Cold sores and genital herpes explained

What the herpes simplex virus is

Herpes simplex is a common virus that comes in two closely related types. Type 1 (HSV-1) traditionally causes cold sores around the mouth, and type 2 (HSV-2) traditionally causes genital herpes, but either type can affect either area, partly because of oral sex. After the first infection, the virus does not leave the body; it stays dormant in nearby nerves and can reactivate later, causing further outbreaks. Many people who carry the virus never notice symptoms, or have such mild ones that they do not realise. This is why the virus is so widespread and why it can be passed on by someone who has no visible sores. Understanding this helps take some of the fear and stigma out of a very ordinary infection.

Cold sores

Cold sores usually begin with a tingling, itching or burning feeling around the lips, followed by small fluid-filled blisters that burst, crust over and heal, typically within one to two weeks. The first-ever infection, often in childhood, can be more unpleasant, sometimes with sore gums and feeling unwell, but later outbreaks are usually milder. Cold sores often return, and triggers can include being run down, other infections, stress, strong sunlight and, for some women, their periods. They are contagious, especially when blisters are present, and spread by close contact such as kissing or sharing items like cups, cutlery, towels or lip products. Most cold sores clear on their own, but antiviral creams or tablets can help if started early, and a pharmacist can advise.

Genital herpes

Genital herpes causes small blisters around the genitals or anus that burst to leave sore, red areas, sometimes with pain when passing urine, itching or flu-like symptoms during a first episode. As with cold sores, the first outbreak is often the worst, and later ones tend to be milder and shorter. Some people have frequent recurrences and others very few. Genital herpes is a sexually transmitted infection, so it is best assessed and diagnosed at a sexual health (GUM) clinic, where testing and confidential advice are available. Being diagnosed can feel distressing, but it is a common and manageable condition. Antiviral tablets can treat outbreaks and, for people with frequent recurrences, can be taken regularly to reduce how often they happen.

How herpes spreads and how to reduce the risk

Herpes spreads through direct skin-to-skin contact with the affected area, including kissing for cold sores and vaginal, anal or oral sex for genital herpes. It is most infectious when sores are present, but can also be passed on when there are no visible symptoms, because the virus can be shed from the skin quietly. You cannot catch it from toilet seats or towels left lying around in the way many people fear, though sharing items during an active cold sore can spread that. To reduce the risk, avoid kissing and oral, vaginal or anal contact when sores are present, use condoms, which lower but do not remove the risk, and avoid sharing items when you have an active cold sore. Being open with partners allows shared, informed decisions.

Living with herpes and special situations

For most people, herpes is an occasional nuisance rather than a serious health problem, and outbreaks often become less frequent over time. Simple self-care — keeping the area clean, pain relief such as paracetamol, and antiviral treatment when needed — helps manage outbreaks. A few situations need extra care. People with a weakened immune system can have more severe or persistent outbreaks and should seek medical advice. Herpes near the eye can affect vision and needs prompt assessment. Genital herpes in pregnancy is important to discuss with a midwife or doctor, especially a first infection late in pregnancy, because of a small risk to the baby around birth; with the right care this is usually managed safely. If in doubt, a GP or sexual health clinic can offer tailored advice.