Herpes simplex: What you need to know about cold sores and genital herpes

Figure 1: Herpes simplex viruses can remain in the body for life.

Herpes simplex is a widespread viral infection that can manifest as cold sores on the lips or as problems in the genital area. But how are the viruses transmitted, how can an infection be recognised and what treatment options are available? In this article you will learn about the differences between HSV-1 and HSV-2, how a herpes infection typically develops and which tests can help with diagnosis. You will also read about the conventional treatment of herpes simplex and which measures can help reduce the risk of transmission and better manage recurrent symptoms.

What is herpes simplex? An overview of the two herpes pathogens

The widespread viral infection herpes simplex (often referred to simply as “herpes”) is caused by herpes simplex viruses (HSV). Two types are distinguished: herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2). HSV-1 commonly causes oral herpes but can also cause infections in the genital area. HSV-2 primarily affects the genital area and is usually transmitted through sexual contact. However, the distinction is not absolute: both virus types can cause either oral or genital infections.¹

Once infected, the viruses remain in the body for life. They retreat into nerve cells and can persist there in a dormant state.² Under certain conditions they can become active again and cause symptoms. Typical signs are small, clustered, fluid-filled blisters that often burst and crust over. Transmission can occur not only when symptoms are visible but also when the infected person is not currently experiencing any symptoms.

How does a herpes infection arise and how does the virus spread?

A herpes infection occurs through contact with herpes simplex viruses HSV-1 or HSV-2. Transmission mainly takes place via direct skin-to-skin or mucous membrane contact with an infected person. For oral herpes, this can be through kissing or contact with saliva. Genital herpes is usually transmitted during sexual intercourse. Visible blisters or other symptoms need not be present. The viruses can be shed from the skin or mucous membranes even when the infected person is asymptomatic.³ After entering the body, the viruses replicate initially in the skin or mucous membrane cells. They then travel along nerve pathways to certain nerve ganglia, where they establish a long-term presence.

In these ganglia the herpes viruses can remain latent for extended periods. Under certain circumstances they reactivate and travel back along the nerves to the skin or mucous membrane. This can lead to a recurrent outbreak with tingling, burning, itching and the typical painful blisters. Possible triggers include physical or psychological stress, febrile infections, hormonal changes or intense UV exposure. Which factors favour an outbreak varies from person to person. The frequency and severity of symptoms can also vary widely: some people experience only a single outbreak, while others have regular recurrent episodes.

From itching to cold sores: Typical symptoms

A herpes simplex infection can cause a range of symptoms. Which symptoms occur depends, among other things, on the affected body area and whether it is a primary infection or a recurrent outbreak. Some infections occur without noticeable symptoms. Often an outbreak is initially signalled by tingling, itching, burning or a feeling of tension. Later, small, clustered blisters filled with fluid may form. These can break open, ooze and then crust over.

Typical symptoms of herpes simplex include:

• Tingling and itching
• Burning and a feeling of tension
• Formation of blisters, usually occurring in clusters and filled with fluid
• Painful skin changes
• General signs of illness (especially in primary infection), e.g. fever, fatigue, headache and limb pain, and swollen lymph nodes

For oral herpes, blisters on the lips or at the border between the lips and facial skin are typical. Occasionally the surrounding skin areas may also be affected. In genital herpes, blisters, sores, itching, burning and pain can occur in the genital and anal area. Painful urination is also possible. Symptoms usually subside within a few days to a few weeks. With recurrent outbreaks the symptoms are often milder than during the first infection. It is also important to note that not every herpes infection causes visible blisters. Genital herpes in particular often goes unnoticed or presents with nonspecific symptoms.

Recognising and diagnosing herpes simplex: Key tests

A herpes simplex infection can often be suspected based on the typical skin and mucous membrane changes. Clinicians pay particular attention to clustered blisters, painful open areas or crusts during examination. Accompanying symptoms such as itching, burning and tingling, as well as the affected body region, provide important clues. Because other infections and skin conditions can cause similar symptoms, a visual diagnosis alone is not always sufficient. Targeted laboratory diagnostics can be useful, especially for unclear symptoms, genital herpes or a first-time outbreak.

The most reliable method is considered to be the so-called PCR test. For this, a swab sample is taken from a fresh herpes blister or an open skin lesion and examined in the laboratory for the viral genetic material. The test can also differentiate between HSV-1 and HSV-2.⁴ Another option is a blood test that detects antibodies against herpes simplex viruses. This can provide evidence of past contact with the virus but does not reliably indicate whether an active outbreak is present or in which body region the infection occurred. Which test is appropriate is decided by the treating clinician based on the symptoms and the examination findings.

