What it means

Herpes is caused by two viruses: HSV-1 and HSV-2. Both can infect the mouth and the genitals — the distinction is blurring, and oral HSV-1 is the most common cause of cold sores.

Two things make it feel worse than it is:

  1. It is extremely common. A large majority of adults carry one of these viruses. Cold sores are the visible form of a very common infection.
  2. It is manageable, not curable. Once acquired it stays in the body and reactivates. Most people have fewer and milder outbreaks over time, and some have none after the first.

How it spreads

  • Direct skin-to-skin contact with an active sore, including oral, vaginal or anal contact.
  • Oral sex can transmit herpes in either direction. Oral HSV-1 can be given to a partner’s genitals, and genital HSV can be given to a partner’s mouth.
  • A person with no symptoms can still transmit it, because the virus is shed intermittently even between outbreaks. This surprises most people, and it is why appearance is not a reliable guide.
  • It is not spread by sharing a toilet, towel, cup or cutlery, or by sitting on a toilet seat.

What can vary

Many people have no symptoms at all and never know they have it. This is common and not a problem in itself.

When symptoms occur:

  • First episode is usually the worst: painful clusters of blisters that turn into shallow ulcers, often with a flu-like feeling, fever, swollen glands, and pain or difficulty passing urine.
  • Recurrent outbreaks are typically milder and shorter, and often preceded by tingling or burning.
  • Prodromal symptoms — tingling, itching or burning before any sore appears — are common and useful, because starting treatment at that point makes a real difference.

Possible explanations

Diagnosis is by swab of a lesion, ideally taken early in an outbreak. Blood tests can show exposure but cannot reliably tell you where the infection is or whether you are actively infectious, and appearance alone is not diagnostic.

Treatment: antivirals shorten outbreaks and, taken long-term as suppressive therapy, reduce both outbreaks and transmission.

Warning signs

  • First episode — worth testing, because a first episode can be more severe and treatment shortens it.
  • Eye involvement — pain, light sensitivity, or a sore near the eye. Herpetic eye infection needs urgent assessment because it can affect sight.
  • Difficulty passing urine, or pain too severe to urinate.
  • First infection in a newborn — urgent assessment required.
  • Symptoms during a first pregnancy, particularly late in pregnancy — worth mentioning early so it can be assessed.

What to do next

Get tested if you have symptoms. A swab is more reliable than a blood test for diagnosing an active episode.

If you have been diagnosed, ask specifically about suppressive antiviral therapy. It reduces outbreaks and reduces transmission, and it is underused.

If a partner has herpes and you have never had it, ask about vaccination. There is no vaccine for herpes, but there is now one for mpox, and hepatitis A and B vaccination may also be worth discussing.

Self-care

  • Start antivirals at the first tingle, not at the first blister.
  • Keep lesions clean and dry. Pat rather than rub.
  • Wash your hands after touching sores.
  • Avoid skin-to-skin contact with an active lesion, including oral contact.
  • Do not scratch — scratching spreads it and increases scarring.
  • Wear loose clothing and avoid friction.
  • Take paracetamol or ibuprofen for pain, if you can take them.

When to seek help

Routine: known herpes management and suppressive therapy.

Prompt: first episode; outbreaks becoming more frequent; recurrent outbreaks near the eye.

Emergency: eye involvement, urinary retention, or first infection in a newborn.

How to talk about it

“I think I might have herpes — how do I get it confirmed?”

“I’ve been getting outbreaks more often.”

“How do I stop passing it on?”

Disclosure is genuinely difficult and there is no single right way to do it. Clinicians can help you work out what to say if you want that.

Myths and stigma

“Herpes means you have been unfaithful.” Herpes is so common — most adults carry one of the two viruses — that assuming it points to anything about a relationship is usually wrong, and it does enormous damage when people believe it.

“Someone with cold sores is dirty.” Cold sores are ordinary HSV-1 infections. They are common from childhood and have nothing to do with hygiene.

“If you have it you will have outbreaks forever.” Many people have them only once, or very occasionally, and suppressive antiviral treatment reduces both outbreaks and transmission substantially.

Sources

Public sources are linked so you can read the detail rather than take this site’s word for it. None of this has yet been reviewed by a qualified clinician — see how we handle medical review.

Keep reading

Related articles

Picked by editorial hand rather than algorithm, so they follow the questions this page actually raises.

Related articles

  • STIs & sexual health

    Getting tested for STIs

    What is tested for, how tests work, what happens at a sexual health appointment, how often testing makes sense, and how to get tested easily.

References

Where this comes from

Linked so you can check it against a recognised public health source rather than take this site's word for it.

  1. Genital Herpes — CDC US Centers for Disease Control and Prevention (opens in a new tab)
  2. Genital herpes — NHS NHS (opens in a new tab)

These are public sources from recognised health organisations, linked so you can read the detail rather than take this site's word for it. Reading them does not tell you whether any of it applies to you, and none of these articles has yet been reviewed by a qualified clinician. How we handle sourcing and review.