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By Medical Author: Dr. Jasmine Shaikh

By Medical Reviewer: Pallavi Uttekar

There are two types of herpes virus that cause sores—painful blisters (fluid-filled bumps) that can break open and ooze fluid. Herpes simplex virus 1 (HSV-1) causes oral herpes (cold sores) and sometimes genital herpes, and herpes simplex virus 2 (HSV-2) mostly causes genital herpes. Sores caused by HSV-1 and HSV-2 look similar. Herpes virus infects nerve groups, so you only get sores at the site of infection. If you have genital herpes, the sores are in the genital area. If you have oral herpes, they stay in the oral/nose area.

Herpes sores develop in five stages. Here is how they look at each stage.

Stage I:

• Initially, many people infected with herpes virus experience burning, tingling or numbness on and around the sores. This happens a day before stage II. This is called prodrome.

• When you get infected for the first time, you may develop flu-like symptoms (aches, fever, fatigue) at this stage.

Stage II:

• Blisters (small, red, fluid-filled bumps) appear on the margins of the lips, nose, cheeks or inside of the mouth or on the genitals. They may be painful or tender.

• The skin around blisters becomes red.

• Fever-like symptoms developed during the first stage may continue.

• This stage lasts for about one to three days.

Stage III:

• Blisters may merge and then burst. They ooze and liberate fluid, which may be clear or light yellow.

• Oozing clears leaving behind a shallow open sore.

• The duration of this stage is anywhere between one to three days.

Stage IV:

• Shallow open sores dry and crust over.

• You may experience itching.

• This stage doesn’t develop in moist areas such as inside the mouth and genitals.

Stage V:

• The crust falls off followed by healing of the sores.

• Picking of the crust or scabs may result in bleeding followed by scarring.

• Herpes sores can sometimes take a long time to heal— up to between two and four weeks.

Because of their appearance, herpes sores may be confused with acne, contact dermatitis or ingrown hairs. Therefore, the only way to know for sure if you have herpes is to see a skin specialist (dermatologist) or sexual health specialist and have testing done.

What are the other symptoms of a herpes outbreak?

If you are experiencing the first outbreak of herpes, you are most likely to experience signs and symptoms that may include:

• Fever

• Chills

• Headache

• Bodyache

• Painful gums (oral herpes)

• Sore throat (oral herpes)

• Swollen lymph nodes

People who experience a herpes outbreak for the first time may develop the lesions 4 to 20 days after getting exposed to the virus. 

After the initial infection, the herpes virus stays inactive (dormant) in the nerves. It has a tendency to get reactivated and emerge as a new sore in certain situations. It is the reactivation that leads to the recurring outbreaks of herpes. Thankfully, consequent outbreaks after the first infection are usually associated with symptoms that are milder; even blisters heal faster than before. 

Outbreaks may be triggered by different things - stress, other illness, fatigue, hormone changes that occur during the menstrual cycle, or anything affecting your immune system, though anything can trigger an outbreak, and sometimes you may not know the trigger.  

If you touch sores present in your mouth or genitals and then touch other places in the body, you can transmit the infection to those places; one such example is herpes infection in the eyes. Children have a greater tendency to spread the virus from oral sores to their fingertips when they suck their thumbs. Once you have an established infection, and your body has produced antibodies, the chances of this happening are very low.

It is important to know that in some people, asymptomatic herpes infections may occur. These people may not experience any symptoms but can still spread the virus to other people through oral-to-oral or sexual contact. Herpes can be transmitted asymptomatically (without symptoms present) by anyone with the virus because of something called asymptomatic viral shedding. This is when the virus is present on the skin with no symptoms. 

What should you do if you have herpes?

Herpes is contagious at all stages. It is most contagious when blisters burst and release their fluid.

If you have herpes, you should take precautions to avoid its spread to other parts of your body and to other people. Here is what you should do.

• Use protection such as condoms and dental dams during sex (even when you do not have an active sore. This is to prevent transmission of infection during the stage of asymptomatic shedding).

During an outbreak of rash: 

• refrain from sexual activity

• Avoid touching the infected region (genitals in case of genital sores and lips or other parts of the face in case of cold sores)

• Avoid Deep Kissing (for oral herpes)

• Avoid sharing personal items such as towels, soaps and cosmetics with others.

• Wash your hands with mild soap or clean them with alcohol-based sanitizer before touching yourself or others.

• Starting antiviral medications during the outbreak with the doctor’s advise can reduce the intensity of symptoms by about 70 percent. 

You can resume sexual activity once the outbreak resolves.

Remember, genital herpes is a common sexually transmitted disease (STD). Sores may be painful or may cause you discomfort. However, the disease is not deadly and rarely causes serious complications. Therefore, do not panic if you are diagnosed with it. There is no cure for herpes but certain over the counter and prescription medications from a doctor can help reduce the severity of symptoms and cause the sores to heal faster. Practice safer sex to the reduce risk of contracting herpes.

For any additional concerns about herpes, do not hesitate to ask your doctor.