X
More than 60,000 patients use Brite
4.6 stars
Your health finally understandable with Brite
Enter email and you're done. No subscription, no credit card.
Search, tap and you're done. Over 3,400 medicines.
Check, remind, get an overview.
Sarah K., 34
I finally understand my therapy. The app reminds me, answers my questions — and I don't feel alone with it anymore.
At a glance
Record in brite when your flare-ups happen and what triggers them — and get reminded to reach for your cream or tablet at the first tingling. Free of charge.
Herpes on or around the eye, as well as blisters in newborns, pregnant women and people with a weakened immune system, always need medical assessment — do not treat these yourself.
Herpes is a very common infection with the herpes simplex virus (HSV). Typical are the small, grouped blisters that burn, itch and crust over after a few days — best known as cold sores („fever blisters“) and as genital herpes. The virus is widespread: most adults carry it, often without ever having had noticeable symptoms.
What is special about herpes viruses is that after the first infection they never leave the body. After the first contact they retreat into certain nerve ganglia and stay there in a dormant state for life — this is called latency. From there they can „wake up“ (reactivate) again and again and trigger a fresh flare-up. This explains why herpes typically comes back in the same spot every time: on the lip, at the entrance of the nose or in the genital area.
You can picture it like a dormant lodger in the nervous system: as long as the immune system keeps it in check, it stays invisible. Only when the defences are weakened or irritated by certain triggers does the virus travel back along the nerve pathway to the skin and cause a fresh outbreak there. That is why herpes cannot be permanently „cured“ — but the individual flare-ups can be treated well, shortened and, with the right strategy, often made less frequent too.
There are two closely related types of the herpes simplex virus that could long be clearly assigned — today they increasingly overlap:
| Feature | HSV-1 | HSV-2 |
|---|---|---|
| Classic site | Lips, mouth, face | Genital and anal area |
| Most common form | Cold sores (herpes labialis) | Genital herpes (herpes genitalis) |
| Transmission | Usually in childhood, often via saliva/kissing | Usually through sexual contact |
| Prevalence | Very high — most people have had contact | Rarer, but also widespread |
| Tendency to recur | Often on the lip | Genital often more frequent than HSV-1 there |
Important to know: the strict division „HSV-1 belongs on the lip, HSV-2 in the genital area“ is no longer accurate. Both types can occur at both sites. Genital herpes in particular is today in many cases caused by HSV-1 — for instance through oral sex, in which the lip virus reaches the genital area. For treatment the exact type usually does not matter much: the antiviral agents work against both. For counselling, the risk of recurrence and prevention, however, the distinction can be helpful, because genital herpes caused by HSV-2 recurs more often on average.
Alongside these two main forms there are further variants: herpes at the entrance of the nose, on the cheek or on the chin, herpes of the eye (herpes keratitis, an ophthalmological emergency), as well as special situations in small children (the painful first infection in the mouth, „mouth rot“) or in people with a severely weakened immune system. The basic principle always stays the same: the same virus, the same latency, the same treatment routes.
A herpes flare-up almost always runs the same pattern — and knowing this pattern is the key to the right treatment. Because the decisive phase comes right at the start, before any blisters are even visible.
With the first infection the symptoms are often stronger than with later flare-ups: more extensive blisters, pain, swollen lymph nodes, fever and a general feeling of illness can be added. With genital herpes the first infection is especially unpleasant — with painful blisters, burning when passing urine and swelling. Later reactivations are usually milder and shorter, because the immune system already knows the virus. The accompanying itching and burning are annoying, but a typical part of the course.
The actual cause is always the same: the herpes simplex virus lying dormant in the nerve ganglion. A flare-up does not arise from a new infection, but from a reactivation of the virus already present. The interesting question is therefore: what makes the dormant virus become active again? This is where the triggers come into play — and knowing them is one of the most effective levers against frequent flare-ups.¹
The triggers vary from person to person — and that is exactly what makes personal trigger management so effective. Anyone who notes over a few weeks when a flare-up occurs and what preceded it will quickly spot patterns: is it always the sun? Always a stressful phase? Always after an infection? Once the pattern is clear, many flare-ups can be avoided — for example through consistent use of a UV protection stick for the lips on holiday, or by acting early at the first signs of an infection.
On the subject of transmission many guides make it too easy for themselves. So here is the honest part: herpes is contagious — namely through direct contact with the fluid of the blisters or with the virus in saliva or genital secretions. It is transmitted through kissing, shared glasses or towels, oral and sexual intercourse, as well as by touching your own blisters and then touching other parts of the body (the eyes, for instance).
The most contagious phase is the one with weeping, open blisters. Sensible precautions during an active flare-up are: do not kiss (with cold sores), no shared glasses or towels, do not touch the blisters and wash your hands thoroughly after contact, no contact with newborns and people with a weakened immune system. With genital herpes, condoms lower the risk of transmission but do not remove it entirely, because not all of the skin is covered.
Diagnosis: in most cases the doctor recognises herpes at a glance from the typical appearance of the grouped blisters — a visual diagnosis. In unclear cases, with genital herpes, in a severe course or in special situations (pregnancy, weakened immunity), a swab is taken from a fresh blister and the virus is detected directly in the laboratory (PCR). A pure blood test for antibodies only tells you that there was contact at some point — it is not suitable for confirming an acute flare-up and is therefore only used in certain situations.
If you take only one thing from this article, let it be this: with herpes, the timing decides whether the treatment succeeds. Antiviral agents such as aciclovir only slow the virus while it is actively multiplying — that is, right at the start of a flare-up. Once the blisters are fully formed or already crusting over, the moment for drug treatment has largely passed.¹
This also explains why many people are disappointed when a herpes cream „does nothing“: usually it was simply applied too late. The trick is to start the treatment at the very first signs — not only once you can see the herpes. That is why it pays to keep an antiviral cream at home and when travelling at all times, so you can react immediately at the decisive moment.
The treatment depends on how strong and how frequent the flare-ups are and where they occur. As a rule: mild cold sores can often be treated with a cream, while pronounced flare-ups and genital herpes usually need tablets.¹,²
With frequent recurrences (roughly from six or more flare-ups a year, especially with genital herpes) there is a further option: long-term or suppressive therapy. Here a low dose of an antiviral agent is taken daily over months. This markedly reduces the number of flare-ups, eases the symptoms and additionally lowers the risk of passing the virus on to others unnoticed. Whether such a therapy makes sense is something you decide together with your doctor's practice.
brite reminds you of your therapy and helps you document your flare-ups and triggers — so you never miss the time window.
Because herpes stays in the body, the most important long-term strategy is not fighting the virus but avoiding reactivations. This is where you make the biggest difference in everyday life — often without a single medicine:
The crusts themselves also want looking after: do not scratch them open and do not prick them, because both encourage an additional bacterial infection and can leave scars. Gentle care, hand-washing after touching and a patch over the spot help the skin heal cleanly. Another, rarer but important point: the spread of the blisters to other parts of the body via your own fingers — above all transfer to the eye should be avoided at all costs.
Ordinary cold sores heal on their own and are harmless. But there are situations in which herpes must be medically assessed or even treated as an emergency. You should know these:
With herpes, the early start and knowing your triggers count. brite helps you hit the decisive time window, document your flare-ups and recognise patterns — so the next treatment takes hold faster and flare-ups become less frequent.
Document your flare-ups in brite and find out what triggers them — the first step towards fewer outbreaks.
