Herpes (HSV)

Herpes is caused by the herpes simplex virus, which has two types: HSV-1 (commonly causes oral herpes/cold sores) and HSV-2 (most commonly causes genital herpes). Both types can affect the mouth or genitals. Herpes is a lifelong condition with no cure, but antiviral medications can manage symptoms and reduce transmission risk.

Herpes spreads through skin-to-skin contact — including kissing, oral sex, vaginal sex, and anal sex — with an infected person. It can spread even when no sores are visible (asymptomatic shedding). Condoms reduce but don't eliminate risk because the virus can be present in areas not covered by a condom. Sharing lip balm, utensils, or razors can spread oral herpes.

Many people with herpes have no or very mild symptoms. When symptoms occur:

• Painful blisters or sores on or around the genitals, buttocks, thighs, or mouth
• Flu-like symptoms during the first outbreak (fever, swollen lymph nodes)

Recurrences are typically milder and shorter. The first outbreak can occur 2–12 days after exposure.

The most accurate testing is a swab of an active sore sent for culture or PCR. Blood tests (HSV IgG antibody tests) can detect herpes without symptoms but have limitations: they cannot tell where infection is located, HSV-1 vs HSV-2 distinction matters for context, and false positives occur. The CDC does not recommend routine blood testing for people without symptoms.

There is no cure for herpes. Antiviral medications (acyclovir, valacyclovir, famciclovir) can:

• Shorten outbreaks
• Reduce severity of symptoms
• Reduce the frequency of recurrences

Daily suppressive therapy (taking antivirals every day) reduces transmission risk by about 50% and is recommended for people with frequent outbreaks or who want to protect partners.

Prevention steps:

• Use condoms or dental dams during sexual activity
• Avoid sex during outbreaks or when you feel one starting (prodrome symptoms)
• Consider daily suppressive antiviral therapy to reduce transmission risk
• Disclose herpes status to partners before sexual contact

Having herpes does not mean you can't have fulfilling relationships.