Is That a Cold Sore? All You Need to Know About Herpes

Remember that episode from The Office in which the character Michael Scott comes to work wearing a fake moustache to hide his cold sore? His situation gets even more hilarious (and pitiful) when he starts reaching out to all of his ex-girlfriends (who end up insulting him in some way or the other) to inform them to get tested for herpes. While that certainly was a great piece of painfully creepy TV comedy, the story aptly pointed out how herpes can be a difficult topic to discuss.

Herpes, a common yet often misunderstood infection, can bring about discomfort, emotional distress, and stigma. Let's take a new look at the world of herpes, blending medical insight with real-life experiences and lifestyle tips.

What is herpes and its types?

Cold sores, also known as fever blisters, which appear around your mouth or on your lips, result from the herpes simplex virus. This viral infection is quite widespread, affecting millions of people globally.

Now, there are two main types of herpes infections that we humans deal with:

• Oral herpes

• Genital herpes

Herpes simplex virus type 1 (HSV-1) is the cause of oral herpes. You might recognise this condition in the form of cold sores or fever blisters, appearing as fluid-filled blisters or clusters around the lips or mouth.

On the other hand, genital herpes, caused by the herpes simplex virus type II (HSV-II), is mainly spread through sexual contact, making it a sexually transmitted disease (STD). As implied by its name, it primarily affects the genital regions.

How common are herpes infections?

Herpes infections are widespread globally. Around 3.7 billion people under 50 have oral herpes (HSV-1), and approximately 491 million aged 15-49 have genital herpes (HSV-2). In a revealing 2005 study, 63% of individuals in India tested positive for HSV antibodies. Notably, there was a higher incidence of HSV-2 infection among men and an increasing seroprevalence associated with age.

How does someone get a herpes infection?

Ever wondered how someone can catch herpes? It's actually quite contagious and is typically passed from one person to another through close physical contact. Herpes is caused by HSV, which can be transmitted in several ways:

Skin-to-skin contact

The virus can spread through direct contact with an infected area, even if no visible sores are present.

Kissing or oral contact

HSV-1 (commonly causing cold sores) is often spread through saliva during kissing or sharing utensils, lip balm, or drinks.

Sexual contact

HSV-2 (typically associated with genital herpes) is mainly transmitted through vaginal, anal, or oral sex.

Contact with genital fluids

Herpes can be passed through exposure to fluids from an infected person, even if they have no symptoms.

Touching infected surfaces or objects (rare)

Though uncommon, it is possible to catch herpes from personal items shortly after use by an infected person.

Picture this: Grandma, with all her love, giving kisses on the cheeks to her adorable grandchildren during family get-togethers. Little do they know, this affectionate moment could lead to the transmission of oral herpes. HSV-1, the culprit behind cold sores or oral herpes, spreads easily through saliva or skin contact. So, sharing kisses, utensils, or even touching a cold sore, and then the mouth can unwittingly pass on the virus. It's a reminder that even the sweetest gestures can carry a risk, highlighting the importance of being mindful of our actions to protect our loved ones. 

Perhaps, in some cases, people might mistake a cold sore for acne and try to pop it or add a topical cream to it without thinking that it could be something entirely different.

Genital herpes, caused by the HSV-2 virus, is mainly spread through sexual activities such as vaginal, anal, or oral intercourse. Similar to oral herpes, this virus can also be transmitted even when no apparent symptoms are present.

Practising safe sex by using a barrier contraceptive like condoms or by simply avoiding sexual contact when an outbreak happens are crucial steps in preventing HSV-2 transmission.          

While herpes can be challenging to prevent entirely, being mindful of potential transmission routes and taking proactive measures can significantly reduce the risk. By maintaining proper hygiene and staying informed, we can protect ourselves and others against the transmission of HSV.

Just how serious is herpes?

Herpes generally doesn’t cause any serious health issues or death, yet it can occasionally lead to serious complications in immunocompromised patients, such as those affected by HIV. The risk of contracting HIV is tripled by an HSV-2 infection.

“Oral herpes is quite common. In 90% of the cases, it is self-limiting, and no treatment is required. In symptomatic cases, we prescribe specific medications, and after that, it does not cause much trouble,” says Dr Rehyanath P, a practising dentist at Firstcare Medihub in north Kerala.

Herpes during pregnancy can cause foetal infection; therefore, one needs to be properly evaluated and treated at this stage.

Herpes symptoms

Understanding the distinct signs of oral and genital herpes is essential for timely diagnosis, management, and prevention of transmission. Below is a breakdown of the typical symptoms associated with each form.

Oral herpes (Herpes Simplex Virus Type 1 – HSV-1)

Initial infection

• Often resembles a flu-like illness

• Accompanied by painful blisters in or around the mouth

Recurrent outbreaks

• Begin with redness, swelling, and itching

• Progress to painful blisters that crust over typically within four to six days

General symptoms

• May include fever, headaches, body aches, and swollen lymph nodes

• These symptoms generally subside within two to three weeks

Genital herpes (Herpes Simplex Virus Type 2 – HSV-2, and sometimes HSV-1)

Initial infection

• Symptoms usually appear 2 to 12 days after exposure

• Often more severe than recurrent outbreaks

• Painful blisters or sores develop around the genitals, anus, or mouth

• Sores may appear in multiple genital regions

• Healing typically occurs within five to seven days

Recurrent outbreaks

• May begin with tingling, itching, or pain in the affected area.

