The Outbreak Guide

This is a guide of how to deal with all herpes outbreaks both oral and genital. This is collected data from polls on Reddit, the support group, internet research, TikTok, and personal experience. Please talk to your doctor before making any drastic changes to diet or supplement intake.

Also it is important to remember that each person is affected by HSV differently and while some things are triggers for some they may not be for you. Same for solutions and treatments, to some they may be the fix all but they may not work for you. Herpes is an interesting virus that presents itself differently to everyone. There is no magic cure. This is meant to be a guide of things that have worked for others and save you a bunch of research, this is NOT meant to be an outbreak bible to follow blindly.  ALWAYS consult a doctor before making any drastic changes to diet, exercise, supplement intake or medication changes. It is also important to understand that with most treatments consistency is key. Most treatments for herpes take time to start working so if you do not see results right away give it some time before trying something new. This is especially true for your first outbreak.

If you have anything to add, or change PLEASE reach out on Reddit: Mylovelyladylumps69, IG: Bubblieinblu,  Tiktok: Bubblieinblu, or Discord: Bubblieinblu / The Herpes Questions Discord Chat  HOWEVER I will NOT look at any scam websites that claim that they “cured” herpes. I will also  NOT look at images of a herpes outbreak and diagnose you / tell you if it is herpes.

Table of Contents

Common Outbreak Myths:

Herpes Prognosis:

How is Herpes Related To Your Immune System:

Hormones / Menstrual Cycles / Pregnancy:

Overall Supplement & Vitamin List:

Diet Choice:

Alcohol & Other Substances:

Herpes Prodrome Symptoms:

Types of Herpes Outbreak:

Things Commonly Confused With Herpes:

Oral HSV Info/Prevention/Remedies:

Genital HSV Info/Prevention/Remedies:

Herpetic Whitlow (Finger Herpes):

Ocular Herpes:

Tips For Herpes Scarring:

Tips For Nerve Pain:

Tips For Painful Urination:

Antiviral Information:

Where Antivirals CHEAP (With or Without Insurance):

Outbreak Prevention For Fitness:

Sources To Look At:

Herpes Cure / Vaccine:

Herpes Outbreak AI Tool: This site you can use as a herpes coach you can ask it questions and it will pull answers based on this document and the cited sources.   https://notebooklm.google.com/notebook/8ce08509-050f-4603-b5f2-d6614604a059 

Herpes Tracker: Hi 👋 my name is Romain. I'm building 👄 Herpes Tracker to understand what triggers my herpes outbreaks 🦠 and how to best manage the condition. If you need anything, please reach out at romain@herpestracker.com. PS: I would love for you to take part in building Herpes Tracker. Join me as a Lifetime Founding Member to help create this tool! herpestracker.com 

Outbreak Guide Overview AI PodCast:

This is an AI generated podcast that analyzes this document to make a comprehensive audio overview. Unfortunately I cannot upload audio alone so I made it into a video. https://youtu.be/927VELqlJ34?si=9scD9hHvzpxIhEKK 

Common Outbreak Myths:

This is a list of common myths about herpes and why they are wrong with cited sources.There are specific sections for outbreaks & treatment myths. https://docs.google.com/document/d/1-6oZmnfywTFNYScKYC7Mh7MXZKrA0GUcztS8Bz5bW0k/edit?usp=sharing 

Herpes Prognosis:

During your first outbreak it may feel as if you are doomed to have endless painful outbreaks for the rest of your life. But this is not true for most people. For most people with herpes the first outbreak is the worst and all other outbreaks are more mild. The longer you have herpes the less symptoms and outbreaks you will tend to have, and the outbreaks that you do have will tend to be more mild and not painful.

The reason for this is that in order to fight off herpes outbreaks your body needs to produce antibodies to fight off herpes. The longer your body has herpes the better your body becomes at producing the antibodies. So your body does not have as severe of a reaction to the herpes cells.

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Also over time you will become better at understanding your triggers, treatment  and symptoms. When you are first diagnosed all of the herpes stuff is new to you meaning that you most likely do not know how to properly treat it or it could take time to get the medication that you need. Some people (myself included) not only didn’t use proper treatment methods during their first outbreak but did things that made it worse and lasted longer due to lack of knowledge. Most herpes treatments work best when you start them early or when you first feel symptoms which is unlikely to happen during a first outbreak. By understanding your triggers you will be able to avoid things such as stress, certain clothing and in some rare cases certain foods which will lead to less outbreaks overall. Different treatments and triggers affect people with herpes differently and it takes trial and error to figure out what will work best for you. Unfortunately with herpes there is no magic cure that works for everyone so do not give up or get discouraged.

How is Herpes Related To Your Immune System:

An important thing to remember at the end of the day is herpes is just a virus, Herpes Simplex Virus, and though it may seem scary due to the stigma, understanding how viruses work can help make it less scary. A virus is a tiny infectious agent that can only reproduce by invading the cells of a living organism. On its own, a virus is not considered truly “alive”; it’s more like a genetic parasite wrapped in a protein shell.

How a Virus Works:

  1. Attachment: The virus sticks to the surface of a host cell (like a human cell).
  2. Entry: It injects its genetic material or enters entirely.
  3. Hijack: The virus takes over the cell’s machinery to make copies of itself.
  4. Assembly: New virus particles are assembled inside the host cell.
  5. Release: The cell bursts or buds off new viruses, which go on to infect more cells.

For Herpes Specifically:

  1. Entry: Herpes enters the skin (Epithelial Cells) through a lesion on the skin or a mucus membrane site. A mucus membrane is an area of the body that is lined with a soft, moist tissue that produces mucus such as the eye, nose, mouth, genitals or anus. This skin is thinner and more permeable than your other skin making it more susceptible to viruses.
  2. Hijacking: Once inside the nucleus of the Epithelial Cell it copies the cells DNA and builds viral proteins (These proteins are what the Western Blot blood test is testing for and why is is the most accurate test without an outbreak present)
  3. Outbreak Begins: the cell then bursts or buds to form the outbreak and infect the nearby cells creating the physical symptoms of a herpes outbreak.
  4. Laying Dormant: Some of the herpes virus enters the nerves through the nearby sensory nerve endings and travels to the ganglion
  • Trigeminal Ganglion for oral herpes which are the nerves at the base of your neck.
  • Sacral Ganglion for genital herpes which are the nerves at the base of your spine.

Once there the virus becomes “latent” or dormant and hides in the cell nucleus and stops replicating.

  1. Future Outbreaks: when triggered (usually by stress, illness, weakened immune system, menstruation etc.) it can reactivate the virus in the ganglion and the virus will hitchhike on the Kinesin (a motor protein that carries vesicles, organelles or in this case viruses) back down the nerve axon back to the original area of your first outbreak and begin the whole process again.

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In general, to protect yourself from getting a virus, or in the case of a recurring virus like herpes, prevent from getting a flare up, some of the most effective practices are to practice good hygiene and to support your immune system. Anything that helps your immune system will help your body fight off the herpes virus from infecting your cells and replicating causing an outbreak. When you're healthy, all these immune responses are working together to suppress the virus.When you're sick, stressed, sleep-deprived, or immunocompromised, your immune system is distracted or weakened, and herpes may reactivate more easily, causing an outbreak. This is why people who are immunocompromised have a harder time suppressing outbreaks and why cold sores / fever blisters were named because they tend to follow a cold/fever.  

How the Immune System Controls Herpes Specifically:

  1. T-Cells Recognize Infected Cells:
  • Your immune system learns to recognize cells infected with herpes (HSV-1 or HSV-2), especially after the first outbreak.
  • Special immune cells called CD8+ T-cells (also called cytotoxic T-cells) find and destroy infected cells before the virus can spread.
  1. Antibodies Prevent Spread (Partially):
  • Your body produces antibodies (IgG, primarily) that recognize herpes if it tries to reactivate and infect nearby cells.
  • These antibodies don’t clear the virus entirely, but they slow it down and help keep it localized. (This is why spreading the same strain of herpes to another part of your own body aka autoinoculation is uncommon)
  1. Natural Killer (NK) Cells Respond Quickly:
  • NK cells are like your immune system’s first responders. When herpes reactivates, they help contain it quickly, sometimes before symptoms even occur.
  1. Memory Immune Response:
  • Once you've had herpes, your immune system develops a "memory" of it.
  • This means the immune response is faster and more efficient during reactivations, often stopping outbreaks before they get bad or even before symptoms appear. (This is why outbreaks tend to get more mild or even stop over time)

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Hormones / Menstrual Cycles / Pregnancy:

Hormones:

Estrogen and Progesterone:

These hormones, which fluctuate throughout the menstrual cycle, can influence the immune system and potentially trigger herpes outbreaks. Some studies suggest that estrogen may promote herpes simplex virus (HSV) reactivation, while progesterone can increase susceptibility to infection and decrease immune responses.

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Stress Hormones:.

In addition to estrogen and progesterone, other hormones like epinephrine and cortisol, which are released during stress, can also influence herpes outbreaks, particularly in autonomic neurons.

Epinephrine (Adrenaline): also known as adrenaline, is a hormone and neurotransmitter that plays a crucial role in the body's "fight or flight" response to stress. It's released by the adrenal glands and helps regulate organ functions during stressful situations. Studies suggest that epinephrine can induce HSV-1 reactivation, particularly in sympathetic neurons, which are part of the autonomic nervous system. However, it appears to have less or no effect on HSV-2 reactivation in sensory neurons.

Corticosterone: a glucocorticoid hormone, can influence herpes outbreaks by suppressing the immune system. While it's not a direct trigger, high levels of corticosterone, often associated with stress, can reduce the body's ability to keep herpes simplex virus (HSV) dormant, leading to increased susceptibility to outbreaks.

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Thyroid Hormones:

The thyroid gland plays a role in regulating the immune system, and imbalances in thyroid hormones can affect the body's ability to fight off infections, including viral infections like herpes.

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Menstrual Cycles Can Trigger  Herpes Outbreaks:

Unfortunately this can be a trigger for some individuals. You may notice a pattern of outbreaks or prodrome symptoms during your period or the week before. The menstrual cycle involves fluctuations in estrogen and progesterone levels. These hormonal shifts can impact the immune system, potentially making it easier for the herpes virus to reactivate and cause an outbreak.There are a couple of ways to avoid this.

  • Supplements: You can be sure to take lysine and zinc or if you already do increase the dosage (consult a dr before doing more than what is recommended on the bottle) the week before and during when you usually see the outbreak.
  • Antivirals: You can talk to your doctor about taking daily antivirals either all the time or as with the lysine the week leading up to / during your period.
  • Birth Control: You can also discuss birth control options that regulate hormones. This can help your body keep the hormones in check. Talk to your doctor about the different options.

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Pregnancy Can Trigger A Herpes Outbreak:

Similar to your menstrual cycle when you become pregnant your hormone levels will change which can trigger an outbreak. This is especially true for asymptomatic carriers who have never had an outbreak before and even higher likelihood if you did not know your herpes status prior to getting pregnant. 75% of individuals with herpes experience a flare-up during pregnancy. This is likely due to the hormonal and immune system changes associated with pregnancy, which can make the virus more active.

DO NOT FREAK OUT.  This sounds concerning however If you have a history of herpes (or your blood test is positive), your provider may prescribe an antiviral medication such as acyclovir (Valtrex) to reduce the risk of spreading the virus or having an outbreak around the time of your delivery. Antivirals are completely safe to take during pregnancy and will have no effect on you or your baby.

You can have a successful natural birth if you have genital herpes. It is especially safe if you were previously aware of your herpes status. Individuals transmit herpes to their new born babies in less than 1% of the time. A baby born to a person who has herpes can be born with protective antibodies. These antibodies are transferred from the pregnant person to the fetus through the placenta. This transfer of antibodies, primarily IgG, provides some level of protection against herpes, particularly if the pregnant person has had herpes for some time and has developed a good antibody response. The antibodies provide passive immunity, meaning the baby receives protection from the mother's immune system.This protection can reduce the risk of the baby developing herpes, especially if the pregnant person has had herpes for a while and has a strong antibody response.

