The facts about herpes simplex patient information leaflet
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It is very common!
Herpes simplex is the medical name for the virus that causes cold sores,
genital sores and whitlows on fingers or hands. It is common: in the UK,
seven out of ten people have probably caught cold sores somewhere on the
body by the age of 25 and the rate is even higher in other countries.
About four out of five of the people who have got the virus never have symptoms. It
is seldom of any medical importance. Serious complications are rare and
are usually restricted to people who catch the virus on the face.
How many types are there?
There are two types of cold sore virus: herpes simplex type 1 and herpes
simplex type 2. They are almost identical (they share over 90% of DNA).
Either type may cause spots or sores on any bit of skin. The most common
affected sites are the lips/face (up to two thirds of adults), and the
genitals (around ten per cent of adults in the UK, higher in the USA). There are
other herpes viruses including the ones that cause chickenpox and glandular fever.
What is the difference between the
At one time nearly all facial cold sore infections were caused by type
1 virus and type 2 was responsible for most genital herpes diagnoses of genital herpes.
This is no longer the case. Nowadays, half the new cases of genital herpes diagnosed in sexual health clinics, are caused by type 1 virus. The only practical difference is that each type
has a preferred site and is more likely to recur if caught
on the place it prefers - type 1 prefers the face and type 2 the genitals.
How and where can you catch
You catch herpes simplex by direct skin contact, usually with friction,
with the affected patch of skin of someone who has it already. This means
kissing, sex and/or oral sex. Transmission is very likely if there are
obvious spots or blisters, much less likely if there are no symptoms present.
It is not caught off towels, sheets, cups, cutlery, baths, swimming pools
or from blood.
It is easier for the virus
to affect thin skin (mucous membranes - lips and genitals) where the skin
is thinner. Usually 'normal' or 'dry' skin is too thick to allow easy
entry. However if skin is cut or broken in some way the virus may be caught
on other areas. People with eczema or sunburn for example, may catch the
virus elsewhere. It is also fairly common for people to have finger infections
(herpetic whitlows) because there is often broken skin on
the fingers - paper cuts, bitten nails, soreness caused by cleaning products
Can I catch it again
or give it back to my partner? What if my partner already has cold sores?
Herpes simplex is one of those childhood diseases you usually only catch
once (like chickenpox). If you and your partner have the same type of
herpes simplex you will not reinfect each other even on different
parts of the body.
If you each have different
types you could both catch the type you do not have - from each other.
You could catch one type in one place and another type elsewhere, or both
types in the same place. However, most people only catch one type.
If you do catch a second type it will be milder, so it is likely you will not even notice at the time
- and perhaps may never realise it.
Will I get recurrences?
Around half of those diagnosed only have symptoms once. Others have (milder)
recurrences from time to time. In most people these decline over time
and may stop altogether. If you are one of the unlucky people who gets too many recurrences, we can suggest both drugs and self-help suggestions to control them.
How does the virus hide in the body?
After infecting the skin cells the virus establishes itself in the nerves
serving that patch of skin. It travels along the nerve sheath to the nearest
nerve ganglion (nerve junction box) where it remains and does nothing.
If the virus decides to recur it usually travels back to the same bit
of skin. Sometimes it chooses a different nerve and appears nearby. However
the virus is stuck in the part of the body where you catch it. If you
catch it on the face it cannot recur below the chin; if you catch it genitally
it cannot recur above the level of the waist of a bikini. (Important note: sometimes people
catch the virus on two different sites on the same occasion e.g. hands
and genitals or face and genitals - it depends what they get up to. Once
primary symptoms have healed you will not spread the virus to other sites.)
Your doctor may prescribe antiviral pills, but these are not essential.
You will get better by yourself. Aspirin, paracetamol or ibuprofen can
help with pain. Also you can apply an anaesthetic gel or ointment to the
area to numb it: lidocaine 2% gel and 5 % ointment can be bought without prescription
at some chemists. The HVA can suggest other self-help treatments: see
website or phone helpline.
Whether you will get
another outbreak does not depend on the treatment you get but on your
own immune response.
How can I avoid passing on the virus?
Dont rub your affected bit of skin against someone else when you
have symptoms or think they may be on the way. Warning signs may be itching
or aching in the affected area.
Condoms can prevent
transmission if they are put on before there is any skin contact with
the affected skin area, and as long as they come in between the relevant
bits of skin. (Obviously!)
Remember that cold
sores on the face may be caught by doing oral sex with someone who has caught
the virus on the genitals and genital herpes may be caught
through oral sex from someone with facial cold sores.
Sometimes there may
be a small amount of virus on the skin without causing symptoms. This
is often just before a noticeable recurrence starts. This asymptomatic
shedding will usually be infrequent no more than 2% of the
time and may not be enough to infect a partner. It diminishes with
time. It is more likely to happen in the first year and especially in
the first four months after infection. People who have been diagnosed
usually recognise the warning signs of a recurrence before anything is
visible. This is the time to avoid sex/skin contact with the affected
Pregnancy and "www
Women with genital herpes can expect to give birth normally. Herpes simplex hardly ever affects babies although you could get the opposite
impression from some internet sites and books. Generally it is safe to
say that if you see any information about herpes simplex that is worrying
or frightening, it is probably incorrect - contact us for clarification.
We have a detailed leaflet on pregnancy and childbirth, another on transmission...
The trouble is that herpes simplex suffers from an unwarranted stigma. It is caught by most
people somewhere and many of us do not even notice. In the end it is only a skin condition with a ‘cold sore’ as a symptom - and is often trivial.
Information about recurrences and transmission of the virus to different
sites on the body assumes that you have a normal immune system. People who have some skin conditions such as eczema, or defective or suppressed immune systems immune systems may have extra problems with many infections including herpes simplex. In these cases doctors take extra steps to help them.
The Herpes Viruses Association says "If you see an article or website
about herpes that is scary, it is probably wrong. Contact us for the facts.".
See About us for contact details.
This page updated 5-8-2011
Professor Michael W Adler CBE MD FRCP FFCM
Dr B A Evans FRCP
Dr Raj Patel FRCP
Dr Colm O'Mahony MD FRCP BSc DIPVen
Dr Elizabeth Claydon MRCP MB ChB
Dr David Barlow MA BM FRCP
Dr Miriam Stoppard MD FRCP
Dr David Bull MBBS BSc
Dr Phil Hammond MB BChir MRCGP