• Followed by the appearance of sores or blisters that heal over several days

General symptoms

May be mild or absent, yet the virus remains transmissible. Can include:

• Painful urination

• Tender, swollen lymph nodes

• Joint pain

• Fever

• Headache

How is herpes diagnosed?

Generally, a healthcare provider can diagnose herpes through a physical examination. To confirm, they may take a sample from an active sore and conduct special tests.  

Testing is recommended for evaluating high-risk individuals, determining lesion risk, identifying pregnant women at risk of neonatal transmission, and assessing susceptibility to infection from a partner with genital herpes.

Herpes treatment

There is no cure for herpes. But its symptoms can be managed. Doctors may prescribe medications to control herpes symptoms, while over-the-counter pain medications can soothe them.

Here are some tips to help sores heal faster:

• Gently wash the sores with soap and water, then pat them dry

• Avoid bandaging sores to allow air to aid in healing

• Refrain from picking at sores to prevent infection and promote quicker healing

• Use ointment or lotion on sores only if prescribed by your healthcare provider

• Opt for loose-fitting cotton underwear and avoid synthetic materials like nylon. Additionally, avoid tight-fitting pants.

Tips for preventing herpes and lifestyle measures

HSV can be managed and its transmission significantly reduced by following simple preventive measures. Below are key strategies to avoid contracting or spreading oral and genital herpes, followed by guidance for those already living with the virus.

 Preventing oral herpes

To reduce the risk of contracting or spreading oral herpes (typically HSV-1):

• Avoid direct contact with someone's cold sores during an outbreak.

• Do not share personal items such as eating utensils, glasses or cups, lip balm or lipsticks.

• Refrain from oral sex if you or your partner has visible cold sores, as oral herpes can be transmitted to the genitals.

• Learn to differentiate between cold sores and other skin conditions like acne; never pop cold sores, as this can spread the virus to other parts of the body.

 Preventing genital herpes

To minimise the risk of contracting genital herpes (commonly HSV-2 or sometimes HSV-1):

• Practise safe sex.

• Limit sexual activity with multiple partners, particularly those whose HSV status is unknown.

• Avoid sexual contact if either partner is experiencing symptoms or suspects an outbreak.

Hang on to hope

Herpes may seem overwhelming, but remember, millions of people have it, and most lead perfectly normal lives. By adopting measures such as engaging in protected sex, maintaining proper cleanliness, and steering clear of direct interaction during flare-ups, you can reduce the odds of transmitting the virus. Be informed and stay safe.

Frequently Asked Questions

1) Is herpes serious?

Herpes is not a life-threatening disease. But it can cause serious complications in pregnant women and immunocompromised patients.

2) Is a herpes simplex infection contagious?

Yes, herpes infection is highly contagious. One should avoid close contact with infected individuals to avoid contracting this infection.

3) How can I lower the risk of getting a herpes infection?

To minimise the risk of transmitting HSV, it is essential to adopt safe sex measures, ensure proper hygiene, and refrain from direct contact with the affected regions during flare-ups.

4) How to avoid herpes?

To avoid herpes, it's essential to take some precautions: 

Abstain or be monogamous: Refrain from sexual activities or engage in a monogamous partnership with someone who is herpes-free and exclusively intimate with you.

Use condoms: Using condoms can lower the chances of contracting herpes, although they do not provide absolute safety since not all areas are covered.

Avoid contact: Don't touch herpes sores if someone has an outbreak, and avoid sharing items like utensils, glasses, or lip balm with them. 

Oral sex precautions: If you or your partner has oral herpes, it's better to avoid oral sex, especially during outbreaks, as this can spread the virus to the genitals. 

Stay informed: Educate yourself about herpes, its symptoms, and transmission methods to make informed decisions about sexual activity and protection.

5) What is the main cause of herpes?

Herpes is triggered by the herpes simplex virus (HSV). HSV-1 causes oral herpes, while genital herpes is due to HSV-2.

6) What is the best diet for herpes?

A diet with high antioxidant content is preferred to recover from herpes. Also, make sure to drink plenty of water.

7) How often does someone get herpes infections?

Cold sores caused by oral HSV-1 may appear several times annually or once every few years, varying between individuals. Genital herpes outbreaks, primarily caused by HSV-2, tend to occur more frequently, with an average of four outbreaks per year experienced by 70%-90% of affected individuals.

8) How soon after exposure to herpes can an outbreak occur?

The timing of herpes outbreaks varies among individuals. For oral herpes, also known as cold sores, symptoms typically appear three days to one week after exposure. In the case of genital herpes, lesions usually show up around four days after contracting the virus, although this timeframe can range from 2-12 days. Interestingly, for certain individuals, outbreaks may not occur until months or even years after the initial genital herpes infection, and some may never experience symptoms at all.