Neonatal herpes: or herpes that is passed through the uterus or birth canal happen in less than 0.03% of births in the US. There are precautions that you can take to not pass it on to a child. Your OBGYN may prescribe you antivirals to prevent an outbreak during the 3rd trimester and if there is evidence of an outbreak during labor a dr may suggest a c-section to be extra safe.

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Birth Control & Herpes:

Birth control has mixed results for people with herpes, some feel that it helps regulate hormones and decreases the amount of outbreaks while others have the exact opposite reaction. It is important to talk to your doctor about your health history, sexual activity, herpes outbreak history and any other interactions you have had with birth controls in the past.

There are over 30 different brands of oral birth control alone, there are 5 different types of IUDs, 4 different arm implants, as well as insertable birth control like the NuvaRing. Closely monitor your side effects when on any of these and if something is not right then talk to your doctor about switching,

As always when trying something new give it time. Your body needs time to adjust to hormonal changes so if you start a new birth control and  immediately get an outbreak it does not necessarily mean that the birth control is not right for you, your body just may need some time to settle into its “new normal”.

Obviously if things worsen or persist go back to your doctor with your symptoms so you can discuss switching brands, changing from a hormonal to a non-hormonal birth control (or vise versus) or even taking a break from birth control all together until things settle down.  

Diet Choice: 

In SOME rare cases food can be a trigger for people. Lysine rich foods will help you not have an outbreak and arginine rich foods MAY trigger an outbreak. Keep a food journal to see if there is a correlation between food and herpes for you as an individual. Do not panic and immediately change your diet or cut out foods you love in fear. Diet is one of the last things you should look at and you should only go this route if you are having excessive recurring outbreaks after your first year with herpes. Most people (myself included) DO NOT have food triggers and eat a completely normal diet (including occasional McDonald’s runs, PB&J sandwiches, daily coffee and moderate junk food) while having herpes with no issues. If after keeping the food journal or if you are having a lot of outbreaks while taking medications / supplements then you should consult your doctor before looking into your diet.

Lysine and Arginine work together to prevent / cause herpes outbreaks.

Arginine is created in the body and also found in the food that you eat. Arginine is essential for the replication of herpes simplex virus (HSV). In vitro experiments have shown that arginine promotes viral growth, which speeds up the body's ability to reproduce certain viruses, including HSV-1 and HSV-2. Foods that are high in arginine can trigger an outbreak for some individuals.

Lysine is not naturally produced in the body; you only get it from the foods that you eat. Lysine breaks down arginine in your system which is why people with herpes recommend taking Lysine supplements. Lysine rich foods can also help you have less outbreaks.

A really great list of rich l-lysine foods to arginine foods:

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Going Vegan:

A common thing you may see on Reddit or other forums is that drastically changing your diet for example going vegan will basically “cure” you of herpes or at least stop recurring outbreaks. There is no real scientific backing to this and most people with herpes are not vegans. Diet is one of the last things you should look at and you should only go this route if you are having excessive recurring outbreaks after your first year with herpes.

Why People Think It Works: herpes is directly tied to your immune system and the foods you eat can both help and hurt your immune response to viruses. The nutrients we consume play a vital role in supporting the immune system's ability to function effectively. A balanced diet rich in essential vitamins and minerals is crucial for building and maintaining a strong immune system. So in theory eating healthy and “clean” can help your body's immune response to herpes. Vegan diets are often considered healthier than diets that include animal products leading to things like lower cholesterol, blood pressure and lower your risk of things like heart disease, type 2 diabetes, and certain cancers. Vegan diets can also contain an abundance of vitamins, minerals and phytochemicals, which are compounds that have various health benefits, including immune-boosting properties.

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Why It Is Not A Solution: While it seems like switching to a vegan diet can be helpful with herpes there are some reasons why it will not work for everyone and it is not recommended by most doctors as a treatment option for herpes. There is no scientific evidence or studies that being vegan has any correlation to herpes. Additionally, many vegan foods that are used as a source of replacement protein like nuts, seeds, legumes, etc. are high in arginine, which as stated above are potential triggers for herpes outbreaks. Also the immune boosting benefits of switching to a vegan diet can be achieved through over the counter vitamin and supplement intake with your regular diet. Just like with anything to do with your health, moderation is key.  Binge eating unhealthy foods can lead to a variety of different health concerns, however restricting your diet or sudden drastic diet changes can cause stress in the body which is more likely to cause an outbreak. Most people eat a completely normal diet (including occasional McDonald’s runs, PB&J sandwiches, daily coffee and moderate junk food) while having herpes with no issues.

Intermittent Fasting (Starving Out The Virus):

There is a conspiracy theory that is roaming around the internet that herpes is a parasite that can be “starved out” by intermittent fasting. Intermittent fasting (IF) is an eating pattern that cycles between periods of eating and voluntary fasting on a regular schedule. It's not a diet in the sense of specifying what foods to eat, but rather a schedule that dictates when you eat. There are various methods of intermittent fasting, including 16/8, 5:2, and alternate-day fasting. Always consult your doctor or dietitian before making drastic changes to your eating habits as certain individuals can have adverse reactions to skipping meals. It is also not recommended for anyone with a history of any eating disorders, during pregnancy, breastfeeding or if you are on certain medications.  

Is Herpes A Parasite: False. Herpes is not a parasite; there is no scientific backing to this claim at all, only conspiracy theories with no scientific evidence to support the claim. Parasites are living organisms that live on or inside another organism (the host) and benefit by deriving nutrients at the host's expense. Examples include tapeworms, fleas, and lice. Herpes is a proven virus which are not considered living organisms because they cannot reproduce on their own. They need to enter a host cell and hijack the cell's machinery to replicate. This makes them "cellular parasites" in the sense that they depend on a host cell, but they are not parasites in the way we typically think of them.  

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Is Fasting A Treatment for Herpes?: Some research suggests that autophagy, a cellular process that can be triggered by starvation (among other factors), may have implications for herpesvirus replication. Autophagy can help cells eliminate intracellular pathogens and can potentially be a defense mechanism against herpes infections. However there is little research on this topic to determine how effective it is or how long or often you need to fast in order for it to have an impact. There was one research study on oncolytic herpes simplex virus (oHSV), a modified form used in cancer therapy, showed that transient fasting enhanced its replication in cancer cells, potentially increasing its effectiveness. However, this is a specific application in a therapeutic context and not a general recommendation for herpes management.

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Downsides To Intermittent Fasting: There are potential side effects to fasting like hunger, fatigue, and headaches, and the risk of overeating during feeding windows, potentially leading to weight gain. Some individuals may also experience mood changes, sleep disturbances, or find it difficult to sustain the restrictive eating pattern. All of these can cause stress on your body and mind which is more likely to lead to a herpes outbreak. Additionally, intermittent fasting may not be suitable for everyone, particularly those with a history of eating disorders, pregnant or breastfeeding women, or individuals taking certain medications.

While intermittent fasting can have some immune-related benefits, it also presents potential downsides. One concern is that fasting may reduce the number of circulating monocytes, immune cells that help fight infection. When food is reintroduced, there can be a surge of these cells, which could be problematic. Additionally, intermittent fasting can impact the gut microbiota, potentially affecting its diversity and the metabolites it produces, which also influences the immune system. As stated above your immune system can directly impact your outbreak rate and severity.

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Caffeine:

Some places online will have a concern that caffeine can trigger an outbreak you may see on Reddit or on other forums panic about not getting a morning coffee or not being able to consume energy drinks and this is not true. Most people can enjoy their typical daily coffee and do not have to make any changes to their caffeine consumption.

Caffeine in large dosages may indirectly trigger outbreaks by causing dehydration and lowering immune resistance. Some individuals with HSV-2 report that coffee and alcohol consumption directly leads to nerve pain, itching, or flare-ups.

In more recent research however studies have shown that caffeine can inhibit HSV growth and plaque formation, sometimes acting against virus replication. Another study suggested topical caffeine might actually help treat herpes lesions.

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Alcohol & Other Substances:

Alcohol and drugs are as we all know not good for you but they are a part of some people's lives and are enjoyable for recreation. Many people fear that because of their herpes diagnosis that they can no longer take part in these recreational substances. The key is moderation.

Binge drinking (heavily drinking many days a week) can definitely increase the amount of outbreaks that you may have as it weakens your immune system. The same can be said for many of the party drugs used on a night out. You do not need to stop all drinking or drug use because of the diagnosis but keep in mind your body's tolerance and be prepared that if you overdo it there may be a resulting outbreak.

I was diagnosed with oral and genital herpes at 19, I did all the fun things normal 20 year old's did with little to no issues. In the support group that I am in most people are in their 20-30s and most members partake in standard party (weekend drinking) behavior with little to no issue.  

If you or someone you know suffers from substance abuse call the National Drug Helpline at (844) 289-0879  or dial 988 for the Suicide & Crisis Lifeline

Herpes Prodrome Symptoms:

Herpes doesn’t always have full outbreaks with sores or physical signs sometimes leading up to an outbreak there are things called Prodrome Symptoms, or Viral Shedding Symptoms. These are not physical symptoms but feelings that you have that are an indication of an outbreak coming or that you are virally shedding.

Having any of these symptoms does not mean that you are definitely getting an outbreak, it could just be viral shedding. It is best to avoid sexual or skin to skin contact during this time to prevent transmission. These symptoms can include:

  • Nerve Pain: this can range from a dull ache, pins and needles, or a stabbing pain like needles. The pain is usually in the lower back, buttocks and legs for genital herpes and in your neck for oral herpes.  
  • Tingling Sensation: This usually occurs in the area that you get your outbreaks (for example if you only have oral you should only be experiencing tingling in the mouth area). Tingling kind of feels like pins and needles or static in your skin. It is a form of nerve pain but it is not really painful.
  • Itchiness: This is similar to tingling that it usually occurs in the area where you get your outbreaks. Basically it is a similar feeling to when your hair is growing back after shaving.
  • Swollen Lymph Nodes: this isn’t as common but can occur especially before your first outbreak and rarely before all other outbreaks.

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Types of Herpes Outbreak:

Physical outbreaks can look different for everyone; some people will never have a physical outbreak and outbreaks can look different each time you have one. It is important if you think something is a herpes outbreak to refrain from having skin to skin contact with others with that area to be on the safe side. If you have access to go to a doctor while you are having symptoms they can run a swab test and let you know if the physical symptoms that you are experiencing are herpes. These are generalizations and they are not to be taken as the only types of herpes outbreaks that you can have.

Genital Herpes:

  • Sores: These are the standard typical outbreak type. They can look like pimples but do not usually pop like a pimple. They are usually filled with a whitish clear liquid and will go away on their own. Genital herpes most often occurs in clusters ranging in size and occasionally there can be 1 or 2 individual sores only. The outbreaks can be painful but most times are just itchy. The longer you have had herpes usually the more mild an outbreak will be. Some outbreaks can be as small as one sore and it can not itch or be painful at all. It is best to avoid itching, picking or attempting to pop them as the liquid is the most contagious part of the sore. Also picking at them can cause scabbing and potentially scaring.
  • Cuts: Occasionally herpes outbreaks can look like tiny lesions or tears in the skin. These tend to sting more than itch. Many people call them paper cut sores as they look like tiny paper cuts. These will also heal on their own and do not usually contain any fluid.

