Herpes is a recurring condition, meaning it will be dormant for a while and then flare up in a breakout. How long can it stay dormant? Is there a point where you are "safe" from further outbreaks?
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Herpes, in this context, refers to herpes simplex, a virus that comes in two main forms, HSV-1 and HSV-2. This virus is highly contagious, very common, and stays in your system permanently once acquired (known as latency), though the early treatment of the initial infection may prevent this latency.
HSV-1 typically causes cold sores and is generally acquired in childhood. HSV-2 is the cause of genital herpes, a common sexually transmitted disease. However, HSV-1 can affect the genitals if you receive oral sex from somebody carrying it, and HSV-2 can affect the mouth if you give oral sex to somebody carrying it.
Many of us carry one or both of these viruses without knowing it.
HSV-1 is transmitted by skin-to-skin contact. It is typically acquired in childhood through intimate physical contact (but not necessarily sexual) between parents, caregivers, and other children. Furthermore, sexually active adolescents and athletes involved in contact sports such as wrestling may be at increased risk.
HSV-2 is transmitted sexually and is, thus, more common in people who routinely have unprotected sex, especially with strangers or multiple partners. It is more common for it to be transmitted from a partner with a penis to one with a vagina, so women and trans men are at higher risk.
It is very common for herpes simplex infection to be completely asymptomatic. However, symptoms often occur with the initial infection and may recur over time. The frequency of recurrence varies from individual to individual.
Symptoms of the initial infection with either form can be fever, body aches, and swollen lymph nodes.
With cold sores (oral herpes), sufferers experience a tingling, itching, or burning sensation, and then painful blisters erupt in or around the lips. They may rarely spread to other parts of the face, including the eyes.
Genital herpes is characterized by blisters or ulcers on the genitals or anus.
Symptoms typically disappear within about ten days but, again, may come back at a later time.
Here are some more details about the two types of herpes.
HSV-1 is a common herpes virus that is generally transmitted through skin-to-skin contact or, less commonly, shared surfaces and utensils. It is often transmitted by kissing.
It most often causes cold sores (oral herpes), although it can result in severe complications (rarely), especially in newborns. However, HSV-1 can cause genital infection if you receive oral sex from somebody with an active HSV-1 infection. HSV-1 infections of the genitals are less likely to recur as there’s a better immune response toward HSV-1 in this region.
HSV-2 causes genital herpes, a very common sexually transmitted disease. Most infections are either asymptomatic or so mild that the patient may not notice them. When symptoms occur, they typically include pain and inflammation in the genital area and possibly small blisters. It can also cause pain while peeing.
Like HSV-1, it can recur, although subsequent breakouts are typically less severe than the first. HSV-2 can also infect the mouth if you give oral sex to somebody infected. This is generally a milder disease that is less likely to recur.
HSV-1 is typically transmitted through simple skin-to-skin contact, especially face-to-face contact. More rarely, it can be transmitted via surfaces and shared objects, especially objects that touch the mouth or the area around it, such as drinkware, toothbrushes, lipstick, and razors. While it is necessarily considered a sexually transmitted disease, it can be passed on by kissing. Sometimes it infects the genitals through oral sex.
All in all, HSV-1 transmission occurs via oral-oral, oral-genital, and genital-genital contact or through contamination of the skin with infected secretions.
HSV-2 is most often transmitted through sexual intercourse, whether it is vaginal or anal. It can also be transmitted during oral sex and can sometimes infect the mouth. Though ultimately, the mechanisms of infection for both are identical.
Oral herpes is distinctive enough that it is typically diagnosed through a simple inspection. In fact, many people don't even go to the doctor. Your doctor may take a swab of your sores to run tests if they suspect it is something more serious or if there is reason to suspect the infection may be HSV-2. HSV-1 and HSV-2 respond to the same antiviral drugs.
For genital herpes, a swab is typically taken of the vagina, anus, or any present sores to test for HSV-2 and HSV-1. Sores can also be associated with other, more serious STDs, such as chlamydia, so it is important to get tested.
Yes. With oral herpes, most infections are asymptomatic. Not everyone develops cold sores. With genital herpes, between 65% and 90%¹ of people who have it don't know, either because they experience no symptoms or very mild ones that are easily mistaken for something else.
If you have ever had cold sores or genital herpes, then a strain of HSV is still in your system and can break out at any time or with certain triggers.
The typical incubation period for the initial genital herpes episode before symptoms occur, if they do, is 2–12 days. After the initial infection, both types of herpes can stay dormant for years. In a few cases, it has been known to stay dormant for decades.
The location, frequency, and severity of outbreaks are highly variable but are typical for a patient. Data suggest that they can occur as much as once a month or as infrequently as twice a year. But over time, they tend to decrease in number and severity. However, as the herpes virus remains in your body for life, you are still at risk of an outbreak, even if you have not experienced one for several years.
People who have had genital herpes and have been placed on long-term antivirals to reduce the frequency of outbreaks and protect their partners should continue taking the medication even if it has been long since their last outbreak.
Yes. You can spread herpes to others. The risk is highest if you have active sores. If you have cold sores, you should not kiss or otherwise seek physical contact with others and should not share utensils or towels. When caring for a baby, you should wear a surgical mask. Herpes can be severe in newborns.
If you have genital herpes, you should not have sex, even using protection, until your sores have cleared up. You should talk to your doctor about antiviral therapy that can keep you from passing it to your partner. Always use a condom when having sex, and use a condom or dental dam for oral sex — unless you are in a monogamous relationship with somebody clear of STDs.
It can be transmitted even when dormant, although the chances are much lower.
Herpes can remain dormant for years. In some cases, the infection may never show any symptoms. But you can still transmit herpes to others even if it is dormant, although the risk is lower. People with genital herpes may take viral suppression medication to reduce the risk of transmission to a sexual partner.
Even if you have not had a herpes outbreak in a long time, you still have the virus in your system, and an outbreak may still occur.
Genital herpes: A review (2016)
Herpes simplex type 1 (2022)
Genital herpes: Overview (2006)
Genital Herpes – CDC detailed fact sheet | Centers for Disease Control and Prevention