Herpes diagnosis and management

Herpes refers to infection with herpes simplex virus (HSV), which can cause cold sores (usually HSV-1) or genital herpes (usually HSV-2, though HSV-1 can also cause genital infection). Diagnosis is typically made through clinical examination of a suspicious sore, sometimes supported by a swab test to confirm the virus, or blood tests to check for previous exposure. Testing during an active outbreak generally gives the most reliable results.

Herpes is caused by the herpes simplex virus, which remains dormant in nerve tissue after initial infection and can reactivate periodically, causing recurrent outbreaks. Triggers for reactivation can include stress, illness, sun exposure (for cold sores), hormonal changes, and a weakened immune system. The virus can be transmitted to others even when no visible sores are present, through a process called asymptomatic shedding.

Symptoms include a cluster of small, painful blisters that break open and crust over, typically on the lips (cold sores) or genitals, sometimes preceded by tingling, itching, or discomfort in the area before blisters appear. The first outbreak is often the most severe, sometimes with additional symptoms like fever and swollen glands, while subsequent recurrences tend to be milder. Some people have very mild or barely noticeable outbreaks, while others have more frequent, prominent ones.

For most people, herpes is a manageable, though not curable, condition causing recurrent but generally mild to moderate symptoms rather than serious illness. It can be more significant during pregnancy, where genital herpes needs specific management to reduce transmission risk to the baby during delivery, and in people with weakened immune systems, where infections can be more severe. Emotional and relationship impacts, given the social stigma sometimes associated with herpes, can also be significant and are worth discussing with a healthcare provider.

Management includes antiviral medication, such as aciclovir, to treat outbreaks and reduce their severity and duration, and for people with frequent recurrences, daily suppressive antiviral therapy can significantly reduce how often outbreaks occur and lower transmission risk to partners. Identifying and managing personal triggers, such as stress or sun exposure for cold sores, can also help reduce recurrence frequency. Open discussion with sexual partners and use of barrier protection help reduce transmission risk for genital herpes.

No, there is currently no cure for herpes, since the virus remains dormant in nerve tissue indefinitely once acquired, though antiviral treatment very effectively manages outbreaks and reduces their frequency and severity. Many people find outbreaks become less frequent and less severe over time as the body’s immune response to the virus develops further. With good management, most people with herpes lead entirely normal lives with minimal disruption from the condition.

Both are caused by herpes simplex virus, with cold sores typically caused by HSV-1 affecting the mouth area, and genital herpes typically caused by HSV-2 affecting the genital area, though either virus type can actually infect either location. The management principles are similar for both, using antiviral medication for outbreaks and, for frequent recurrences, suppressive therapy. Genital herpes carries additional considerations around sexual transmission and pregnancy management that are less relevant to typical facial cold sores.

See a doctor for a first suspected herpes outbreak to confirm the diagnosis and discuss management options, particularly for genital symptoms which benefit from specific sexual health assessment. A private sexual health or dermatology assessment can typically be arranged within about one to two weeks. Pregnant women with a history of genital herpes, or new genital symptoms during pregnancy, should discuss this specifically with their maternity team given the implications for delivery planning.