Oral Herpes, Cold Sores, Fever Blisters: whatever you call them these are outbreaks that happen on the mouth. For most people outbreaks are usually 1-2 sores along the lip line. Oral herpes typically does not appear inside the mouth. These sores usually look more like the genital herpes sores (like a pimple filled with the whitest clear liquid) These are more subject to breaking open due to the fact that your mouth moves a lot. It helps to keep the sore moisturized with either a cold sore cream or at the very least chapstick or vaseline.  

Nose Herpes: Just like with oral herpes these sores appear on or around the nostril area. These can be in tiny clusters or like with oral herpes only 1 or 2 sores. Nose herpes is usually HSV-1.

Whitlow: this is the herpes that appears on the fingers.It can cause a blister on your finger or finger swelling. The sores usually appear along the nail bed and cuticles.  Usually you get this during your first outbreak if you have an open lesion on your fingers and touch an open sore. Whitlow is not common and it rarely recurs.  

Herpes Gladiatorum: This usually occurs during contact sports (eg: wrestling) It is when herpes sores form in places other than a mucus membrane site (eyes, nose, mouth, genitals and anus). The outbreak looks like a cluster of sores ranging in size that also look like pimples. It is usually attributed to HSV-1 and is caught when a section of abraded skin comes in contact with a herpes outbreak. The sore of the other person would need to come in contact with skin that has an opening like an abrasion, or lesion in order to transmit.  

This document contains images of herpes and what it may look like. Please note that herpes does not look the same for everyone or on every skin tone. This is just a guide to see what the average sores may look like, being google images can be misleading. Do not use these images to diagnose yourself or to make a decision to have skin to skin contact with someone as herpes can look differently.  All genitalia has been cropped out of the images.  https://docs.google.com/document/d/1bVVVxmTzwniI17a0QZNf_kOsFtI2HzOuvBIvkF3uTRo/edit?usp=sharing 

Things Commonly Confused With Herpes:

When you have herpes there will be some stressful times where you are not sure if you are having an outbreak or not. This is completely normal and you are far from alone. Take a deep breath, do not stress and to be safe treat it as a herpes outbreak. This means if you are experiencing any red bumps, sores or having any sort of discomfort down there (painful urination, strange odors, changes in your discharge, itchiness) it is best no matter what it is to take a break from sexual activities until the symptoms stop and the area returns back to normal.

Herpes outbreaks even with medication will take 3-5 days minimum to heal and can take up to 7-14 days on average to heal on their own with no supplement or antiviral intervention. If you see a sore or red bump and it clears up in 24-72 hours it is most likely not a herpes outbreak. If you have sores or red bumps staying in the same place for longer than 7-14 days go to your doctor. This is not normal herpes behavior and may be something else. If you have sores that seem to appear and disappear and then reappear in the same area this could be a back to back outbreak, for this you should also contact your doctor to make sure that it is a herpes outbreak and not something else. You could also talk to the doctor about starting antivirals, increasing your antiviral dosage, or switching brands.

For a list of other illnesses, STIs that can have similar symptoms of herpes and can be commonly confused with a herpes outbreak check the Things Commonly Confused With Herpes List: here: https://docs.google.com/document/d/1VcQCvJ9vzEY0GzE_0PAAP_3JLZVwwkDg0QNoeDav7PE/edit?usp=sharing 

Components of A Herpes Outbreak:

Stages:

1. Prodrome (Early Symptoms):

Tingling, itching, or burning:

Before blisters appear, some people experience tingling, itching, or burning sensations in the area where the outbreak will occur. These symptoms are called Prodrome symptoms and they could indicate that an outbreak is on the way OR that you are virally /asymptomatically shedding. Having any of these symptoms does not mean that you are definitely getting an outbreak, it could just be virally shedding. It is best to avoid sexual or skin to skin contact during this time to prevent transmission. (You are contagious during times of viral shedding even with no outbreak, sores, visibly present). These symptoms can include:

  • Nerve Pain: this can range from a dull ache, pins and needles, burning or a stabbing pain like needles. The pain is usually in the lower back, buttocks and legs.
  • Tingling Sensation: This usually occurs in the area that you get your outbreaks (for example if you only have oral you should only be experiencing tingling in the mouth area). Tingling kind of feels like pins and needles or static in your skin. It is a form of nerve pain but it is not really painful.
  • Itchiness: This is similar to tingling that it usually occurs in the area where you get your outbreaks. Basically it is a similar feeling to when your hair is growing back after shaving
  • Swollen Lymph Nodes: this isn’t as common but can occur especially before your first outbreak and rarely before all other outbreaks.

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2. Blister Formation:

Small, fluid-filled blisters: Painful, fluid-filled blisters develop, often in clusters. These sores usually form on mucus membrane sites (eyes, nose, mouth, genitals or anus). Sores usually do not form inside the mucus membrane site but rather around the outside such as the lip line. This document contains images of herpes and what it may look like. Please note that herpes does not look the same for everyone or on every skin tone. This is just a guide to see what the average sores may look like, being google images can be misleading. Do not use these images to diagnose yourself or to make a decision to have skin to skin contact with someone as herpes can look differently.  All genitalia has been cropped out of the images.  https://docs.google.com/document/d/1bVVVxmTzwniI17a0QZNf_kOsFtI2HzOuvBIvkF3uTRo/edit?usp=sharing 

3. Crusting and Healing:

Scabs form: The ulcers begin to dry out and form scabs or crusts. When left alone herpes outbreaks should not scar however if you pick at, itch, or irritate the sores they can leave scars especially on lighter skin tones. If scars do form they can clear up on their own but it can take a few weeks see “Tips For Herpes Scarring” below.

4. Healing:

When the skin area gradually returns to normal, the outbreak is considered complete. If you are still feeling residual tingling, itching or burning this can be an indication that your body is still shedding the virus and the skin area can still be contagious. If these feelings persist longer than a week after the outbreak is healed contact your doctor.

5. Recurrent Outbreaks:

Dormant virus: After the first outbreak, the virus remains dormant in nerve cells. It can reactivate and cause recurrent outbreaks. The recurring outbreaks tend to be less severe and shorter in duration than the initial outbreak. If your recurring outbreaks are excessive, extremely painful, or lingering for longer than a week with medication or 2 weeks without medication please contact your doctor!

Parts of An Outbreak

Herpes Sores: the red raised bump is called the sore. This sore is usually red around the skin area and the raised part of the skin can be red, yellowish, or whitish. The raised bumps are usually  in small clusters and the sores themselves should not be hard. In many cases the bumps are filled with liquid. During some outbreaks the sores can break open  leading to them scabbing over and getting a “crusty” appearance while they heal.  Typical Herpes Sores:

Fluid Inside the Sores: This fluid is the most contagious part of the herpes outbreak. The fluid can be clear, yellowish, milky white, or cloudy and can be seen inside the sore. If the sore breaks open this liquid can leak out. After the fluid oozes out, the sore typically forms a crust or scab as it begins to heal. The fluid is known as Serous fluid. Serous fluid is a thin, watery liquid found in various body cavities and tissues. It's primarily composed of water, electrolytes, and proteins. In the case of herpes sores, this fluid collects in the blister-like bumps that are characteristic of the infection. This fluid contains active viral particles of the herpes simplex virus (HSV), making it highly contagious. It is important to avoid direct contact with another person and this fluid and if you have oral herpes (cold sore / fever blisters) avoid sharing straws, utensils, vapes, joints, or any other object that can come into contact with the mouth sores and can potentially get the Serous Fluid on it which has a potential to transmit to another person. If you are sharing objects during an outbreak make sure to wipe the object down to remove any potential Serous Fluid that could have gotten on the object.

Blood: Herpes outbreaks are sores that can break open with friction or from itching the sores. The friction can be caused by something as simple as the clothing you wear rubbing the sores while walking. Though this can cause them to rupture and occasionally bleed there should only be small droplets of blood. The sores should not excessively bleed and for most people they should not bleed at all. During the healing process (especially if the sores break open) the sores can also scab over and if those scabs come off it can lead to a small amount of blood. If you are experiencing a lot of blood or if your sores are bursting on their own GO TO A DOCTOR as the outbreak may be something other than herpes or need further medical attention to prevent infection. Be sure to wear loose comfortable clothing during an outbreak to prevent the sores / scabs from breaking open and avoid scratching the sores. Always be sure to wash your hands before and after touching, itching or applying medication to any open sores, cuts or lesions on your body to prevent infection, or in rare cases autoinoculation

Viral Shedding Area: both during an outbreak and during times of asymptomatic shedding the AREA surrounding the outbreak is also considered contagious not just the outbreak itself. For example if you get oral herpes your whole mouth is considered an area that can virally shed. If you have genital herpes the area that would be covered by a bikini or a speedo would be considered a viral shed area.

Sources:

Oral HSV Info/Prevention/Remedies:

Information:

More commonly referred to as cold sores or fever blisters are the most commonly HSV-1 and rarely HSV-2.

Oral HSV-1: This is the most common strain / location combination. With around 50-80% of the population having oral HSV-1. Oral HSV-1 tends to recur more often and virally shed  more often than oral HSV-2 and there is a higher chance of transmission to your partner’s genitals during oral sex as HSV-1 can live anywhere on the body.

Oral HSV-2:  The rarest location strain combo is oral HSV-2. This is due to how the virus has evolved over time. HSV-2 tends to infect the nerve cells that are located in the genital region, particularly in the sacral ganglia (nerve clusters near the lower spine).

Oral HSV-2 also tends to have less outbreaks / viral shedding than genital HSV-2 or oral HSV-1. It was present on only 0.08% of days (that's like less than 1 day out of 1,000). And people without HIV had it even less often, at 0.1% of days.

Recurrence (when the virus comes back) was also rare for oral HSV-2 infections. It happened at a very low rate—about 0.001 per month, so almost never.

Symptoms:

Oral HSV-1 & 2 outbreaks usually appear as small, painful, fluid-filled blisters that typically appear on or around the lips. Oral herpes outbreaks usually do not appear inside the mouth, gums or tongue (ulcers inside the mouth are usually canker sores that are not herpes related).

Common symptoms include tingling or itching before the blisters appear, followed by the formation of painful blisters that may break open, ooze fluid, and then crust over. Other potential symptoms include fever, swollen lymph nodes, and sore throat, especially during a first outbreak.

Some individuals get one sore at a time, others can get small clusters of sores. The sores usually recur in the same area (ex bottom left section of the lip) but can occasionally appear in a new spot. It is safer to assume the whole mouth area is contagious especially while having an outbreak or symptoms of viral shedding (tingling sensations/ itchiness in the skin area), not just the section of the mouth that is having the outbreak.

This document has transmission and viral shedding rates of the different strains and locations. https://docs.google.com/document/d/1xRL3jM3qLB5nh-b2B7tXOU2wrRoPgXclFBu7lCGpkbI/edit?usp=sharing

Stages:

Not every outbreak follows the exact same stage pattern and with treatment some stages never will happen. But this is the standard timeline for an oral herpes (cold sore) outbreak:

If you pick the sores or have a lighter skin tone occasionally after the sore heals there may be some minor scaring. This is why it is important to not pick at, itch or pop the sores and let them heal. The skin should return to normal the original color, texture and feeling.

Sources:

Oral HSV-2 Stat:

Prevention:

  1. Try to pinpoint your triggers stress is a major trigger for HSV in general, try to relax, take deep breaths, meditate and avoid stressors.
  2. Supplements such as lysine, zinc, B, B12, C, D3, E  can help boost that immune system and prevent all HSV outbreaks.
  3. Lysine chapstick can help prevent cold sores from forming. There are a bunch of different brands to choose from. https://a.co/d/d8Hbb25 
  4. Using Abreva when you feel a tingling sensation or itchiness in that area can help prevent a full outbreak from forming. https://a.co/d/1GHR6cw Generic brand: https://a.co/d/520UCcj 
  5. Lysine: (500mg)and other immune system boosters. At the end of the day herpes is literally a virus (herpes simplex virus). So similar to other viruses the better your immune system the better it will be at fighting off herpes. Lysine is the most popular supplement to take to fight off the pesky virus.

