Herpes simplex virus (HSV)

Herpes simplex virus (HSV), often called herpes, is a very common viral infection. It can cause painful sores or blisters on the skin or on moist areas of the body like the mouth, genitals, or eyes. HSV spreads mainly through direct skin-to-skin contact and is highly contagious. While there isn’t a cure, treatments can shorten or prevent outbreaks, ease symptoms, and lower the chances of passing the virus to others.

Primary care providers are typically the first point of contact for testing and treatment. In more complicated cases, especially for people with weakened immune systems, an infectious disease specialist may be involved in care. At Penn Medicine, our specialists provide expert guidance and support to help you control HSV, protect your health, and maintain your quality of life.

There are two main types of herpes simplex viruses:

• HSV-1: This type most often causes oral herpes (cold sores), which appear around the mouth or lips. It can also cause genital herpes and infections in other parts of the body like the eyes and fingers.
• HSV-2: This type most often causes genital herpes, though it can sometimes lead to oral herpes.

A first HSV infection may cause fever, body aches, headache, sore throat (with oral herpes), or swollen lymph nodes. Some people have no herpes symptoms or only mild ones, so they may not know they’re infected. Symptoms can vary in severity and frequency from person to person. Even without visible sores, HSV can still be transmitted, which is why ongoing care and prevention strategies are important.

When symptoms do occur, whether during the first outbreak or a later episode, they may include:

• Tingling, itching, or burning before sores appear
• Small blisters or open sores in or around the mouth and lips (oral herpes)
• Blisters, bumps, or open sores around the genitals or anus (genital herpes)
• Sores that may break open, ooze, and then crust over

HSV spreads through direct contact with infected skin or bodily fluids.

• HSV-1 is most often passed through close contact with another person’s saliva or the skin around the mouth, such as through kissing or sharing items like lip balm or toothbrushes. It can also spread to the genital area through oral sex. Transmission can occur even when no sores are visible, but it’s more likely when blisters or ulcers are present.
• HSV-2 is usually spread through intimate sexual contact involving the genitals or anus. Because the virus can sometimes be present on the skin without causing symptoms, many people may not realize they have it.

Both types of HSV are common and manageable. Practicing safer sex, using condoms or dental dams, and taking antiviral medication (when prescribed) can help lower the risk of transmission.

If you have visible sores, your provider may take a swab from a blister or ulcer and send it to a lab for testing. The most accurate test of these tissues is called a polymerase chain reaction (PCR) test, which looks for the virus’s genetic material. Sometimes a viral culture may be done instead, though this test is less sensitive once sores start to heal.

If you don’t have symptoms, your provider can do a blood test to check for antibodies, proteins your body makes in response to the virus. This shows whether you’ve had an HSV infection in the past. Because antibodies take time to develop, the test may not detect a very recent infection.

While there’s no cure, herpes treatment can help you manage the symptoms and live comfortably. Antiviral medicines are the most effective option as they can make outbreaks shorter and milder. When taken daily as suppressive therapy, they can reduce how often symptoms return.

If you have less frequent outbreaks, taking medicine only at the start of an outbreak may be enough. Over-the-counter pain relievers or numbing gels can also help ease discomfort from blisters.

With the right treatment plan and follow-up care, most people with herpes lead healthy, active lives.

Living with herpes simplex virus can raise many questions and concerns. At Penn Medicine, you’ll find specialists who understand this condition and will work with you to create a treatment plan that fits your needs. Our team provides the care and guidance you need to control symptoms, reduce the risk of transmission, and manage your health.