What Questions Should I Ask My Doctor
You may want to ask your healthcare provider:
- What is the best treatment for me?
- What happens if I dont treat a cold sore?
- What are the side effects of antiviral medications?
- How can I reduce the risk of future outbreaks?
- Whats the best way to prevent getting another STI?
- How can I protect my partner from getting genital herpes?
- Should I lookout for signs of complications?
Can Herpes Simplex Be Prevented
Antiviral drugs will stop HSV multiplying once it reaches the skin or mucous membranes but cannot eradicate the virus from its resting stage within the nerve cells. They can, therefore, shorten and prevent attacks but a single course cannot prevent future attacks. Repeated courses may be prescribed, or the medication may be taken continuously to prevent frequent attacks.
Herpes Simplex Virus 1
Herpes Simplex Virus 1 is a strain of the herpes simplex virus. People may believe that HSV-1 is the same thing as oral herpes, and that it always causes cold sores to appear on the mouth or facial region, but thats not always true. HSV-1 can be acquired in the genital region, creating genital HSV-1.
Similarly, HSV-2 is popularly known as genital herpes, but HSV-2 can be acquired in the facial region creating oral HSV-2. Both HSV-1 and HSV-2 are nearly identical they share 50% of their DNA and produce almost indistinguishable symptoms. This is why its important to get tested for both strains of the disease.
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What Is Herpes Simplex
Herpes simplex is a virus that causes skin infections. The infection lasts your lifetime, and it causes painful or itchy sores and blisters that come and go. Herpes simplex virus typically doesnt cause severe problems. But it can be dangerous in infants and people with weakened immune systems. There are two types of herpes simplex:
- Herpes simplex 1 tends to affect your mouth or face. It causes cold sores. HSV-1 spreads through contact with saliva .
- Herpes simplex 2 is a sexually transmitted disease . It causes sores on skin that comes in contact with the genitals of an infected person.
Sometimes a herpes infection can affect other parts of your body, such as your eyes or other parts of your skin.
How Do I Treat Genital Herpes
For most people antiviral medicine is not necessary either because their body prevents recurrent symptoms or because they find that adopting a healthier life style makes a difference. See What can I do to prevent frequent recurrences?For people who are unlucky and get frequent recurrences, there are two ways that antiviral tablets can be used.
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How Can I Best Learn To Cope With Herpes Simplex
Some people feel distressed or embarrassed about their herpes simplex infection. Its important to understand that the herpes virus is common. For most people, herpes doesnt significantly interfere with daily life.
To cope with negative feelings, you may consider:
- Connecting with others through support groups or online forums.
- Sharing your feelings with a trusted friend or loved one.
- Speaking with a therapist.
Herpes Pregnancy And Newborn Infants
Herpes can pose serious risks for a pregnant woman and her baby. The risk is greatest for mothers with a first-time infection because the virus can be transmitted to the infant during childbirth. Guidelines from the American Academy of Pediatrics recommend using specific diagnostic tests for women in labor to determine the risk of transmission. Babies born to mothers infected with genital herpes are often treated with the antiviral drug acyclovir, which can help suppress the virus.
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Suppressive Therapy For Recurrent Hsv
Suppressive therapy reduces frequency of genital herpes recurrences by 70%80% among patients who have frequent recurrences . Persons receiving such therapy often report having experienced no symptomatic outbreaks. Suppressive therapy also is effective for patients with less frequent recurrences. Long-term safety and efficacy have been documented among patients receiving daily acyclovir, valacyclovir, and famciclovir . Quality of life is improved for many patients with frequent recurrences who receive suppressive therapy rather than episodic treatment . Providers should discuss with patients on an annual basis whether they want to continue suppressive therapy because frequency of genital HSV-2 recurrence diminishes over time for many persons. However, neither treatment discontinuation nor laboratory monitoring is necessary because adverse events and development of HSV antiviral resistance related to long-term antiviral use are uncommon.
Valacyclovir 500 mg orally 2 times/day for 3 daysOR
Valacyclovir 1 gm orally once daily for 5 days
*Acyclovir 400 mg orally 3 times/day is also effective, but are not recommended because of frequency of dosing.
Treatment For Oral Herpes
The antiviral medications available in pill form have been specifically developed for the treatment of genital herpes. However, it is not uncommon for healthcare providers to prescribe the antiviral drugs to those who have frequent or severe outbreaks of oral herpes.
A recent study found valacyclovir to be effective for treating oral herpes in a one-day treatment of 2 grams taken at the first sign of a cold sore, and then again about 12 hours later.