  1. Vitamin B, B12, C, D3, E, and Zinc ( 15 mg) are also a supplement that helps fight off herpes people in the support group swear by them.

  1. Prescribed Antivirals: Most doctors will not prescribe antivirals for oral HSV however if you have recurrent outbreaks or severe oral outbreaks talk to your doctor about prescribed medication. That can either be taken daily or when having symptoms to shorten the outbreak. Talk to your doctor to see which treatment option works best with your lifestyle, medical history and HSV type.  

At the bottom of this document is more info on antivirals and where to get them.

  • acyclovir (Zovirax)
  • valacyclovir (Valtrex)
  • famciclovir (Famvir)

Triggers:

  1. Stress

This is the number one trigger for herpes. This is why it is so important to not immediately panic and change all the aspects of your life immediately as the stress from worrying about potential triggers is more likely to trigger an outbreak then the “trigger” itself. There is also the physical stress on your body from making major life changes to your diet, exercise or hormones that can also trigger an outbreak.

Stress can lead to a weakened immune system and when your immune system is down that is when the herpes virus is most likely to reactivate. Stress triggers the release of hormones like cortisol, which can suppress immune cell activity and increase inflammation. Stress can reduce the effectiveness of white blood cells which help control the infection and reduce the severity of subsequent outbreaks (particularly CD8+ T cells).

Be sure to try to reduce stress in your life by:

  • Getting a good night's sleep.
  • Meditation
  • Going to therapy to talk out your stressors.
  • CBD oil
  • Making sure to balance your work/school life with things you enjoy
  • Create time for stress relieving activities such as baths, reading time, video games, mindless TV time or anything that gives your body and mind time to decompress.
  • If you are stressed consistently about herpes try to talk to your doctor about ways to relieve the stress either through medication (sometimes taking daily antivirals , supplements or vitamins not only help reduce the physical symptoms of herpes but also trick your mind into not feeling so helpless as you are physically taking meds to help prevent herpes which can cause some mental stress relief.

If there are unavoidable stressors:

  • Talk to your doctor about increasing the dosage of or starting antivirals especially during planned times of stress (major work project, major tests)
  • Take preventative over the counter supplements and vitamins (see outbreak guide below for more information).
  • Preparation for the stressful even to ease the burden (meal prep, plan outfits ahead of time, create a schedule including scheduled time to relax and breathe)

Sources:

  1. Sunlight:

Sunlight is only really a trigger for oral herpes unless you are tanning nude. Sun exposure, specifically ultraviolet (UV) radiation, can trigger herpes outbreaks, particularly cold sores (herpes labialis). The UV light weakens the skin's immune system, making it easier for the dormant herpes simplex virus (HSV-1) to reactivate and cause a flare-up. It is important to note that not everyone has a sun trigger and in most cases herpes outbreaks are only triggered by excessive sun exposure or excessive tanning bed use. Going to the park for the day isn’t a normal trigger for most people with herpes.

Also important to note that these triggers are only on the areas of skin exposed to the UV light. Which is why only oral herpes (or other herpes outbreak sites that are directly exposed to the outside world) are usually triggered by sunlight as most people's genitals are usually covered and not exposed.

  • UV Radiation: can exacerbate HSV by compromising the skin’s integrity allowing the virus to reactivate
  • Immunosuppression: the UV exposure can lead to localized immunosuppression reducing the skin’s ability to suppress the herpes virus
  • Stress Response: skin cells emit stress signals upon UV exposure which can lead to the activation of the herpes virus in that area of skin exposed
  • Sunburn: sunburn causes inflammation in the skin which can activate the herpes virus in the nerve cells leading to an outbreak.
  • Sun Poisoning: a more severe form of sunburn, potentially causing symptoms like fever, chills, nausea, vomiting, and extreme pain. This can potentially cause an outbreak even in areas not directly exposed to the UV radiation as it can make you physically ill which can weaken the immune system. (So in reality the sun exposure isn't causing the outbreak, the weakened immune system is.)

If going tanning or out on a sunny day for extended periods of time make sure to wear sunscreen. You can also wear a hat, and use chapstick that contains SPF or lysine to help prevent outbreaks. If you were exposed to too much sun be sure to keep the skin and your body hydrated. Drink plenty of water, apply aloe on the exposed skin.

Source:

  1. Dry/ Chapped Lips:

A compromised skin barrier can potentially make it easier for the herpes virus to enter and infect the skin as well as the inflammation from the dry skin can activate the herpes virus in the nerve cells and lead to an outbreak. Dry skin / Chapped Lips can also cause you to think that you are getting an outbreak which can cause stress which can also trigger an outbreak.Chapped lips can be itchy which can mimic the feeling of the start of a herpes outbreak. There are even chapsticks that contain lysine to help combat outbreaks topically. https://a.co/d/09LtfNLE 

If you take daily antivirals be sure to drink plenty of water and stay hydrated as antivirals can dry you out. 

Be sure to practice normal skin hydrating practices such as using chapstick and vaseline on your lips, and drinking plenty of water. Be sure to make sure with your sensitive skin areas that the products you are using are safe and always do a small test patch of skin when trying a new product to avoid an allergic reaction and NEVER apply topical creams inside of mucus membrane sites (eyes, nostril, inside the mouth, vagina, or anus) without consulting a medical professional.

Sources:

  1. Friction:

For oral herpes: friction is less of a concern for oral herpes as less things rub against the mouth. When kissing your partner there may be some friction especially if you have dry skin or chapped lips or if your partner has stubble or facial hair. Talk to your partner about proper facial hair care like beard balms, shaving more frequently, beard oils, or conditioner. Make sure the facial hair is clean and that your partner is grooming and has good hygiene practices as beards can contain bacteria which can lead to infection and irritation. Also make sure the beard is trimmed and loose scraggly hairs are removed. If you wear mouth coverings, medical masks, or ski masks in winter make sure they are not too tight and a comfortable, breathable material to avoid friction or irritation.

  1. Food Choices: 

In rare cases junk food or foods containing large amounts of arginine may be a trigger.  Most people (myself included) DO NOT have food triggers in any way. Your best bet if you are getting an excessive amount of outbreaks and have tried other remedies (antivirals and supplements) especially after your first year is to keep a food journal to see if there is any correlation between foods / drinks and outbreak amounts. (See the Diet Choice section above).

For more information regarding diet choices see the Diet Choices Guide: https://docs.google.com/document/d/1ZPQwS7-hE7ePD8Uv4WuoZrpT29_JGhRPF1RfBmnDf98/edit?usp=sharing 

  1. Tattoos / Piercings:

This can happen if you are getting a tattoo or piercing in the area that gets the outbreak. For example if you get oral cold sores and get your lip pierced. Any type of trauma to the area that gets outbreaks has the potential to be a trigger. If you are getting a tattoo / piercing outside the outbreak area it is unlikely to cause any outbreaks unless you are very stressed out about getting the tattoo/piercing. But in that case stress would be the trigger on the tattoo/piercing itself. Not everyone will have this be a trigger. I myself have oral herpes (cold sores) and have gotten permanent lip blushing done (full lip tattoo) and it did not trigger an outbreak. If you are concerned about getting an outbreak consult with your doctor about taking/increasing the amount of antivirals that you take as a preventative measure and you can also take supplements like lysine to help prevent an outbreak.

Treatment:

  1. Topical Over The Counter Creams: When you first feel that tingle go to your local drugstore and grab an over the counter cream. Most only work during the tingle stage of a cold sore, if you try to put cream on an open sore it may sting.
  • Abreva: This for me has worked the best, it is one of the few that have the active ingredient docosanol which blocks the herpes virus at the source before it can spread to the surrounding cells. There are off brands of Abreva but for me the name brand works the best. It shortens the length and severity of the outbreak. You can usually get 2-3 outbreaks per tube and look for coupons online as it can be a little pricey. It tends to knock my cold sores down to 2-4 days and they never get super ugly or painful. The only downside is that it is a white cream so it is noticeable when you put it on. You can purchase this at any drug store, amazon and even most grocery stores.
  • https://a.co/d/1GHR6cw 
  • Generic brand: https://a.co/d/520UCcj 
  • Oral ProCare Medicated Lip Treatment: This is a cream developed by dentists, unlike abreva it is clear which is great for discreteness. When I used this during the tingle stage it completely eliminated the tingling and itchiness. The sore still did come up but the feeling was much less it is also rated to shorten the length of outbreaks. The only active ingredient in this is Ethyl Alcohol. This is a newer product and I can only find it on the actual website.
  • Coverology: This topical cream has the added benefit of also being a concealer to help hide the sores. It comes in dark tone, medium and light which is a limited selection but it is better than the white of Abreva. It does NOT have any active ingredients so it will NOT help you heal faster however it does contain camphor and phenol for immediate relief with a cooling sensation while reducing redness, irritation, and swelling.
  • https://a.co/d/8tcDZE4 
  • Lysine Chapstick: having chapped lips can trigger a cold sore for some people so be sure to have chapstick available and stay hydrated. There are even chapsticks that contain lysine to help combat outbreaks topically. https://a.co/d/09LtfNLE 

  1. Ice: will help with the swelling and the irritation. If you are having a bad cold sore, grab that ice and feel the cooling relief. Best to wrap it in a paper towel so the ice does not burn the skin.

  1. Patches:They sell over the counter cold sore patches https://a.co/d/2DcCuuh to help cover up the sore and provide some relief they even sell some with honey in it to help with healing https://a.co/d/f8WzZ7W 
  • Mederma Cold Sore Patches: These patches look like the clear acne/ blemish patches for your face. They contain Hydrocolloid Gel which is a moisture-retentive dressing that helps wounds heal by absorbing exudate (a fluid that leaks from blood vessels into nearby tissues, or is released through a wound or pore by an organism) and creating a moist environment. These patches help make the cold sore more discreet and you are able to put makeup over them. While it doesn’t have the active ingredient to prevent the cold sore from spreading like Abreva it claims to promote the faster healing of the cold sore as well as keeping the moist environment to prevent scabbing which can reduce the risk of scarring. These patches are NOT to be used to prevent transmission but the patch can offer some protection from outside contamination. You get 15 patches for around $13 and you leave each patch on for 12 hours (I have tried them and they do seem to stay on for the full 12 hours).  https://www.mederma.com/cold-sores/ 
  • Acne Blemish Patches: A cheaper option that may also work once the sore has broken open are the typical acne blemish patches. Just make sure to check the ingredients to make sure that there is nothing that would irritate the sore further. Most acne patches contain Hydrocolloid Gel that is used to help heal wounds and is the same ingredient in the Mederma Cold Sore Patch. Avoid patches that use Salicylic Acid as that can erode skin, and cold sores are compromised skin which  would make healing take longer. Some acne patches contain tea tree oil which has antiviral properties that can help fight herpes simplex virus. Tea tree oil also has anti-inflammatory and antiseptic properties which can reduce inflammation and irritation caused by cold sores. This is a cheaper alternative to the Mederma Patches but it requires you to do your own research on the ingredients as each brand of pimple patch can be different. I also found that the pimple patches do not stay on the lip or cover with makeup as well as the Mederma ones.

To find patches I went on Amazon and typed in Hydrocolloid Patches Tea Tree Oil & double checked that they were the only ingredients and DID NOT CONTAIN SALICYLIC ACID if there were other oils listed in the patch I googled what the oil was used for or just typed  “____ Oil good for cold sores?” and made a decision based on the results. These are some examples:

  1. Coconut Oil: Using coconut oil (raw,virgin & unscented) on the more sensitive skin areas. Coconut oil not only moisturizes the skin but also contains natural antibacterial, antimicrobial properties to help soothe the area. There is some evidence that rubbing coconut oil on a cold sore will aid in healing and prevent scarring.

