stop outbreaks, there are none that are totally fool-proof. The following tips can help relieve your herpes pain and discomfort.
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What Should I Do If I Have Genital Herpes
If you have genital herpes:
- See a doctor or nurse as soon as possible for testing and treatment.
- Take all of the medicine. Even if symptoms go away, you need to finish all of the antiviral medicine.
- Tell your sex partner so they can be tested and treated if necessary.
- Avoid any sexual contact while you are being treated for genital herpes or while you have an outbreak.
- Remember that genital herpes is a lifelong disease. Even though you may not have a genital herpes outbreak for long periods of time, you can still pass the virus to another person at any time. Talk with your doctor or nurse about how to prevent passing the virus to another person.
Treatment Of Recurrent Infection
Recurrences of herpes are often mild and infrequent, and most patients do not seek treatment. Drug therapy to prevent recurrences is available and effective, but because of cost and inconvenience issues, it is traditionally reserved for use in patients who have more than six outbreaks per year. Suppressive therapy in these patients is intended to reduce the frequency and severity of herpes symptoms, decrease the transmission of HSV to sexual partners and infants of infected mothers, and decrease the transmission of associated viral diseases . Unfortunately, only the first goal has yet proved to be attainable.
Acyclovir has been used to suppress recurrences of genital herpes, decreasing the frequency by as much as 80 percent and preventing recurrence by as much as 45 percent of patients.6 Successful suppression for as long as five years without adverse effects has been reported.3 The drug is titrated from a starting dose of 400 mg twice daily to achieve maximal efficacy with the lowest, least frequent dose.1 Therapy should be discontinued once a year to assess whether its continuation is necessary. In addition, cost and compliance should be discussed with the patient. Acyclovir resistance has not been a problem in immunocompetent patients but has been documented in 4 percent of HIV-infected persons.1
Dosages and Characteristics of Chronic Suppressive Treatment Regimens for Recurrent Genital Herpes Infection
This dosage is not FDA-labeled for this indication.
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Why You Should Go To A Sexual Health Clinic
You can see a GP, but theyll probably refer you to a sexual health clinic if they think you might have genital herpes.
Sexual health clinics treat problems with the genitals and urine system.
Many sexual health clinics offer a walk-in service, where you do not need an appointment.
Theyll often get test results quicker than GP practices and you do not have to pay a prescription fee for treatment.
How Can Herpes Be Prevented
Correct and consistent use of latex condoms can reduce, but not eliminate, the risk of transmitting or acquiring genital herpes because herpes virus shedding can occur in areas that are not covered by a condom.25,26
The surest way to avoid transmission of STDs, including genital herpes, is to abstain from sexual contact, or to be in a long-term mutually monogamous relationship with a partner who has been tested for STDs and is known to be uninfected.
Persons with herpes should abstain from sexual activity with partners when herpes lesions or other symptoms of herpes are present. It is important to know that even if a person does not have any symptoms, he or she can still infect sex partners. Sex partners of infected persons should be advised that they may become infected and they should use condoms to reduce the risk. Sex partners can seek testing to determine if they are infected with HSV.
Daily treatment with valacyclovir decreases the rate of HSV-2 transmission in discordant, heterosexual couples in which the source partner has a history of genital HSV-2 infection. 27 Such couples should be encouraged to consider suppressive antiviral therapy as part of a strategy to prevent transmission, in addition to consistent condom use and avoidance of sexual activity during recurrences.
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Is Herpes Simplex Related To Herpes Zoster
Herpes simplex and the varicella-zoster virus are related, but they arent the same. VZV causes chickenpox and shingles.
Like HSV-1 and HSV-2, shingles can cause a painful, blistering rash. The shingles rash usually shows up on the back, side, abdomen , neck and face. It is often only on half of your body, following the pattern of your nerves. See your healthcare provider if you have a new rash and suspect you may have shingles.
A note from Cleveland Clinic
Herpes simplex is a virus. Once you have herpes, its a lifelong condition. A herpes infection can lead to outbreaks , but youll also have times when you have no symptoms. The main sign of herpes is sores that appear on the infected skin. Some people choose not to treat herpes, especially if symptoms are mild. Others take antiviral medications to reduce the severity and frequency of outbreaks.
Last reviewed by a Cleveland Clinic medical professional on 05/17/2022.
References
Outbreaks For Asymptomatic Hsv
The majority of herpes infections, of both HSV-1 and HSV-2, are asymptomatic. This means that you can be infected with the herpes virus and have viral DNA in your body without any visible symptoms.
People with asymptomatic herpes can still spread the virus to others while not having any cold sores or genital herpes lesions.
Sometimes, people with asymptomatic herpes might experience an initial outbreak of cold sores or genital herpes, only to have the virus disappear after the first outbreak. In this case, herpes is still present in the body, but simply remains inactive and doesnt produce further outbreaks.
It can be difficult to know whether or not you have asymptomatic HSV-1 or HSV-2, or simply have infrequent herpes outbreaks. However, if youre confident you have herpes but havent had an outbreak for several years, its likely that you have an asymptomatic infection.
Even if youre asymptomatic, its still important to take precautions against spreading herpes to other people. Herpes remains in the body even if you dont have any symptoms, and there is a risk that you could spread the virus through kissing, oral sex or other sexual activity.