There are two topical antiviral medications prescribed for the treatment of oral HSV symptoms: acyclovir ointment and penciclovir cream. Both work to speed up the healing process and reduce the viral activity. These topical drugs are put directly on the lesions themselves, but can also be used at the onset of prodrome.
Other topical treatments for oral herpes are available over-the-counter , but are not antiviral compounds like acyclovir and penciclovir. Some also contain ingredients that numb the area and induce temporary relief from the discomfort of an outbreak. Unfortunately, some OTC treatments may actually delay the healing time of symptoms because they can further irritate the area with repeated applications. There is only one OTC FDA-approved cream, called Abreva®, which has been clinically proven to help speed the healing process.
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What Is The Treatment For Herpes Simplex
Mild, uncomplicated eruptions of herpes simplex require no treatment. Blisters may be covered if desired, for example with a hydrocolloid patch. Severe infection may require treatment with an antiviral agent.
Antiviral drugs used for herpes simplex and their usual doses are:
- Aciclovir 200 mg 5 times daily for five days
- Valaciclovir 500 mg twice daily for five days
- Famciclovir as a single dose of 3 x 500 mg
In New Zealand, famciclovir is not currently funded by PHARMAC .
Higher doses and/or longer courses of antiviral drugs may be used for immunocompromised patients, eczema herpeticum, or for disseminated herpes simplex.
Topical aciclovir or penciclovir may shorten attacks of recurrent herpes simplex, provided the cream is started early enough.
Is Herpes Simplex Related To Herpes Zoster
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.
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Treatment Of Cold Sores
Currently, there are no cures or vaccines for cold sores caused by the herpes simplex virus . Frequent hand washing will help reduce the spread of the virus to other parts of the body or to other people. Also, applying cool, moist compresses to the lesion may decrease pain and keep the lesion from drying and cracking.
- Many people acquire the virus and have no symptoms or signs.
- For others, painful fluid-filled small blisters appear near the area where the virus entered the body.
- Typically, the blisters heal completely but may reappear at some point in the future.
- In between attacks, the virus resides deep in the roots of the nerves of the involved area.
- When herpes simplex flare-ups appear in their most common location, around the mouth, chin, and upper lip, people often refer to them as “cold sores” or “fever blisters.”
- Oral herpes may cause ulcers, fluid-filled blisters, or sores anywhere inside the mouth, including the gums and the tongue.
- It may also cause sores inside the nose and around the nostrils. Herpes may also affect the eye.
Suppressive Therapy For Recurrences
To suppress outbreaks, treatment requires taking pills daily on a long-term basis. Acyclovir and famciclovir are taken twice a day for suppression. Valacyclovir is taken once a day. The doses for these antiviral drugs are reduced in people with impaired renal function.
Suppressive treatment can reduce the frequency of outbreak recurrences by 70% to 80%. It is generally recommended for people who have frequent recurrences . Because herpes recurrences often diminish over time, you should discuss annually with your provider whether you should stay with drug therapy or discontinue it.
There is some evidence that valacyclovir may help prevent herpes transmission, particularly in situations where one heterosexual partner has HSV-2 and the other partner does not. However, this drug does not completely prevent transmission. While taking any suppressive therapy for genital herpes, it is still important to regularly use latex condoms and to avoid any sexual activity during recurrences.
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Ruling Out Conditions That Resemble Oral Herpes
Simple canker sores are often confused with the cold sores of HSV-1. Canker sores frequently crop up singly or in groups on the inside of the mouth, or on or underneath the tongue. Their cause is unknown, and they are common in perfectly healthy people. They are usually white or grayish crater-like ulcers with a sharp edge and a red rim. They usually heal within 2 weeks without treatment.
This aphthous ulcer is located in front of and just below the bottom teeth.
Oral candidiasis is a yeast infection that causes a whitish overgrowth in the mouth. It is most common in infants, but can appear in people of all ages, particularly people taking antibiotics or those with impaired immune systems.
Other conditions that may be confused with oral herpes include herpangina , sore throat caused by strep or other bacteria, and infectious mononucleosis.
How Herpes Is Treated
There is no cure for herpes.
- The health care provider may prescribe antiviral medicine to help speed up the healing process. It also shortens the time when the virus can spread from the herpes sores.
- Pain may be treated with medicine such as Tylenol or Motrin or by applying an ice pack wrapped in a towel to the affected area.
- If sores are in the mouth, avoid foods high in acid, like citrus fruits and juices.
- The infected area should be kept clean and dry.
- Wash hands often and avoid touching the sores to prevent spreading the virus.
- It is important to stay healthy by getting enough rest, having proper nutrition and exercise and managing stress well.
