Herpes 101: What Everyone Should Know About This Common STI

We get it—hearing the word "herpes" might make you a little uncomfortable. You might picture painful sores or worry about awkward conversations with partners. But with the World Health Organization (WHO), approximately 3.7 billion people worldwide having HSV-1 and nearly 500 million having HSV-2, herpes is incredibly common even though many people never develop symptoms or have such mild symptoms they don't realize they're infected.

We created this guide for you to walk through what herpes really is, how it spreads, what symptoms look like (if they appear at all), and how to manage this common infection in a practical, empowering way.

What Is Herpes, Exactly?

Herpes simplex virus (HSV) is a viral infection that can affect various parts of your body, most commonly appearing around the mouth or genital area. There are two main types:

HSV-1 (oral herpes): Primarily spreads through oral contact, causing infections in or around the mouth (often called cold sores), but can also cause genital herpes. Most adults worldwide have HSV-1.

HSV-2 (genital herpes): Typically spreads through sexual contact and primarily causes genital herpes, though it can occasionally infect the mouth through oral sex.

While they have preferred "territories," both types can infect either location. In fact, genital herpes caused by HSV-1 is becoming increasingly common, especially among young adults who may contract it through oral sex.

The Numbers: How Common Is Herpes?

The prevalence of herpes might surprise you. A recent Johns Hopkins Medicine study found:

• 50 to 80 percent of American adults have oral herpes (HSV-1), which causes cold sores
• Genital herpes affects about one out of every six people in the U.S. aged 14 to 49
• Worldwide, the numbers are higher: 67% for HSV-1 and 13% for HSV-2

These statistics show that herpes is extraordinarily common, though most people carrying the virus may not know they have it.

How Herpes Spreads

The herpes virus spreads primarily through direct skin-to-skin contact, typically when:

• Someone with oral herpes kisses another person
• A person with oral herpes performs oral sex (which can cause genital herpes)
• Someone with genital herpes has vaginal, anal, or oral sex
• Sharing items that touch sores (like lipstick or razors) with an infected person

An important fact to understand: HSV is most likely to be spread when an infected person is having an outbreak, but it can also be transmitted without any symptoms being present. This is called "asymptomatic viral shedding" and is one reason why herpes can spread so easily.

The Silent Nature of Herpes

One of the most confusing aspects of herpes is that many people never know they have it. Here's why:

• Most people with HSV-2 (genital herpes) do not know they have it because it does not always cause symptoms
• Even when symptoms do appear, they can be easily mistaken for other conditions like ingrown hairs, pimples, yeast infections, or razor burn
• The virus can remain dormant in your body for years before showing any symptoms

This silent nature of herpes is why regular STI testing is so important if you're sexually active with multiple partners.

Recognizing Herpes Symptoms (When They Appear)

When symptoms do show up, they can vary widely in intensity from person to person. Here's what to watch for:

First Outbreak

The initial herpes outbreak is usually the most severe and can include:

• Flu-like symptoms such as fever, chills, muscle aches, fatigue, and nausea
• Small, fluid-filled blisters that may appear in clusters
• Painful sores that may crack open, ooze fluid, and then crust over
• Burning or tingling in the affected area
• Pain when urinating (especially with genital herpes)
• Swollen lymph nodes

The first herpes outbreak typically lasts about 2 to 4 weeks and develops 4-12 days after contracting the virus, though the blisters can take 2-4 weeks to heal completely.

Recurrent Outbreaks

After the initial infection, the virus goes dormant in nerve cells but may reactivate periodically. The good news? Repeat outbreaks are usually shorter and less painful than the first one. Most people find that:

• Episodes become less frequent over time
• Symptoms are less severe than the initial outbreak
• The healing process happens more quickly (usually 7-10 days)
• They may develop a "prodrome"—tingling, itching, or burning that signals an outbreak is coming

The Stages of a Herpes Outbreak

When an outbreak occurs, it typically follows these stages:

1. Prodrome: An early group of symptoms that may include itchy skin, pain, or tingling at the infection site, usually 1-2 days before visible symptoms appear
   
   
2. Blisters appear: Small, fluid-filled blisters form on the affected area
   
   
3. Ulceration: The blisters eventually burst, leading to ulcers forming that can be quite painful
   
   
4. Crusting: The open sores begin to dry out and form scabs
   
   
5. Healing: The scabs fall off, leaving skin that may temporarily be redder or darker than usual but typically heals without scarring
   
   

What Triggers Herpes Outbreaks?

Several factors can trigger a dormant herpes virus to reactivate, including:

• Stress, illness, or a suppressed immune system
• Hormonal changes, including menstruation
• Fatigue
• Sun exposure (especially for oral herpes)
• Physical trauma to the area
• Friction from sex or tight clothing

Understanding your personal triggers can help you better manage the condition and possibly prevent some outbreaks.

Testing for Herpes

If you suspect you might have herpes, testing is straightforward:

• Visual examination: A healthcare provider may be able to diagnose herpes by examining visible sores
• Swab test: If sores are present, a provider can take a sample of fluid from a blister for testing
• Blood test: This can detect herpes antibodies even when no symptoms are present, though it can't tell you when you were infected

Twentyeight Health offers convenient, discreet testing options if you're concerned about herpes or other STIs.