If you have asymptomatic herpes, the best approach is to speak to your doctor about treatment options and the use of suppressive therapy to reduce your risk of infecting others.
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Creating A Personalized Treatment Plan
You may be wondering which option is best for you. While both a suppressive treatment plan and episodic treatment plan are effective, choosing the right plan can have a significant impact on the frequency and duration of your cold-sore/herpes outbreaks.
Taking the next step can be difficult, especially when it involves an awkward doctors visit. At wisp, you can chat discreetly with a US licensed doctor and avoid the most embarrassing step in establishing care. With your personalized treatment plan, its easy to speak with your doctor whenever you need to, as well as manage current prescriptions through your HIPAA compliant Patient Dashboard.
Effectively managing your outbreaks begins with a better self-care routine established between you and your doctorand is the first step to living a better life.
Box 1 Presentation Of First Episode Of Genital Herpes
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Multiple grouped vesicles that rupture easily leaving painful erosions and ulcers
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There may be associated systemic symptoms such as fever and myalgia
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Healing of uncomplicated lesions takes two to four weeks
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Severe complications are rare but can include autonomic neuropathy with urinary retention and aseptic meningitis
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What Is A Herpes Outbreak
A herpes outbreak happens when lesions called blisters or sores start to form on your genitals, bottom or mouth. If you have oral sex, you can also get oral herpes in the mouth. Your first outbreak of genital herpes will generally last longer with more severe symptoms, such as a fever or muscle aches.
Recurrent infections happen because the virus stays dormant in your body. Once triggered, the virus reactivates which leads to an outbreak. Triggers for recurrent infections can include being stressed, being on your period or feeling run down.
You might have an outbreak of herpes a long time after youve had unprotected sex. The virus can stay in your body and not cause symptoms straight away.
Episodic Care & Medication
If your doctor feels that an episodic treatment plan is right for you, your symptoms may match the following:
- Infrequent outbreaks
- Outbreaks cause mild pain or discomfort
- You are able to detect early signs of an outbreak, allowing you to treat it before the virus advances
Both acyclovir and valacyclovir are effective in an episodic treatment plan. The CDC suggests one of the following episodic treatment regimens:
- Acyclovir 400 mg orally three times a day for 5 days OR
- Acyclovir 800 mg orally twice a day for 5 days OR
- Acyclovir 800 mg orally three times a day for 2 days OR
- Valacyclovir 500 mg orally twice a day for 3 days OR
- Valacyclovir 1 g orally once a day for 5 days
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Herpes Drugs Dont Stop Herpes Shedding
Got Genital Herpes? Youre Still Infectious, Even if Drugs Cut Symptoms
Even when they dont have an active herpes outbreak, people who carry genital herpes viruses are at risk of infecting their sex partners. With the discovery of drugs that prevent herpes outbreaks, there was hope that the drugs would also prevent herpes transmission. But theres been troubling evidence that this may not be true.
Now University of Washington researcher Christine Johnston, MD, and colleagues show that people with no herpes symptoms often shed infectious genital herpes virus even while taking very high doses of anti-herpes drugs.
Short episodes of genital shedding occur frequently with antiviral therapy, even for high-dose regimens, Johnston and colleagues report. These breakthrough episodes are typically , last several hours, and occur at much the same rate irrespective of antiviral dose.
One in 5 Americans and Europeans carries HSV-2, the virus that causes most cases of genital herpes HSV-1 causes some cases. Most people have few, if any, of genital herpes painful symptoms: blisters on or around the genitals or rectum.
Theres no cure for herpes infections. Thats because herpes viruses travel up nerves to take up latent form in the nerve root. Powerful anti-herpes drugs acyclovir , famciclovir , and valacyclovir prevent most outbreaks in most people. But they dont eliminate virus hiding in nerve cells.
Can You Get Herpes On Your Tongue
While you may associate herpes type 1 with cold sores on your lips, it is possible to suffer from the symptoms of herpes on your tongue. This is referred to as oral herpes and usually affects more of your mouth than just your tongue. More than half of all adults in the United States are thought to have oral herpes.
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Why Do I Get Cold Sores So Often
Find out why you get cold sores so often and what can be done to reduce the number of recurring outbreaks.The facts about cold sores
Cold sores are an infectious chronic inflammatory skin disease caused by the herpes simplex virus. The infection occurs in the form of vesicular eruptions, usually located on the periphery of the mouth and lips. Herpes is a contagious and recurrent disease thats why its impossible to get rid of. Unfortunately, outbreaks will erupt and subside throughout your lifetime. However, that doesnt mean you have no control over the frequency with which that typical tingling and burning sensation will be felt.
What causes cold sore outbreaks?
You can stop wondering why you get cold sores so often and instead make every effort to avoid conditions that trigger an outbreak. They include:
- stress and anxiety
- some foods and allergies
It goes without saying that you should also avoid kissing anyone when you have a cold sore, as well as sharing your utensils or towels.
Nothing works
If youve tried to avoid conditions that can encourage cold sore outbreaks, and still cant seem to avoid them, you may need to consult a doctor and get some more advice on what you can do to control it.
Ask your doctor for help
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