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Support Fred Hutch Research
The Jerome Labâs herpes research thus far involves only HSV-1, but the scientists are now working on ways to extend their success to HSV-2. The first step will be to repeat their experiments using HSV-2 in guinea pigs, which, unlike mice, experience natural reactivations of herpes virus infections, just as humans do.
What Home Remedies And Over
Home remedies include applying a cool wet compress to the lesion to decrease pain and keep the lesion from drying and cracking. Applying compresses too often will cause more drying, however, so a moisturizing balm should be applied after the lesion is first softened with a wet compress. Lemon balm and L-lysine are popularly used as home remedies. While there is there is very limited data suggesting that these substances have antiviral properties, and not enough data to support recommendations, these remedies seem generally well tolerated for those who wish to try them at their own risk.
Natural treatment options provide pain relief and treat cold sores
Lemon balm, L-lysine supplements, citrus bioflavonoids, Lactobacillus acidophilus and bulgaricus, vitamin C, vitamin E oil, and vitamin B12 have also been considered in the potential treatment of herpes simplex virus, but there is no good clinical evidence to support these treatments. Lemon balm may have some anti-herpes properties, but it is impossible to tell if it is effective in affected people from the few laboratory experiments that have been published. L-lysine similarly has limited laboratory data suggesting antiviral properties and has been touted for reducing recurrence of herpes. Unfortunately, results in patients with cold sores have been highly variable and there are no high quality studies suggesting benefit.
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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:
- Kissing someone who has symptoms of an active herpes virus
- Engaging in any form of unprotected sex
- Having sex with multiple partners
- Spreading the virus through contact with cold sores on the eyes, secretions on the fingers, or ulcers/sores on buttocks and upper thighs
- Having certain other illnesses that lower immune function, such as HIV/AIDS, an autoimmune disorder or hepatitis
- Eating a poor diet that causes nutrient deficiencies and lowered immunity
- Smoking cigarettes, drinking high amounts of alcohol or abusing drugs
Symptoms Of Oral Herpes
Oral herpes is most often caused by HSV-1, but can also be caused by HSV-2. It usually affects the lips and, in some primary attacks, the mucous membranes in the mouth. A herpes infection may occur on the cheeks or in the nose, but facial herpes is very uncommon.
Primary Oral Herpes Infection
If the primary oral infection causes symptoms, they can be very painful, particularly in children. Symptoms include:
- Tingling, burning, or itching around the mouth are the first signs.
- Red, fluid-filled blisters that may form on the lips, gums, mouth, and throat.
- Blisters that break open and leak. As they heal, they turn yellow and crusty, eventually turning into pink skin. The sores last 10 to 14 days and can be very uncomfortable.
- Blisters that may be preceded or accompanied by sore throat, fever, swollen glands, and painful swallowing.
Recurrent Oral Herpes Infection
A recurrent oral herpes infection is much milder than the primary outbreak. It usually manifests as a single sore, commonly called a cold sore or fever blister . The sore usually shows up on the outer edge of the lips and rarely affects the gums or throat.
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How Long Do Sores From Herpes Simplex Last
If youre infected with HSV-1, commonly known as oral herpes, you may notice tingling or burning around your mouth in the days before a cold sore appears. These blisters break open and ooze fluid before forming a crust. Usually, sores last for seven to 10 days.
If youre infected with HSV-2, commonly known as genital herpes, your first outbreak may last between two to four weeks. Recurrent outbreaks usually last between three to seven days.
What Does Recurrent Herpes Look Like
Recurrent herpes occurs in the area where it first appeared, though most of the time, there are fewer blisters or a milder outbreak than the first time. Although the face is the most common site of infection, other areas of the body may be involved:
In recurrent herpes, it often takes 7-10 days before the ulcers completely disappear and the skin returns to normal.
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Genital Herpes Treatment In Pregnancy
You may be offered antiviral treatment:
- to treat outbreaks in pregnancy
- from 36 weeks to reduce the chance of an outbreak during birth
- from diagnosis until the birth if you first get herpes after 28 weeks of pregnancy
Many women with genital herpes have a vaginal delivery. You may be offered a caesarean, depending on your circumstances.
What Happens At A Sexual Health Clinic
The doctor or nurse at the sexual health clinic will:
- ask about your symptoms and your sexual partners
- use a small cotton bud to take some fluid from 1 of your blisters or sores for testing
The test cannot:
- be done if you do not have visible blisters or sores
- tell you how long you have had herpes or who you got it from
Symptoms might not appear for weeks or even years after you’re infected with the herpes virus.
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