Treatment Options: Managing Herpes Effectively

While there's no cure for herpes, effective treatments can help manage symptoms and reduce transmission:

Antiviral Medications

These are the primary treatments for herpes outbreaks:

• Acyclovir (Zovirax): An older medication that's often less expensive
• Valacyclovir (Valtrex): A newer medication that requires fewer daily doses
• Famciclovir (Famvir): Another option that works similarly

These medications can be taken in two ways:

1. Episodic therapy: Taking medication only when you have an outbreak to shorten its duration and severity
2. Suppressive therapy: Taking antiviral medicine daily can help reduce the risk of spreading genital herpes to your sexual partners and reduce the frequency of outbreaks

Home Remedies and Self-Care

During an outbreak, these strategies can help ease discomfort:

• Taking over-the-counter pain relievers like acetaminophen or ibuprofen
• Wearing loose-fitting clothing to prevent friction on sores
• Keeping the affected area clean and dry
• Applying petroleum jelly to genital sores before urinating to reduce stinging
• Taking warm baths to soothe genital sores
• Applying cold compresses to reduce pain and inflammation

Preventing the Spread of Herpes

If you have herpes, you can reduce the risk of transmitting it to partners by:

• Always using condoms and dental dams during oral, anal, and vaginal sex, though remember herpes can still spread through skin not covered by protection
• Avoiding sex during outbreaks, even with a condom
• Being aware of prodromal symptoms and avoiding sexual contact when you feel them
• Talking with your doctor about taking herpes medication every day, which can lower your chances of spreading herpes
• Having honest conversations with partners about your herpes status

It's worth noting that studies have shown that using daily antiviral medication reduced transmission rates from 4% to 2% over an eight-month period when couples were also advised to use condoms.

Herpes During Pregnancy

If you're pregnant and have herpes, don't panic. While there is a risk of passing the virus to your baby during childbirth (called neonatal herpes), this is relatively rare, especially if you've had herpes for some time before becoming pregnant.

Important things to know:

• Tell your healthcare provider about your herpes diagnosis
• If you have an active outbreak near your due date, your provider may recommend a cesarean section
• Medication may be prescribed during the last weeks of pregnancy to reduce the risk of an outbreak during delivery
• The risk is highest if you contract herpes for the first time late in pregnancy

Living Well With Herpes

A herpes diagnosis doesn't mean the end of your dating or sex life! Many people with herpes have healthy, fulfilling relationships. Here's how to thrive while managing herpes:

• Own your health status: Educate yourself about herpes so you can correct misconceptions and advocate for yourself
• Communicate openly: Have honest conversations with partners before becoming intimate
• Practice self-compassion: Remember that herpes is extremely common and doesn't define your worth
• Connect with support: Online forums and support groups can help you connect with others managing herpes
• Focus on overall health: A strong immune system may help reduce outbreaks, so prioritize sleep, nutrition, and stress management

When to See a Healthcare Provider

While herpes rarely causes serious complications, you should consult a healthcare provider if:

• You suspect you have herpes and want to confirm the diagnosis
• You're experiencing a first outbreak (these can be quite severe and may benefit from antiviral treatment)
• Your outbreaks are severe or frequent
• You're pregnant and have herpes or develop symptoms during pregnancy
• Herpes sores don't heal within two weeks
• You have a weakened immune system

Common Questions About Herpes

Can herpes be cured? No, there's currently no cure for herpes. Once infected, the virus remains in your body for life. However, many people successfully manage the condition with medication and self-care strategies.

Can I still have sex if I have herpes? Yes, but it's important to take precautions to protect your partners. Using condoms, avoiding sex during outbreaks, taking daily suppressive therapy, and having open conversations with partners can significantly reduce transmission risks.

Will I have outbreaks forever? Not necessarily. Many people find that outbreaks become less frequent and less severe over time. Some people have an initial outbreak and then never experience another one.

Can I transmit herpes without having symptoms? Yes. Asymptomatic viral shedding means the virus can be active on your skin without causing visible symptoms. Studies have shown that asymptomatic shedding occurs between 1% and 3% of the time in patients with HSV-2 genital infections.

Can I get herpes from a toilet seat or hot tub? No. The herpes virus doesn't survive long outside the body and is not transmitted through toilet seats, towels, or swimming pools.

The Bottom Line

Herpes is an incredibly common infection that, while not curable, is manageable for most people. With the right information, treatment, and support, you can lead a full and healthy life with herpes.

And if there’s one fact to remember, it’s this: Having herpes doesn't define you or your worth as a person or partner. Millions of people worldwide live with herpes and maintain healthy, fulfilling relationships and sex lives.

If you think you might have herpes or need support managing the condition, Twentyeight Health is here to help with discrete testing, treatment options, and supportive care that puts you in control of your sexual health.

This article was medically reviewed by Twentyeight Health's clinical team.