  1. Manuka Honey: as listed above Manuka aids in healing it is safe to use on a sore and is said to speed up healing.
  2. Vitamin B, B12, C, D3, E, Zinc: herpes is a virus at the end of the day so anything that helps your immune system can also help with herpes. Many of these vitamins are all in one daily vitamin supplement that can be found at any pharmacy, supermarket or amazon. https://lornahealth.com/conditions/herpes-virus-infection-simplex-genital/
  3. L-Lysine:(500mg) is an immune system booster and is used to block the amino acid called arginine which herpes uses to multiply. Recommended 2000 mg daily until sores are gone, then 500 mg thereafter for prevention. Any brand will work but check the ingredients to make sure that it says Lysine only and there isn’t anything artificially added.
  4. Antivirals: Most doctors will not prescribe antivirals for oral HSV however if you have recurrent outbreaks or severe oral outbreaks talk to your doctor about prescribed medication. That can either be taken daily or when having symptoms to shorten the outbreak. Talk to your doctor to see which treatment option works best with your lifestyle, medical history and HSV type.  
  • acyclovir (Zovirax)
  • valacyclovir (Valtrex)
  • famciclovir (Famvir)
  1. Red Light Therapy: particularly using specific wavelengths like 635nm, can be an effective treatment for cold sores, potentially shortening healing time and reducing the duration of outbreaks when used in conjunction with antiviral treatments. It may also help prevent future outbreaks when used regularly. Red light therapy can help reduce inflammation at the site of the cold sore, which is a key factor in healing. However there have been very few studies to support this evidence specifically for herpes. Red light therapy devices can be pricey and though some people see benefits you may want to discuss with a doctor before spending money on a remedy that only potentially may work.

Sources:

Links To Buy:

  1. Heat Therapy: a newer treatment that people are trying is heat therapy. There is very limited research on this however there has been some positive feedback on Reddit for a device called Intercept. The device uses precisely calibrated thermal energy (exactly 123.8°F) and is applied directly to the lip at the first sign of tingling. The localized heat interferes with HSV‑1 virus replication and stimulates the heat shock response, which helps infected cells self-destruct. The local immune response is boosted, helping the body contain the virus early  which stops the cold sore from ever surfacing. There are also some other options on Amazon as well.

 Links To Buy:

Genital HSV Info/Prevention/Remedies:

Information:

Unlike oral herpes genital herpes can easily be HSV-1 or HSV-2. With 1 in 5 adults having genital HSV-2 and 10-15% of all genital herpes caused by HSV-1.  

Genital HSV-1: Is the rarer of the 2 strain location combinations for genital herpes. It is usually contracted through oral sex with a partner who has oral HSV-1 (cold sores). According to Terri Warren (herpes expert) genital HSV-1 almost always has an initial first outbreak (so if you test positive via blood test for HSV-1 with no symptoms present it is most likely asymptomatic oral herpes). Genital HSV-1 virally sheds less than genital HSV-2 meaning that is less likely to transmit to a partner through sex.

Genital HSV-2: This is the most common form of genital herpes. With 1-5 adults being diagnosed with it, unlike genital HSV-1 many people can be asymptomatic for GHSV-2 (meaning that there are no physical signs or symptoms).

Symptoms:

Symptoms for genital HSV-1 & 2 look very similar. It can manifest as sores or blisters on the genitals, or anus. While many individuals with genital herpes experience no or mild symptoms, it can also cause painful outbreaks and flu-like symptoms during initial infections.

Sores can look differently for every individual with some getting one sore at a time and others getting clusters of sores in an area. There are two main ways a physical herpes outbreak can manifest:

  • Sores: These are the standard typical outbreak type. They can look like pimples but do not usually pop like a pimple. They are usually filled with a whitish clear liquid and will go away on their own. Genital herpes most often occurs in clusters ranging in size and occasionally there can be 1 or 2 individual sores only. The outbreaks can be painful but most times are just itchy. The longer you have had herpes usually the more mild an outbreak will be. Some outbreaks can be as small as one sore and it can not itch or be painful at all. It is best to avoid itching, picking or attempting to pop them as the liquid is the most contagious part of the sore. Also picking at them can cause scabbing and potentially scaring.
  • Cuts: Occasionally herpes outbreaks can look like tiny lesions or tears in the skin. These tend to sting more than itch. Many people call them paper cut sores as they look like tiny paper cuts. These will also heal on their own and do not usually contain any fluid.

One thing is true for both genital HSV-1 and HSV-2 the first outbreak is usually the biggest, most painful and lasts the longest. This can be due to a couple of factors such as:

  • Antibody Creation: Your body overtime gets better at creating the antibodies for herpes making the outbreak more mild and shorter.
  • Availability of Medication: most herpes treatment / medication take time to work into your system. For your first outbreak most people do not have these medications on hand and antivirals need to be prescribed which only happens after diagnosis. This delay in treatment causes the herpes virus to manifest to the full extent causing larger, longer and more painful outbreaks that are avoided when medication is taken sooner.
  • Understanding The Virus: during a first outbreak before you know what is happening you may accidentally do things to exacerbate the outbreak. Things like itching, popping, or touching the sores can cause the outbreak to spread larger and for the sores themselves to rupture and become more painful. After your first outbreak once you learn how to handle the outbreak you will be better at doing things to prevent the spreading of the outbreak to larger areas.

This document has transmission and viral shedding rates of the different strains and locations. https://docs.google.com/document/d/1xRL3jM3qLB5nh-b2B7tXOU2wrRoPgXclFBu7lCGpkbI/edit?usp=sharing 

Stages:

Not every outbreak follows the exact same stage pattern and with treatment some stages never will happen. But this is the standard timeline for a genital herpes outbreak:

  1. Tingaling Sensation

Many outbreaks begin with a "tingling sensation” around the area that gets an outbreak. This sensation can feel differently from person to person and even outbreak to outbreak. The feeling is usually mild and not painful,  some ways it  has been described to feel:

  • Similar to how it feels when the hair starts to grow back after being shaved.
  • Minor pins and needles in the skin area
  • Static under the skin
  • Itchiness in the skin
  • Nerve pain or aching in the lower back or legs
  1. Formation of Sores:

The sores can begin to form starting as a red flat area and then start to raise and fill with liquid. These sores can be itchy and occasionally painful especially if they are in an area that experiences friction and burst open, other times the sores can not hurt or itch at all. Some ways the sores may present:

  • Sometimes they appear over a large area and sometimes they can be one singular sore.
  • Usually they are in small clusters of a few sores in a small area. (around the size of a US quarter)
  • Sometimes the sores are not raised at all but look like cuts or “missing skin”; these are called paper cut herpes sores by the Reddit community.  If you suddenly have these micro-tears in your skin with no explanation it may be a herpes outbreak.

Forming:

Typical Cluster:

Paper Cut Sores:

  1. Healing:

Once the sores have formed they will start to heal. In some cases the sores may bust and ooze fluid. It is important to try to not pop the sores or touch the fluid. This is the most contagious part of the outbreak and can not only make the outbreak bigger if you are popping or spreading the fluid around but especially during your first outbreak can potentially spread it to other areas of the body (after the first outbreak the chances of Autoinoculation is very low.)

The sores, especially those that have burst open may dry out and scab depending on how you are treating it. It is important to not pick at the scabs or reopen the sores as this may lead to scarring or infection. It can also make the outbreak last longer as picking the scabs slows the healing process.

  1. Fully Healed:

Once the scabs and sores disappear the skin should return to its original color, texture and there should be no lingering feelings of tingling or itchiness. Occasionally after the physical symptoms clear up the tingling sensation may linger for a few days. This is an indication that you are still virally shedding and are still contagious. You should refrain from all sexual activity until all symptoms are clear both visible and invisible.

Even after all symptoms clear it may still be a good idea to wait at least 24-48 hours prior to having any skin-to-skin contact with the area to make sure that all symptoms are cleared up.

If you have scarring or discoloration of the skin the skin may not return to the same color as before the outbreak. If you can go to your doctor to make sure that the outbreak is healed prior to any skin-to-skin contact. Otherwise you have to trust your own instincts on whether the outbreak is lingering or if it is just scarring. Check for changes in the area, scars should remain the same color and shape. A scar may slowly fade but they should not be changing shape, drastically changing color or texture every day as an actual outbreak might.. See the Tips on Herpes Scaring Tab below for information on how to help the skin return to its normal color.

Sources:

Teri Warren Stat:

Asymptomatic Rates:  

Genital HSV-1 Shedding Info:

Prevention:

  1. Prescribed Antivirals: The most obvious way to prevent outbreaks is to talk to your doctor about prescribed medication. That can either be taken daily or days leading up to a “romantic” encounter. Talk to your doctor to see which treatment option works best with your lifestyle, medical history and HSV type.  At the bottom of this document is more info on antivirals and where to get them.
  • acyclovir (Zovirax)
  • valacyclovir (Valtrex)
  • famciclovir (Famvir)
  1. Lysine: (500mg)and other immune system boosters. At the end of the day herpes is literally a virus (herpes simplex virus). So similar to other viruses the better your immune system the better it will be at fighting off herpes. Lysine is the most popular supplement to take to fight off the pesky virus.

  1. Vitamin B, B12, C, D3, E, and Zinc ( 15 mg) are also a supplement that helps fight off herpes people in the support group swear by them.

  1. CBD Oil: is used to help with stress so if stress is a trigger definitely give that a try.

  1. Avoid Arginine: In RARE cases foods that contain high amounts of arginine, including peanuts, chocolate, raisins, carob, gelatin, cereal grains, and other arginine-rich foods or nutritional supplements can cause outbreaks. Arginine competes with lysine for absorption and when lysine is low, herpes outbreaks increase.

Triggers:

Triggers are things that when recognized can help prevent outbreaks. Triggers are personal and can be different for everyone. These are the most common triggers for most people with herpes. It is important to note that triggers can change throughout your life and most people notice a decrease in outbreaks and triggers after the first year of having herpes. Some common ones are:

  1. Stress

This is the number one trigger for herpes. This is why it is so important to not immediately panic and change all the aspects of your life immediately as the stress from worrying about potential triggers is more likely to trigger an outbreak then the “trigger” itself. There is also the physical stress on your body from making major life changes to your diet, exercise or hormones that can also trigger an outbreak.

Stress can lead to a weakened immune system and when your immune system is down that is when the herpes virus is most likely to reactivate. Stress triggers the release of hormones like cortisol, which can suppress immune cell activity and increase inflammation. Stress can reduce the effectiveness of white blood cells which help control the infection and reduce the severity of subsequent outbreaks (particularly CD8+ T cells).

Be sure to try to reduce stress in your life by:

  • Getting a good night's sleep.
  • Meditation
  • Going to therapy to talk out your stressors.
  • CBD oil
  • Making sure to balance your work/school life with things you enjoy
  • Create time for stress relieving activities such as baths, reading time, video games, mindless TV time or anything that gives your body and mind time to decompress.
  • If you are stressed consistently about herpes try to talk to your doctor about ways to relieve the stress either through medication (sometimes taking daily antivirals , supplements or vitamins not only help reduce the physical symptoms of herpes but also trick your mind into not feeling so helpless as you are physically taking meds to help prevent herpes which can cause some mental stress relief.

If there are unavoidable stressors:

  • Talk to your doctor about increasing the dosage of or starting antivirals especially during planned times of stress (major work project, major tests)
  • Take preventative over the counter supplements and vitamins (see outbreak guide below for more information).
  • Preparation for the stressful even to ease the burden (meal prep, plan outfits ahead of time, create a schedule including scheduled time to relax and breathe)

Sources:

  1. Shaving 

Excessive and repeated removal of body hair can cause micro-cuts, a weakened skin barrier and irritation. Shaving the area can cause micro tears in the sensitive skin area especially if you do not use the proper tools or take the proper precautions.This can potentially trigger an outbreak especially in the sensitive skin areas around the genitals.

