Despite the stigma that surrounds it, herpes is a very common condition. According to the World Health Organisation, 3.7 billion people under the age of 50 have herpes simplex virus type one (HSV-1) - 67% of the world population. A further 417 million people are believed to have herpes simplex virus type two (HSV-2). But despite being so common, many people with the herpes virus will only have outbreaks very rarely - and others with the virus may never experience symptoms.
For people who do experience symptoms, a herpes outbreak can be both painful and embarrassing. But while there is currently no cure for herpes, what many people don’t realise is that the condition is highly treatable. If you’re currently suffering an outbreak, or want to prevent one occurring, there are treatments that can effectively manage the condition. But what are these treatments? What’s the difference between HSV-1 and HSV-2? And will there ever be a cure for this common but frowned-upon condition? We reveal all in our ultimate guide.
What is herpes?
Herpes is the shortened name for the herpes simplex virus, a viral infection that comes in two types: herpes simplex virus type one (HSV-1) and herpes simplex virus type two (HSV-2). Both types are very common, highly contagious, and present with symptoms that tend to occur during intermittent outbreaks.
What is the difference between HSV-1 and HSV-2?
Both types of herpes present with similar symptoms. The difference, however, tends to be the part of the body where symptoms appear. HSV-1 produces mostly cold sores - painful blisters that appear around the lips, mouth or nose. HSV-1, on the other hand, produces blisters that appear on and around the genitals, which are referred to as ‘genital herpes’. However, it’s important to remember that this isn’t a hard and fast rule: HSV-1 can sometimes produce sores in the genital region, while HSV-2 can produce sores around the mouth.
What are the symptoms of herpes?
Most people with herpes will never experience any symptoms at all. However, herpes is almost always characterised by blisters in the skin or mucous membranes of the mouth, lips, nose or genitals. As they heal, the blisters will form a scab, but these shouldn’t scar as long as they aren’t broken in the healing process.
If you contract the virus, the first outbreak may also present with flu-like symptoms. These include:
- Swollen lymph nodes
- Headache
It’s important to remember that while HSV-2 appears generally in the genital area, the actual location of an outbreak can change quite significantly.
Genital herpes in men and women can appear:
- On the buttocks and thighs
- In and around the anus
- In the urethra
- Around the mouth
In women, sores can appear:
- In the vagina
- Around the genital region
- In the cervix
In men, sores can appear:
- On the penis
- On the scrotum
After the initial outbreak, you may experience symptoms shortly before recurrences happen. These include:
- Burning, tingling or itching in the area you were first infected
- Lower back pain
- Pain in the buttocks and legs
Recurrences tend to be less painful than the original outbreak, and heal quicker as well.
What does herpes look like?
Herpes sores usually present as fluid-filled blisters. Over a few days, the sores break open, ooze, and then scab over before finally healing. Sores can either appear in isolation or as parts of clusters.
How do you get herpes?
As mentioned before, herpes is highly contagious. In most cases, it is transmitted through skin-to-skin contact with the affected areas. This can take place through:
- Kissing
- Vaginal and anal sex
- Oral sex
- Genital-to-genital rubbing
However, it’s important to remember that you can spread herpes to other areas of your body as well. Scratching an infected region and touching your face, for example, can cause the virus to spread to the area you touched. And you don’t have to be engaged sexually with a person to pass herpes to them, either. A peck on the lips is all it takes to pass the virus from one person to another.
Another reason why herpes is so common is because it can be spread even when the person transmitting it has no symptoms. This is a form of transmission known as ‘asymptomatic shedding’, and happens more often during sex than contact with lesions does. This is why it’s important to wear a condom when having sex, be open with your sexual partners about STIs, and see a doctor or sexual health clinic if you think you may have genital herpes.
What treatments are there for herpes?
Most outbreaks of cold sores and genital herpes will go away without treatment. If you want to make an outbreak less troublesome, soaking the affected area in warm water can help the pain, as will over-the-counter painkillers such as paracetamol and ibuprofen.
However, if you’re struggling with frequent outbreaks, or need to avoid an outbreak for whatever reason, there are antiviral medications that can suppress the herpes virus effectively. These include:
- Aciclovir - an antiviral that works by preventing the herpes virus from reproducing, thereby reducing symptom severity
- Valaciclovir - the precursor to aciclovir, which is converted to aciclovir in the body. Valaciclovir is better absorbed by and remains longer in the body, meaning less frequent doses are required
- Valtrex - a medically-equivalent, branded version of valaciclovir
Each of these medications have two uses: outbreak control and suppression. The first is to stop an outbreak when it emerges, and only requires the medication to be taken for a few days. Suppression, on the other hand, is designed to stop an outbreak occurring over an extended period of time. You might choose to use this, for example, if you have important events coming up in your life that you want to avoid an outbreak for.
What are the side effects of aciclovir and valaciclovir?
Like most medications, aciclovir and valaciclovir can cause side effects. However, these are usually mild. They include:
- Nausea and vomiting
- Diarrhoea
- Abdominal pain
- Headaches
- Dizziness
- Skin rashes
In rare cases, some side effects will require immediate medical attention. These include:
- Signs of kidney problems, such as urinary changes and back/side pain
- Mood changes, including agitation, confusion and hallucinations
- Shaky or unsteady movement
- Difficulty speaking
- Signs of a severe allergic reaction, including rash, itching, swelling, severe dizziness and trouble breathing
When will herpes be cured?
The question as to whether herpes can be cured has an interesting history. There is essentially nothing special or important about herpes as a medical condition: the vast majority of humanity has at least one type of herpes simplex virus, most people experience no symptoms at all and people who do only experience it in bouts. But when the company who developed aciclovir took the product to market under the name Zovirax in the 1980s, it needed to give people a reason to care. As it turned out, calling herpes ‘incurable’ was a great way to turn heads.
The supposed incurability of herpes was a good marketing strategy. But in reality, it means very little. Think about this: what do we know about the common cold? Most people get it at least once a year. When we do get it, do we ask for a cure? No. We blow our noses, take paracetamol, wrap ourselves in blankets and wait for it to go away. But that doesn’t change the fact that, no matter how hard we try, the common cold will always come back.
In many respects, herpes is exactly the same. And it’s easy to think differently by turning the logic on its head: instead of thinking about herpes as an incurable condition, could you not also say that herpes is ‘cured’ whenever you’re asymptomatic? Herpes isn’t a progressive illness - it comes and goes in different frequencies. If it really was incurable, the symptoms would never go away. Instead, it goes away by itself - much like the common cold.
So if you get cold sores or genital herpes, don’t worry about when there’ll be a cure. Instead, remember that your symptoms are temporary and there are treatments to make them less severe.