Signs of Herpes
Written by Ada’s Medical Knowledge Team
What are signs of herpes?
The signs of herpes are the observable manifestations of the herpes simplex virus (HSV).[^1]
Herpes, also referred to as herpes simplex and HSV, is a viral infection caused by the herpes simplex virus and generally transmitted through interpersonal contact. There are two types of the herpes simplex virus: HSV-1 and HSV-2, both of which can cause oral and/or genital herpes.
Herpes is a common condition in both men and women and highly contagious. Although there is currently no way to cure the condition completely, it is possible to effectively manage the signs and symptoms.
- In oral herpes, most signs and symptoms present in and around the mouth.
- In genital herpes, most signs and symptoms present around the genital region of both sexes.
Herpes should generally be thought of as a non-serious condition, in which complications are rare. If you are concerned that you may have herpes, try using the free Ada app to find out what the problem is.
The majority of people infected with oral herpes, or herpes labialis, will present no signs or symptoms and may thus be unaware of the condition. When oral herpes does present itself, the most common sign is the presence of blisters and ulcers in and around the mouth and lips, sometimes referred to as cold sores.
These ulcers will typically be red in color and sometimes bleed or weep puss; they may also be highly itchy and cause pain or discomfort. Although the mouth and lips are the most typical locations for ulcers to appear, they may also present themselves on the tongue, face or any other area of skin on the body.
In babies and toddlers, a first infection may be symptomless. If symptoms are present, these usually include a high fever and painful, ulcerating blisters in the mouth and pharynx, i.e. the cavity behind the nose and mouth. In babies, herpes simplex infection is also called herpetic gingivostomatitis or aphthous stomatitis. Refusal to eat or drink may be a sign that a baby or toddler is experiencing the pain associated with the infection.
Babies and toddlers who are affected should be treated with local anaesthetic medications, i.e. creams and gels, rather than antiviral medications. Always consult a doctor and check the instructions on the packet to ensure that the type medication is suitable for a child and to find out the appropriate dose.
After the initial outbreak, the herpes infection may become dormant and lead to recurrent outbreaks later in life. If you are concerned that you may have oral herpes, try using the Ada app to find out what the problem is.
Like oral herpes, the majority of people infected with genital herpes will be unaware of the condition. When signs and symptoms do appear, this can be weeks, months or years after the initial infection, though it is most common for them to appear after four to seven days.
When signs of genital herpes appear for the first time, they may include:
- Blisters around the genitals, rectum, thighs and buttocks. Commonly, these blisters will burst, becoming red and sometimes painful
- In women, blisters and ulcers may appear on the cervix
Symptoms which may also be present include:
- Pain when urinating
- General illness, including aches, pains and flu-like symptoms.
Blisters and ulcers will typically last for up to 20 days.
After the initial outbreak, the herpes simplex virus will remain dormant in the body. In some cases, no further outbreaks will occur, while in others, recurrent outbreaks are possible. Recurrent infections are generally less severe and last for a shorter period than the initial outbreak.
Signs of genital herpes in recurrent outbreaks include:
- Small blisters around the genitals, rectum, thighs and buttocks
- In women, blisters may also appear on the cervix
People may also experience a sensation of burning or itching around the genital area or legs, often before blisters appear.
In rare cases, herpes labialis can also cause blisters or ulcers to appear in and around the mouth and face.
Herpes esophagitis (herpes in the throat)
The herpes simplex virus (HSV-1 or HSV-2) can also affect the throat, leading to a condition known as herpes esophagitis. In these cases, the condition will typically cause no outward signs but will lead to symptoms such as:
- A sore throat
- Chest pain
- Irritation when swallowing.
Herpes esophagitis can sometimes indicate that an individual has a weakened immune system, which may be caused by a serious condition such as diabetes, cancer or HIV. For this reason, it is important to consult a doctor if there is any suspicion of herpes in the throat.
Herpes simplex eye infection
The herpes simplex virus (usually HSV-1) can, in some cases, spread to the eye, causing an eye infection. This will often occur when the virus reactivates itself after an initial infection, which may happen randomly or as, among other factors, a result of:
- An illness
- Eye injury
Signs that the herpes simplex virus has spread to the eye include:
- A red eye
- Swelling around the eye
- Watering of the eye
- Pain in the eye
- Sensitivity to light
- Blurred vision.
The infection will usually affect only one eye, though it is possible for it to occur in both.
If any signs of herpes in the eye occur, it is important to seek the advice of a medical professional urgently. If left untreated, the following complications are possible:
- Scarring of the cornea
- Glaucoma, leading to optic nerve damage which may result in blindness
- Loss of vision, though this is rare.
Herpes in men and herpes in women – is there a difference?
In general, the signs of herpes in men and women are the same. However, in regard to genital herpes, the exact location in which blisters and ulcers appear can differ.
Both men and women may develop blisters and ulcers around:
- The buttocks
- The thighs
- The anus.
Men, however, may also develop symptoms on:
- The penis
- The scrotum.
While women may develop them on:
- The vagina
- The vulva
- The cervix, which is the lower section of the uterus (womb).
In rare cases, if an ulcer on the cervix becomes infected, this can cause cervicitis, a condition involving inflammation of the cervix.