Shaving has been known to lead to the stressful game of Herpes VS. Razor Bump. There are a few ways to prevent this:

  • Never dry shave and use warm water
  • Using soothing shaving creams while shaving to make it less rough on the skin
  • After shaving gels and creams (be careful this is a sensitive skin area so do your research)
  • Do not use a dull razor
  • Try using clippers or scissors to trim the hair rather than shaving the hair all the way off to help prevent skin irritation that a close shave can cause.
  • Brazilian Waxing: many people in the support group I am in do this and it doesn't seem to trigger outbreaks.
  • Laser Hair Removal: this according to Reddit triggered some people I did not have an issue with that. You can get some great deals on Groupon.

  1. Sex: 

For some people (not everyone) sex can be a trigger. There are some things that can be done before, during and after to help prevent this. This is especially important for people with vaginas as the skin is very sensitive down there and is more susceptible to infections, viruses and STIs.

  • Lubrication: to avoid friction triggers make sure the area is properly lubricated. Lube and foreplay are your friends. If the area is not properly lubricated there will be friction which can cause those micro tears which are triggering the outbreaks.
  • Positions: certain sexual positions can be rougher on the genitals and the genital area than others. If one particular position is consistently triggering you try a different way that is more gentle on the area that gets the outbreaks.
  • Body Hair: whether it be facial hair during oral sex or pubic hair during regular sex  sometimes it can get stubbly which can cause friction rashes. Make sure that everyone's body hair is either long and soft or smoothly shaven excess stubble can cause those micro tears.
  • Shaving: freshly shaven skin can be more sensitive then if you shave 24-48 hours before, try to avoid having sex directly after shaving.  
  • Peeing after sex: not only is this important to clean the area of bacteria and sexual debris but it can also help prevent UTIs.
  • Cleaning the area: using a baby wipe or showering after sex will also help keep the area clean which can help remove unwanted bacteria and sexual debris.
  • Moisturize: using a cream that is SAFE for that area and do not put any product inside the vagina. Try sticking to natural scent free creams for that area and do a test patch to make sure that it is safe. Dry skin is more susceptible for friction burn and micro tears that can trigger an outbreak.
  • Coconut Oil: using coconut oil (raw,virgin & unscented) on the more sensitive skin areas. Coconut oil not only moisturizes the skin but also contains natural antibacterial, antimicrobial properties to help soothe the area.
  • Put on soft comfy clothing: the skin is most likely very sensitive after sex putting on tight, itchy or materials like lace directly after sex can make the friction burn or the micro tears in the skin worse or more irritated leading to a higher chance of an outbreak.
  • Take Supplements: before or after sex take some lysine or whatever supplement works for you. D-mannose is an over the counter supplement that is used to reduce the chances of a UTI. Herpes advocate Suzbub swears by it as an after sex supplement.  
  • Antivirals: if sex is a major trigger for you, talk to your doctor about taking a higher dosage after sexual activities or changing your dosage when you are sexually active.
  • Relax, do not stress: stress is the leading trigger for a herpes outbreak becoming hyper fixated and stressing about a potential outbreak will increase the chances of having one.

  1. Body Hair:

Hair removal can be a trigger for herpes (see #2). But in some cases so can hair growth. When your hair grows back it can itch and tingle which can mimic the beginning stages of a herpes outbreak which can cause you stress which can make you more likely to have an outbreak (see  #1), itching the skin can also cause micro-tears in the skin which also leads you to be more susceptible to an outbreak. Having stubble that rubs against clothing or skin (of either other parts of your own body or a partners) which can cause an increase in friction which can also be a trigger for some people, (see #3 &5).  Having body hair for some people is also a stressor being the hair makes it harder to see and inspect the skin to see if there is an outbreak.

However, for others having the hair gives them peace of mind as hair removal can lead to other red bumps that can cause stress (razor bumps, micro cuts, etc.). There is also a theory that having body hair especially in the pubic area helps prevent the spread of herpes as it acts as a barrier between the skin and your partner's skin. It has been proven that hair follicles produce sebum, an oil which actually prevents bacteria from reproducing, helping overall health of the area. While pubic hair has been proven to reduce friction during sex (which can also be a herpes trigger see #3) and may help prevent against certain infections (cellulitis, some STIs, UTIs, vaginitis and yeast infections) there are very little studies on how it specifically affects herpes.

Your Partners Body Hair: If your partner has stubble either in their pubic region or on their face sometimes it can get stubbly which can cause friction rashes. Whether it be facial hair during oral sex / making out or pubic hair during regular sex make sure that everyone's body hair is either long and soft or smoothly shaven excess stubble can cause those micro-tears which make you more susceptible to an outbreak. Also avoid having sex directly after shaving as this is when the skin is very sensitive.

Sources:

  1. Friction /Underwear or Irritating Clothing: 

Friction not only from sex but from irritating clothing, tight clothing or excessive exercise can also be a trigger for some people. When wearing tight or irritating itchy fabrics there is a potential for the clothing to create micro tears or abrasions in the skin. When the skin is irritated or damaged, it can disrupt the virus's dormancy and trigger it to replicate, leading to an outbreak.

The skin around the genitals tends to be very delicate and sensitive. Wearing fancy lace undergarments, especially combined with tight clothing irritated my skin leaving me more susceptible to an outbreak. Leave the lace for sexy time and get some comfy undies for daily use.  It is also better for the vagina to not have that irritating fabric on it all day anyway.

During an outbreak in general avoid tight clothing like skinny jeans, tight leggings or work out clothing and use cotton underwear. Try when you are able to let the sores breathe (going commando around the house etc). If you wear male underwear get some loose cotton boxers for relief during an outbreak and avoid tighty-whities or constricting boxer briefs..

When doing physical activity especially in hot weather make sure to wear breathable, comfortable fabric. If you have areas that rub against each other (ex: thigh rub while walking) make sure to lubricate the area with either anti-chafing sticks, creams or even use a stick deodorant to prevent chafing. Especially do this if the area that rubs is around the areas that get the outbreaks.

Examples of Friction Prevention:

Sources:

  1. Menstrual Cycle:

Unfortunately this can be a trigger for some individuals. You may notice a pattern of outbreaks or prodrome symptoms during your period or the week before. The menstrual cycle involves fluctuations in estrogen and progesterone levels. These hormonal shifts can impact the immune system, potentially making it easier for the herpes virus to reactivate and cause an outbreak.There are a couple of ways to avoid this.

  • Supplements: You can be sure to take lysine and zinc or if you already do increase the dosage (consult a dr before doing more than what is recommended on the bottle) the week before and during when you usually see the outbreak.
  • Antivirals: You can talk to your doctor about taking daily antivirals either all the time or as with the lysine the week leading up to / during your period.
  • Birth Control: You can also discuss birth control options that regulate hormones. This can help your body keep the hormones in check. Talk to your doctor about the different options.

Sources:

  1. Food Choices: 

In rare cases junk food or foods containing large amounts of arginine may be a trigger.  Most people (myself included) DO NOT have food triggers in any way. Your best bet if you are getting an excessive amount of outbreaks and have tried other remedies (antivirals and supplements) especially after your first year is to keep a food journal to see if there is any correlation between foods / drinks and outbreak amounts. (See the Diet Choice section above).

For more information regarding diet choices see the Diet Choices Guide: https://docs.google.com/document/d/1ZPQwS7-hE7ePD8Uv4WuoZrpT29_JGhRPF1RfBmnDf98/edit?usp=sharing 

  1. Dry Skin:

A compromised skin barrier can potentially make it easier for the herpes virus to enter and infect the skin as well as the inflammation from the dry skin can activate the herpes virus in the nerve cells and lead to an outbreak. Dry skin can also cause you to think that you are getting an outbreak which can cause stress which can also trigger an outbreak. Dry skin can be itchy which can mimic the feeling of the start of a herpes outbreak. Individuals with conditions like atopic dermatitis (eczema) are more likely to be triggered by dry skin.

If you take daily antivirals be sure to drink plenty of water and stay hydrated as antivirals can dry you out. 

Be sure to practice normal skin hydrating practices such as applying topical skin creams, drinking plenty of water, using chapstick and vaseline on your lips. Be sure to make sure with your sensitive skin areas that the products you are using are safe and always do a small test patch of skin when trying a new product to avoid an allergic reaction and NEVER apply topical creams inside of mucus membrane sites (eyes, nostril, inside the mouth, vagina, or anus) without consulting a medical professional.

Sources:

  1. Tattoos / Piercings:

This can happen if you are getting a tattoo or piercing in the area that gets the outbreak. For example if you get oral cold sores and get your lip pierced. Any type of trauma to the area that gets outbreaks has the potential to be a trigger. If you are getting a tattoo / piercing outside the outbreak area it is unlikely to cause any outbreaks unless you are very stressed out about getting the tattoo/piercing. But in that case stress would be the trigger on the tattoo/piercing itself. Not everyone will have this be a trigger. I myself have oral herpes (cold sores) and have gotten permanent lip blushing done (full lip tattoo) and it did not trigger an outbreak. If you are concerned about getting an outbreak consult with your doctor about taking/increasing the amount of antivirals that you take as a preventative measure and you can also take supplements like lysine to help prevent an outbreak.

Treatment:

* As always, talk to your doctor about prescribed medications if you are having frequent or severe outbreaks. Also do not make any drastic changes without consulting a doctor or nutritionist.These are suggestions and things that have worked for others it is not a bible to be followed blindly. At the bottom of this document is more info on antivirals and where to get them. *

  1. Baths were my personal godsend. They soothed the irritation and the itching. For added relief use epsom salt. During the first outbreak many people suffer from painful urination. I found that peeing while submerged in warm water helped immensely. (Sounds gross but it works and the good news is you are already in the tub to wash off after.) Make sure the epsom salt is scentless if you have sensitive skin, you can get epsom salt at most pharmacies, grocery stores or amazon.  https://a.co/d/3I9Ph17 
  • If you do not have a bathtub you can purchase a Sitz Bath that goes over a standard toilet for relief. Its intended use is for hemorrhoid or postpartum care but people in my support group say that it also gives relief during an outbreak. They range from $15-$30 Limited-time deal: https://a.co/d/1x1b3R8 
  1. Warm Compress: If you do not have access to a tub or a Sitz, or the sores are in an area that water is hard to reach. Similar to a cold compress apply clean, soft washcloth filled with warm water to the affected area. Repeat as needed every 4 hours. A warm compress can help soothe the irritation, reduce itchiness and help with sensitive skin.
  2. Cool Compress: You can also use a cold compress to reduce swelling, and inflammation. Apply an ice pack or a clean, soft washcloth filled with ice to the affected area. Repeat as needed every 4 hours. Be sure to never place ice directly on the skin.
  3. Witch Hazel Pads: These pads are usually used for postpartum however that same cooling relief can help with your herpes outbreak to feel some relief from the burning pain and swolleness of the area especially at bedtime. https://a.co/d/1lpOIaS 
  4. Loose clothing: during your outbreak wear loose clothing it will aid with the irritation as well as not further rupture the sores making the outbreak bigger. If you can try to go bottomless as much as possible (if you live with people wear dress / loose basketball shorts and nothing under it and go commando) Some examples of cute things to wear:
  1. Cotton underwear only. The cotton underwear absorbs that liquid from the sores rather than allowing it to be smeared everywhere making the outbreak larger.
  2. Vaseline: If you have a sore in a particularly bad spot such as a place that chafes or right by the urethra making it difficult to urinate you can put some vaseline on the sore to ease the discomfort. Herpesgoddess also recommends using a spoon to redirect the urine from the sore.
  3. Zinc (30mg) is also a supplement that helps shorten the length of the outbreak so up your intake during an outbreak to aid in healing so if you didnt use it to prevent it you can use it to shorten. Make sure to take on a full stomach or it may cause nausea. Any brand will work, just make sure the only ingredient is zinc and there are no additives. An example of a good brand: https://a.co/d/cUv2urk 
  4. L-Lysine: Up your dosage to 2000mg daily to speed up the outbreak healing process. Take these on an empty stomach or they may cause nausea. As with the zinc there are many different brands just make sure the only ingredient is lysine and there are no additives. An example of a good brand: https://a.co/d/eimVuUZ 
  5. Urban ReLeaf Lemon Balm was suggested by a tiktoker they say that it speeds up the recovery as well as soothing the pain associated with the outbreak. https://a.co/d/5ZBBaAY 
  6. Manuka Honey: as listed above Manuka aids in healing it is safe to use on a sore and is said to speed up healing can also be ingested. You can make a mix with coconut oil, and a couple of drops of tea tree oil for better results.They also sell manuka honey bandages for whitlow.