How is herpes simplex conventionally treated?

Depending on the affected body area and the severity of the symptoms, different treatment approaches are chosen for herpes simplex. Because the viruses remain in the body for life after infection, herpes cannot yet be completely cured. The primary aim of therapy is therefore to relieve symptoms and to shorten the duration and severity of an outbreak. Antiviral medicines that inhibit the replication of the herpes viruses are mainly used in clinical practice. For oral herpes, for example, creams containing the active ingredients aciclovir or penciclovir are used.

For severe symptoms, genital herpes or frequently recurrent outbreaks, antiviral drugs in tablet form are often prescribed. Commonly used active substances include aciclovir as well as valaciclovir and famciclovir. For recurrent genital herpes, longer-term suppressive therapy may be considered, in which the medications are taken regularly. This often reduces outbreaks and lowers the risk of viral transmission, but does not eliminate it entirely. In addition, cooling compresses, gentle cleansing of affected skin areas and avoiding friction can help relieve symptoms.

10 tips for prevention and holistic relief of herpes

Herpes simplex viruses remain in the body after an infection and can reactivate from time to time. A weakened immune system or stress often trigger a renewed flare-up, which is why a holistic approach is sensible. While an infection cannot be completely prevented or cured, certain behaviours can reduce the risk of transmission and help manage symptoms better. The following tips combine general hygiene measures, a mindful approach to potential triggers and medically established treatment options.

• Avoid direct contact during an outbreak: If you have visible cold sores, avoid close physical contact until the affected areas have fully healed. However, transmission is also possible without visible symptoms.
• Pay careful attention to hand hygiene: Wash your hands if you have accidentally touched an affected area or applied a cream. Avoid picking at blisters and do not touch your eyes afterwards. This can reduce the risk of spreading the virus.
• Avoid sharing personal care items where possible: Lip care products, razors or towels that have come into direct contact with affected areas should not be shared. It is particularly sensible to pay attention to personal hygiene items during an acute outbreak.
• Protect your lips from intense sunlight: For some people, UV exposure can trigger recurrent cold sores.⁵ A lip care product with an appropriate sun protection factor helps protect the lips from intense sunlight. Observe whether sunlight is associated with recurrent outbreaks for you personally and adjust your behaviour accordingly.
• Ensure sufficient sleep and regular rest: Lack of sleep and prolonged stress are associated with recurrent outbreaks in some people. Regular sleep patterns, rest breaks and a balanced daily routine can have a preventive effect, although they do not guarantee that herpes flare-ups will not occur.
• Reduce stress where possible: Certain relaxation exercises, walks, breathing techniques or enjoyable social activities can help you cope better with stress.
• Eat a balanced and varied diet: A well-balanced diet rich in vegetables and fruit, wholegrain products, legumes and suitable protein sources contributes significantly to health and personal well‑being.
• Support the normal function of your immune system: Zinc and vitamin C contribute to the normal function of the immune system when intake is adequate. Food supplements can be used within the framework of general health maintenance, but should not be regarded as a universal herpes prophylaxis, as additional supplements do not automatically prevent herpes or relieve an acute outbreak.
• Treat yourself and others with care: Herpes simplex is widespread and is not something to be ashamed of. If you know you are infected, you can talk openly with close contacts about transmission routes and protective measures. In the case of a primary infection, unclear skin changes or particular risks – for example during pregnancy – it is always sensible to seek medical advice.

Disclaimer

This article is not a substitute for treatment by a qualified practitioner. The basis of this contribution is studies and current literature. It must not be used for self-diagnosis or self-treatment. Discuss any ideas from this article with a practitioner you trust if necessary.

Biography

Katharina Korbach regularly writes blog posts about medicinal plants and natural active ingredients for the Narayana Verlag. Early on she developed an interest in language and began writing her own literary texts. A serious illness during her final school year led to an intensive engagement with health and nutrition topics that continues to this day. After repeated failures of conventional medical treatments, she opted for a more self‑effective naturopathic approach. A plant‑based diet was an important key in her healing journey.

Katharina studied Cultural Studies (B.A.) and Applied Literary Studies (M.A.). In 2022 she published her debut novel "Sperling" with Berlin Verlag. Today she lives in Berlin as a freelance writer, medical editor and lecturer. She prefers to spend her free time with friends or at barre training. She also loves travelling and trying out new vegan recipes.

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