Maternal and neonatal herpes
If a woman is infected with the HSV during pregnancy, it is possible for the virus to be passed on to the newborn baby, normally during delivery. Although this is rare, the resulting neonatal herpes can pose serious risks to newborns.
Signs that a pregnant woman is infected with the herpes simplex virus are the same as those in non-pregnant people. The risk of neonatal herpes is highest in cases where the pregnant woman develops herpes for the first time in the late stages of pregnancy, as the body is unlikely to have the necessary antibodies for combatting the virus. Women with HSV in a latent form, i.e. who have had the virus previously without recurrence, have a very low risk of passing the virus onto the newborn baby.
Good to know: When acute/florid HSV infection is present around the time of the expected date of delivery, a Cesarean birth (C-section) will usually be recommended before the waters break to avoid the transmission of infection from mother to child.
Signs that a newborn baby has neonatal herpes include:
- Lack of energy
- Floppiness (limp limbs)
- High temperature
- High-pitched cry
- Breathing difficulties or grunting
- Rapid breathing
- Blue skin and tongue
- Skin rash.
If there is a suspicion of neonatal herpes, a doctor or midwife should be contacted as a matter of urgency. Treatment will typically involve the use of antiviral drugs administered intravenously over several weeks.
Causes of herpes
Herpes is caused by the herpes simplex virus, which typically enters the body through the skin around the mouth, genitals and anus. It is also possible for the virus to be passed on through other areas of skin on the body as well as the eyes, though this is less common.
Oral herpes is commonly passed on through activities such as kissing and sharing eating utensils, while genital herpes is typically transmitted through activities such as:
- Vaginal or anal sex; even with a condom, HSV can still be transmitted via skin-to-skin contact between a person with an active infection and others
- Sharing sex toys
- Close genital contact.
Herpes will typically be diagnosed through a physical examination, where a doctor will check for the signs and symptoms of the condition. This will generally be enough to diagnose herpes, to confirm the presence of the condition, however, laboratory tests, including blood tests, can also be ordered.
Treatment for herpes is aimed at managing the symptoms and controlling recurrent outbreaks. The most common treatment method is the use of antiviral creams and ointments, which will usually be applied at home. Antiviral drugs are also available to help manage herpes, though these are generally reserved for people experiencing recurrent outbreaks.
When to see a doctor or visit a sexual health clinic
Genital herpes is a sexually transmitted infection (STI), meaning that the most appropriate place to seek treatment may be a sexual health clinic. Most sexual health clinics operate a walk-in service, avoiding the need for an appointment. In most cases, oral herpes and the other forms of the condition are not STIs, meaning a general doctor’s surgery is the most appropriate place to seek treatment.
Seek treatment when any of the signs or symptoms of herpes appear.
To prevent spreading herpes to other people, care should be taken to avoid skin to skin contact during an outbreak of the condition. Activities such as kissing, sharing utensils and sexual activity should be particularly avoided.
Good to know: A condom does not offer effective protection against the transmission of HSV. Avoiding all sexual activity is recommended during an outbreak of herpes, because HSV can spread via any form of genital contact between a person with an active infection and others.
Signs of herpes FAQs
Q: What are the signs of a herpes outbreak coming on? A: People who experience recurrent outbreaks of genital herpes may come to recognize the early signs of a herpes outbreak coming on. These may include localized pain in the genital area and/or tingling and/or a shooting pain in the legs, buttocks or hips. Early signs and symptoms may present hours or days before the appearance of ulcers or blisters.
Q: What are the early signs of mouth and lip herpes? A: The early signs of mouth and lip herpes, otherwise known as oral herpes, typically manifest between 6 and 24 hours before the appearance of the first blister or ulcer. These early signs include tingling, pain and/or itching in and around the mouth or on the lips.
Q: What are the signs of anal herpes? A: Anal herpes is not a form of herpes in itself; the term refers to the development of signs of genital herpes in the anal area. The most typical sign of anal herpes is blisters or ulcers in or around the anus, which may become painful.
Q: What are the signs of herpes on the tongue? A: In some cases, oral herpes, or herpes labialis, can cause signs and symptoms to appear on the tongue. This will most likely be ulcers, which will typically be red in color and may cause some pain.
Q: What is the relationship between cold sores and herpes? A: Cold sores are an alternative name for the blisters and ulcers experienced as a symptom of oral herpes. Cold sores, therefore, are caused by the HSV virus, most typically HSV-1, but in rare cases HSV-2, the virus responsible for genital herpes. Most people will first experience cold sores in childhood.
Q: Can oral herpes become genital herpes? A: Although it may be misleading to say that oral herpes can become genital herpes, it is the case that the virus that typically causes oral herpes, HSV-1, can also cause genital herpes, which is more usually caused by HSV-2. This means that a person with HSV-1 can cause genital herpes in another person through oral sex, even if they are not displaying symptoms of the condition.
^1]: American Academy of Dermatology. “Herpes Simplex.” Accessed: October 16, 2017.
UpToDate. “Patient education: Genital herpes (Beyond the Basics).” July 5, 2017. Accessed: July 10, 2018. ↩
The New Zealand Herpes Foundation. “Reassurances about Genital Herpes during pregnancy and birth.” Accessed: October 20, 2017. ↩