Raw Honey: https://a.co/d/7GSF5TC Bandages: https://a.co/d/dWMq56G 

  1. Desitin: yes baby diaper rash cream. Not only does it help act as a barrier chafing it is also made with 13% zinc oxide which helps the sores heal faster. It is also safe for babies, making it extremely gentle on the skin! They sell off brand diaper rash creams just check the ingredients to make sure you’re getting the most zinc for your buck as that is what aids in healing the most. Also if you are not familiar with diaper rash cream it can be messy and is thick. A little goes a long way! https://a.co/d/4ddY61o 
  2. Bactine Spray: Typically used for cuts it had lidocaine in it to help the tingling and itchiness go away and it is safe to use on outbreaks being it is meant for open wounds. One Redditor (Nully18. They suggest keeping by your bedside table as for most night time is the worst for itchiness and nerve pain associated with outbreaks.  https://a.co/d/3XRqTkS 
  3. FemiClear: an amazon reviewer as well as someone in the support group said that this definitely helped especially their first outbreak. The amazon comment: “For an existing outbreak it is best to use FemiClear, some honey on the back of my hand, mix it with about two drops of femi clear 3x a day, it  works well to clear up irritations. If you don't have Manuka honey, try mixing local raw honey (not the stuff in the bear, that's not gonna do it) with turmeric and freshly cut/pressed garlic + femi clear. Keep the honey mixture and femi clear separate. Only mix when you're ready to apply. The honey will take away the burn of the femi clear and help your skin heal quickly.” https://a.co/d/g5RWSx7 
  4. Coconut Oil: you can put it on a pad before going to bed for cooling relief, or you can put it directly on a sore.  https://a.co/d/eudA7lN 
  5. Tea Tree Oil: While tea tree oil does not produce immediate results, it does play a role in accelerating the natural healing process. It also has healing and antiseptic properties that help prevent further infection. Take a cotton swab and apply some tea tree oil on it. Use it when you notice any itching or tingling sensation on your skin. While the oil is not that strong, you may want to dilute it by adding some water to avoid damaging your sensitive skin. Continue with the same procedure several times a day. Be sure to apply the oil to the outbreak before bed – you have to do it until the scabs finally disappear. Regular application will help prevent an outbreak and the process of swelling, ulceration, and scabbing may end in just a couple of days. Tea Tree oil should not be ingested or put inside the body (vaginal canal) and should be diluted before being put on sensitive skin.
  1. Hydrogen Peroxide: people on Reddit have suggested using Hydrogen Peroxide when they feel a tingling sensation or see a sore popping up. Dab some peroxide on the area 2-3 times per day. The redditor mentions that 3% food grade works really well and to be careful as there are higher strengths which could potentially sting or hurt to use. It is said to speed up the outbreaks bringing healing time down to 3 - 5 days. Some people say combining alcohol and hydrogen peroxide can help dry out the sore. Source: https://healthmatch.io/cold-sores/hydrogen-peroxide-on-cold-sore 
  2. Neem Oil: was suggested by Redditor Nully18 who has studied Ayurveda medicine and has had herpes for 13 years. It is used topically and can help speed up the healing of an outbreak. There are also Neem Herbal Supplements that can be orally taken. They suggest 2x a day in the morning and before bed.
  1. SssstingStop: This is typically used for bug bites, poison ivy or oak. It has high ratings on Amazon. It was recommended by Redditor Nully18 to help alleviate itchiness. It is compact and not herpes related for discreteness so it is easy to carry around in a purse or backpack for relief on the go.  
  1. Aloe Vera: can be put on topically to an outbreak to help soothe and cool inflamed areas. Apply topically as needed. (Herpes Advocate @pickeringfitness)  https://photos.app.goo.gl/gvA1BF6jR1XYozYG7 

Herpetic Whitlow (Finger Herpes):

Whitlow is when you get herpes outbreaks on your hands and / feet. Whitlow is more commonly associated with HSV-1 but can also be HSV-2 in rarer cases.

How You Contract Whitlow:

The most common way is by touching a cold sore (HSV-1) or a genital herpes sore (HSV-2) on another person and then touching your finger, especially if you have a cut or break in the skin.

Some individuals during their first outbreak can self-inoculate. Meaning that they can pass herpes to themselves through touching one of their own herpes sores. This can only really happen during a first outbreak and if you have an open cut or lesion on your finger. After the first outbreak your body develops long term antibodies for the particular strain of herpes that you have and that makes it difficult to catch the same strain again in a different location.

Unlike oral and genital herpes Whitlow only can occur if there is an open lesion outbreak in the skin. This is due to the fact that the regular skin on the hands is much thicker than the skin on mucus membrane sites making the virus unable to penetrate the skin barrier on regular skin without it being weakened or cut.

*Though this is true for most individuals there can be rare cases that stray from the norm, herpes affects each individual differently and there are always exceptions to the rules. This is meant to be a guideline not a strict rule book. *

Diagnosis:

Whitlow is considered uncommon with only 2.4-5 cases per 100,000 individuals.

Whitlow is most commonly contracted by:

  • Children: especially those who suck their thumbs
  • Healthcare Providers: especially dentists, dental hygienists or respiratory therapists
  • Contact Sport Athletes: especially wrestlers or any sport where there is direct contact of hands and mouths with no protective sports gear (helmets, or gloves.)
  • Newly Diagnosed Individuals: who are initially diagnosed with herpes in a different location and itch, apply medication or touch an open sore during their first outbreak without washing their hand directly afterward or if they have a break, cut or lesion in their fingers at the time of direct contact with a sore.

 Symptoms:

Like oral and genital herpes symptoms can include pain, tingling, burning, redness, swelling, and blisters or sores on the finger that can be itchy. In some cases individuals can experience fever, flu like symptoms and swollen lymph nodes.

The sores usually develop around the nail bed and cuticles or can appear in an area experiencing an open cut or lesion. Some examples to look at: https://www.nhs.uk/conditions/herpetic-whitlow/ 

Not all finger bumps are immediately herpes!

The human body can get bumps and blisters for many reasons that are not herpes related. More commonly a finger bump can be a basic warts, cysts, or a rash from something you touched or an allergic reaction. It is important to go to your doctor right away to be properly diagnosed and treated.

Prognosis / Treatment:

Whitlow is self-limiting, meaning it resolves on its own within 2 to 4 weeks. While it can be painful, the infection usually heals without complications, especially in individuals with healthy immune systems. Recurrences are possible, but these are often less severe than the initial infection. Though there are few studies base on Whitlow, due to what we know about herpes as a virus it is surmised that though viral shedding is possible it is considered less likely to occur based on the nature of the virus and the thickness of the skin on your hands versus the thin skin on the mucous membrane areas.

Whitlow is treated the same way as other HSV locations through antivirals, supplements and occasionally topical creams.  

Transmission:

Whitlow is usually transmitted to another person if they come in direct skin to skin contact with an open sore or blister. As stated above there is a chance of viral shedding however it is less likely to occur than in other areas especially mucus membrane sites.

Just as with oral and genital herpes transmission is most likely when an active outbreak comes in contact with a mucus membrane site (eyes, nose, mouth, genitals or anus), or a cut or break in the skin. If you are having an active outbreak on the fingers make sure to avoid touching these areas on others as well as yourself (autoinoculation is uncommon however especially during a first outbreak can occur and it is better to be overly safe than put yourself at risk of reinfection in a new location.

If you are a parent of a young child, wear latex or nitrile gloves while doing diaper changes, during feeding, bath time or any other activity that would require you to touch a mucous membrane area on your child while the outbreak is present. Also consult with your doctor and make a plan if you contract or know you have Whitlow while you have an infant.

Daily antivirals can help prevent outbreaks from occurring, and help lower the chance of viral shedding.  

Sources:

Ocular Herpes:

Ocular herpes is primarily caused by HSV-1 and rarely caused by HSV-2 this is due to the nature of HSV-2 and how it tends to infect the nerve cells that are located in the genital region, particularly in the sacral ganglia (nerve clusters near the lower spine) rather than the nerves in the base of the neck. Ocular herpes is considered uncommon and affects 500,000 people in the United States. (0.147% of the population).

Symptoms:

It is important to note that ocular herpes symptoms can mimic many eye issues that are much more common than herpes. Please do not panic immediately that you have ocular herpes prior to seeing a doctor and getting tested. Eye allergies, pink eye, scratched corneas, contact lenses or environmental irritants can all make your eyes red, itchy, puffy or swell.

Ocular herpes can cause redness, pain, and blurred vision in one or both eyes. Other symptoms may include swelling around the eye, sensitivity to light, and a feeling of something being in the eye. In some cases, there may be a rash or blisters on the eyelid or surrounding skin

Transmission: 

Just like with oral and genital herpes Ocular herpes is contracted through skin-to-skin contact with a person who has a strain of HSV (ex: someone kissing your eye). There is also a chance of contracting ocular herpes through autoinoculation (spreading herpes to yourself from one area of the body to another) this only can happen during your first outbreak if you touch a sore with your hand and then rub your eye immediately afterwards without washing, or wiping off your hands. After your first outbreak your body develops antibodies for the particular strain of herpes and it makes it much more difficult to transmit the same strain to other parts of the body.

Ocular herpes rarely transmits to a partner as the partner would have to come in skin-to-skin contact with your eye inorder for you to transmit. Though this can happen it is much less likely than if you have outbreaks in other areas of the body.

Treatment:

Antiviral medications, such as eye drops or oral medications, are used to control the infection and prevent recurrences. In severe cases, steroid eye drops may also be used to reduce inflammation. The same oral supplements, vitamins and antiviral medications that are used to treat oral / genital herpes can be used for ocular herpes. Be sure to consult with your doctor on what treatment options are right for you.

 Unlike herpes in other locations (mouth/genitals) it is important to seek treatment for ocular herpes. If left untreated in some cases it can lead to visual impairments or in rarer cases blindness.

Sources:

Tips For Herpes Scarring:

Prevention

In order to prevent the outbreak from leading to scarring it is important to:

  1. Try to not itch the sores or pick at healing sores or scabs from the outbreak.
  2. Do not attempt to pop or force the sores to burst open.
  3. Try to allow the outbreak to do its thing with minimal physical intervention. If you have to handle the sore be sure to wash your hands before and after to prevent infection which can make the outbreak worse and can lead to scarring.
  4. Do not wear tight clothing which may cause friction which may cause the outbreak to burst or break open.
  5. If the sores are visible wear sunscreen, hats or coverings over the sores as sun exposure can have an higher chance of scarring.

