Herpes is a very common infection caused by HSV-1 and HSV-2. Approximately a third of the world’s population aged 0–49 have oral herpes, and half a billion have genital herpes. According to the Centers for Disease Control and Prevention (CDC), many with herpes are unaware they have an infection, with an estimated 87.4% aged 14–49 going undiagnosed.¹ ²
While we don’t currently have a cure for herpes, most people with herpes lead perfectly normal, healthy lives. The impact of the condition can vary from person to person. Most herpes outbreaks are not deadly, and they’re usually harmless in children and adults. However, neonatal herpes can be very serious and lead to fatality.
Let’s learn more about herpes transmission, treatment, and complications.
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A herpes infection can cause oral herpes or genital herpes. Some people infected with herpes are asymptomatic but remain contagious.
A wide range of herpes symptoms can be very similar to other conditions, making it somewhat difficult to detect in the absence of obvious sores.
Herpes sores may look like pimples at first. If they’re associated with flu-like symptoms, such as a fever, you might mistake it for another condition altogether.
Many people feel a tingling or burning sensation before the sores appear. Herpes sores can appear on several parts of the body:
They can appear as blisters, which can break and turn into sores. The sores are the most infectious symptom of herpes. Even in the absence of external sores, herpes sores can also be found on the cervix or inside the urethra, causing painful issues that may be hard to diagnose.
The initial outbreak usually causes more severe symptoms. It often lasts 2–4 weeks and begins 2–20 days after exposure to the virus. However, the first outbreak can also occur years after exposure. Repeated outbreaks are more frequent in the first year following the first outbreak.
Besides sores, herpes can also cause:
Itching and burning sensations
Oral herpes doesn't cause as much of a feeling of general illness as genital herpes.
Herpes can be much more debilitating and even fatal for babies.
A baby’s symptoms may include:
Blisters anywhere on their body
Jaundice (yellowing of the skin and eyes)
Not breathing for short periods
Blue appearance (cyanosis)
There are many strains of herpes. Common ones include:
Varicella-zoster virus, which causes chickenpox (varicella) and shingles (herpes zoster)
Herpes simplex (HSV-1 and HSV-2), which causes cold sores and genital herpes
Epstein-Barr virus, which can cause mononucleosis (mono)³
The location of outbreaks does not confirm whether your sores are due to HSV-1 or HSV-2. Both types of herpes can occur in either the mouth or the genitoanal region. You can have both forms of herpes, as having one doesn't stop you from contracting the other.
Herpes is usually not usually a serious health condition, and fatality is extremely rare in children and adults with strong immune systems. While neonatal herpes infection is rare, it can lead to significant complications and even death.
Yes, neonatal herpes can be fatal for newborns. Fortunately, estimates state that only about 12–60 newborns per 100,000 (depending on region) contract neonatal herpes.
There are three types of neonatal herpes:
Skin, eyes, and mouth (SEM)
Encephalitis (CNS infection)
Disseminated disease affecting multiple organs
The survival rate depends on the type, with SEM never being fatal, while the disseminated variant has an 85% mortality without treatment. Treatments significantly improve the survival rate and reduce the likelihood of disabilities.⁴
Central nervous system (CNS) infection is somewhat rare in newborns, but the fatality rate is up to 60%. Prevention and early treatment are vital, as complications can be devastating.
In adults, fatality from herpes infection is extremely rare and is caused by the spread of infection, leading to sepsis and organ failure.⁵
Herpes infection can mimic cervical cancer because it can create ulcers on the cervix even when there are no noticeable skin lesions.⁶
In rare cases, herpes infections of the CNS can lead to encephalitis (brain inflammation), which can be fatal. This primarily happens in newborns and people who are immunocompromised.⁷
Herpes simplex virus spreads through skin-to-skin contact and sexual contact. While it's impossible to spread the virus by sharing food and drinks, a small kiss may be all it takes. This is especially true when kissing someone experiencing an oral outbreak. Comparatively, it's even more contagious during sexual activity, whether involving the mouth, genitals, or anus.
Genital herpes is more commonly spread through sexual activity, whereas oral herpes spreads more often through skin-to-skin contact or contact with someone’s infected saliva.
Herpes can also be passed from a mother to her baby, especially during vaginal delivery if the mother is experiencing a genital herpes outbreak. This is why a pregnant woman needs to tell her doctor if she has a history of herpes or suspects infection. If the mother has herpes, they can treat her accordingly and try to prevent the infection from spreading to her baby.
As herpes can spread so easily through a simple kiss or skin-to-skin contact, it’s crucial to avoid nuzzling or kissing an infant if you have a herpes infection to reduce their risk of contracting neonatal herpes.
Oral herpes can cause outbreaks of cold sores on and around the lips. They can be painful, and stopping the spread of cold sores requires some lifestyle changes.
If you’re experiencing periodic oral herpes outbreaks, you can reduce your potential spread by taking precautions and medications as soon as possible during an outbreak. Speak to your doctor for advice on what’s best for you.
Safe sex is also recommended, as cold sores can spread to the genitals through oral sex, especially during an active cold sore outbreak.
Genital herpes requires making certain lifestyle modifications, such as:
Always using condoms to reduce risk during sexual contact
Abstaining from sex during outbreaks
Discussing STDs with sexual partners
Pregnant women with genital herpes can increase the health outcome of their baby by seeking treatment and advice from their doctor as early as possible.
You can lead a normal, healthy sex life with oral or genital herpes. It requires several safeguards to protect you and your partners. The specific precautions may depend on whether the partner also has herpes, especially if it’s a different strain. If they don't have herpes, safe sex is critical.
In either case, it's important to have a candid conversation about it. From there, limit or abstain from sexual activity during outbreaks. During sexual activity, condoms will help prevent the spread, but they will not guarantee protection. Suppressive therapy is also available to reduce the frequency and duration of outbreaks.
While there's no known cure for herpes, treatments like medications and specialty creams can lessen the pain and prevent future outbreaks from occurring as frequently.
Other commonly recommended herpes treatments to lessen the pain include:
Ice packs on the sores
Soft, loose cotton clothing
Reducing stress when possible
Pat-drying the region around the sores
Keeping the sores clean and not picking at them speeds healing. Pain relievers can help reduce the temptation to scratch or itch cold sores.
It's still unknown what exactly triggers individual outbreaks, but specialists believe that they occur more often due to:
Poorly managed stress
Hormonal fluctuations (including periods)
Oral herpes outbreaks can be caused by:
Injuries and irritation to the lips
Sunburns and sun exposure
Herpes infections are incredibly common, with symptoms ranging from nothing at all to painful sores. There is also the potential for complications, such as cervical ulcers or CNS infections.
Newborns are especially susceptible to fatality and complications caused by a herpes infection. For the many millions of adults who have HSV-1 and HSV-2, it is extremely rare for herpes to lead to death. Almost everyone with herpes can lead a normal and healthy life.
Genital herpes – CDC detailed fact sheet | Centers for Disease Control and Prevention
Massive proportion of world’s population are living with herpes infection | World Health Organization
Chapter 68 herpesviruses (1996)