Treatment

  • Bio Oil: on the left over scars after healing https://a.co/d/ghdobho
  • First Honey Wound Healing Ointment: [ 1 oz — 28.4g ] | 100% Active Leptospermum | Fast Relief & Skin Repair | Manuka Honey from New Zealand | Antibiotic Free Burn Care, Scar Gel, Dressing Aid https://a.co/d/eZ2Vsfk
  • Savlon Wound Healing Gel: with scar preventative once scabbing has started and it helps with healing I can only find it in the UK. https://amzn.eu/d/8XIUNsn
  • Mederma Scar Gel: Treats Old and New Scars, Reduces the Appearance of Scars from Acne, Stitches, Burns and More. https://a.co/d/5ZWVdzd

Tips For Nerve Pain:

Nerve pain can be one of the most annoying parts of having herpes for some, nerve pain occurs because when herpes is laying dormant (not having an outbreak) it lives in your nerve endings. HSV-2 tends to live in the nerve endings in the base of the spine and HSV-1 tends to live in the nerve endings in the base of the neck. Not everyone has nerve pain and it can be different every time it occurs. You should NOT have constant nerve pain and it should not be ALL OVER your whole body. If your nerve pain is consistent, extremely painful, or in areas other than your legs, lower back, buttocks, or area that you get outbreaks consult a doctor as nerve pain can be an indication of a different illness.  

Types Of Nerve Pain: 

All nerve pain can happen on its own or prior to an outbreak. It is best to avoid all types of skin to skin contact with the area you are getting the nerve pain and the area that you usually get your outbreaks.

  1. Tingles: This feels almost like pins and needles, this is the most common sensation, it is not painful and feels like static.  
  2. Itchy Skin: this usually only occurs in the area that you get your outbreaks. It feels mildly itchy and is not painful. Almost the same sensation as the feeling you get when hair is growing back after shaving.
  3. Soreness:  This feels like a dull ache, kind of like a sore muscle after lifting at the gym. The main difference is if you rub the sore area you do not feel relief as the soreness is in your nerves not your muscles.
  4. Stabbing Pain: this can feel like little needles either in one concentrated area or up and down your legs. This can range from painful to mildly uncomfortable.

Tips To Relieve Nerve Pain:

  1. Baths: warm water and epsom salt can help with nerve pain. Make sure the epsom salt is scentless if you have sensitive skin, you can get epsom salt at most pharmacies, grocery stores or amazon.  https://a.co/d/3I9Ph17 
  2. Antivirals: Antivirals help with flare ups in general so they also help with preventing and easing nerve pain. You can also at your doctor's recommendation up your dosage of antivirals during nerve pain. They also sell a topical antiviral cream that you can rub on the area.
  3. Lidocaine Cream: this is a topical cream that numbs the skin. This doesn't help with healing but it does help with pain relief. As always everyone's skin has different sensitivity levels so do a test patch to see if it irritates the skin. Also avoid putting directly on sores or lesions to avoid it burning or stinging. https://a.co/d/dHuI1LF or https://a.co/d/gE7hIr1 
  4. Shingles Creams: they sell over the counter shingles nerve pain cream that people have said help calm their nerve pain. They sell such creams at any pharmacy and even on amazon. As always everyone's skin has different sensitivity levels so do a test patch to see if it irritates the skin. Also avoid putting directly on sores or lesions to avoid it burning or stinging. https://a.co/d/iZsh5vs or https://a.co/d/faAIfcd 

Post Herpetic Neuralgia:

Herpetic neuralgia is a chronic pain condition that can occur after a herpes zoster infection. This is usually associated with Shingles and not HSV-1 or HSV-2 however in rare cases it can occur especially in people over 60, or immunocompromised people. Genital herpes infection can cause inflammation of the nerves in the genital area. This inflammation can damage the nerves, leading to chronic pain. If you are experiencing intense nerve pain, or consistent nerve pain for longer than a week or recurring nerve pain without an outbreak occurring, talk to your doctor.

This pain can include:

  • Burning Pain (usually in the genital area).
  • Stabbing Pain (usually in the genital area).
  • Shooting Pain (usually in the genital area).
  • Sensitivity to touch or temperature.
  • Numbness
  • Tingling Sensation
  • Itchiness in the skin.

Treatment for Herpetic Neuralgia can include:

  • Daily Antivirals
  • Pain relievers such as gabapentin, or pregabalin
  • Nerve blockers including injections of numbing agents into the affected nerves to provide temporary pain relief
  • Lifestyle changes such as stress management, exercise, good sleep and hygiene can help improve overall well-being and reduce pain.

Sources: 

Tips For Painful Urination:

  1. Baths:I found that peeing while submerged in warm water helped immensely. (Sounds gross but it works and the good news is you are already in the tub to wash off after.)
  2. Pouring Warm Water: using a small cup pour warm water (not hot) over the area as you urinate. If you pour the warm water as you urinate it can dilute the urine and make it less painful and have less of a stinging effect as urine alone.
  3. Spoon Method: Using a spoon to redirect the urine. You can use the back of a spoon to redirect the urine away  from any sores that may be in the path of urine which can also help with stinging making it less painful.
  4. Vaseline can be used as a barrier against urine as well as chafing on sores in bad areas. Vaseline is not great for healing so only use when really necessary and let the sore breathe when you can.
  5. Helping the Urine Not Touch A Sore: put medical gloves on both hands, then hold my labia apart while also covering them (as that's where pretty much all of my sores are), and sit with my legs spread completely open on the toilet. Then I just push a bit to ensure my pee comes out in a steady stream and doesn't trickle (it coming out in a stream keeps it from touching any sores and causing irritation). This has genuinely kept the pain away, and if somehow any sores do get irritated, it's a sliver of the pain it has been.
  6. For Wiping: if you have anal herpes or if you have to wipe it can be painful especially in public restrooms where the toilet paper is not very plush. There are a few ways to easy the pain:
  • Using Water: instead of toilet paper try cleaning the area with a cup of water this will clean the area gently without disturbing the sores. You can also see about installing a bidet attachment to your toilet they range in price on Amazon and are pretty affordable
  • Wet Wipes: you can use wet wipes instead of toilet paper as it makes clean up easier so there are less passes over the area. The moisture also makes a wet wipe or baby wipe softer and soothing on the sores. Make sure that you buy flushable wipes and that the toilet that you are flushing them in can handle wet wipes instead of toilet paper or you may end up with backed up plumbing. Also make sure the wipes you are using are safe for your delicate areas (some makeup remover / face wipes can contain ingredients that are not good for those sensitive areas)
  • Wet The Toilet Paper: Getting the toilet paper a little damp can help make it less rough on the sores. If you wet it too much it may disintegrate so make sure to use only a little bit of water.
  • Pat/Dab The Area: instead of full wiping motions pat the area dry especially for urination you do not need major wipes to get the excess urine off the area.
  • Anal Clean Ups: For wiping after pooping you may need to get more creative and try to go in a different direction then you are used to in order to avoid the sores in this area to decrease the amount of pain. NEVER wipe fully back to front especially if you have a vagina as this can lead to an UTI. But you can try wiping to the side or to the middle to wipe around the sores.
  • Rinse Off: this obviously only works if you are home or somewhere near a tub or shower. Skip wiping all together and do a quick rinse in the shower or tub. It does not need to be a full body experience just the lower half to get clean without  disturbing the sores.  

Antiviral Information:

*At this time all antivirals have to be prescribed by a doctor.*

Antivirals are safe to take daily especially after a discussion with your doctor about previous conditions, lifestyle choices, and herpes symptoms. The side effect list may look long if you google it however if you look at ANY medication there is usually a booklet of side effects that are unlikely in most cases. Antivirals are so safe that doctors will prescribe it to pregnant mothers who have herpes to make it safe to have a natural delivery.

Sources:

Antivirals are a useful tool especially during your first year to shorten, and lessen outbreak amounts they also have proven to reduce transmission to a HSV negative partner. HOWEVER it is not a requirement and is a personal choice. There are many reasons to not take antivirals such as pre-existing kidney or liver conditions, it interfering with other medication, people with medication anxiety, and in some more rarer cases side effects of the antivirals themselves. Herpes outbreaks will clear up on their own without taking anything, it just may take longer. There are also many other supplements and more holistic treatment options that may work better for you. It is important to discuss with your doctor what is the best route for you.

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Dosage:

Please consult with your doctor on important prescribing, dosing and safety considerations. Every person is different and this is just a guideline provided by Valtrex (Valacyclovir), if you are experiencing any side effects or are still experiencing recurring or extreme herpes symptoms consult with your doctor about changing antiviral brands, or dosage.

Suppression

1g (1x a day)

500 mg (1x a day)*

Initial

1g (2x per day) x 10 Days

Episodic

500 mg  (2x per day) x 7 days

Herpes Zoster

1g (3x per day) x 7 days

No data are available on the efficacy of treatment of more than one year's duration (for suppression), started more than 72 hours (for initial), or more than 24 hours after onset of signs or symptoms (for episodic), or started more than 72 hours after rash onset (for herpes Zoster).

* Recommended dosage is 1g (1x a day) in patients with ≤ 9 recurrences per year an alternative dose is 500 mg (1x per day) *

Source: https://photos.app.goo.gl/pBic1vWc28FPbrAS7 

Statistics: 

Studies have proven that suppressive therapy can reduce the number of outbreaks by at least 75% while antiviral medication is being taken. In another study it found that women taking suppressive therapy had a 94% reduction in subclinical shedding while taking suppressive medication.

Source: 

Take antivirals, Study data shows that people with symptomatic herpes who take valacyclovir are almost 50% less likely to transmit the virus to others than non-medicated people with herpes. In one study, the HSV-2 acquisition rate was reduced from 3.6% to 1.9% using valacyclovir treatment.

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Prognosis: 

Over time your doctor may want to decrease the amount of medication prescribed. This is because over time the prevalence of outbreaks in both HSV-1 and HSV-2 decreases over time naturally. Even though antivirals are a very safe medication to take it is always better to not be on prescribed meds if you are able to do so. They may switch to episodic treatment where they only prescribe medication when you are currently having an outbreak. This is most effective if antivirals are taken within the 1 day of lesion onset or during prodrome symptoms. Also if you are taking antivirals primarily to help prevent transmission they work best if taken 5 days prior to sexual contact. For ways to help prevent transmission to partners besides antivirals check here: https://docs.google.com/document/d/10ccLJMnXAkuKfpU5ng9-1CiWXGPTYYPfDOCvxeB4GX4/edit 

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Side Effects:

It is important to note that ALL medications have a LONG list of side effects that MOST people do not experience and if you have medication anxiety you may not want to read the list and see if any of these happen on their own. None of the side effects are deadly, or will cause irreversible bodily harm as long as you talk to your doctor as soon as you start experiencing symptoms. Switching brands or dosages can change the side effects. I know many people on daily antivirals without any side effects. As always, talk to your doctor IMMEDIATELY if you experience any side effects or if you have any concerns about symptoms or medication.

These common side effects of antiviral tablets and liquid happen in less than 1 in 10 people. There are things you can do to help cope with them:

  • Dehydration: antivirals can cause dehydration which may be a cause of side effects such as headaches, dry skin or feeling dizzy. Make sure to drink plenty of fluids (especially water) while taking the antivirals.
  • Headaches: Make sure you rest and drink plenty of fluids. Do not drink too much alcohol. Paracetamol is safe to take with acyclovir if you need a painkiller. Speak to your doctor if this does not help or your headaches are severe.
  • Feeling Dizzy: If acyclovir makes you feel dizzy, stop what you're doing and sit or lie down until you feel better. Do not drive, ride a bike, or use tools or machinery if you feel dizzy.
  • Feeling or Being Sick (Nausea or Vomiting): Stick to simple meals and do not eat rich or spicy food. It might help to take your medicine after you have eaten. If you're sick, try small, frequent sips of water to avoid dehydration. Signs of dehydration include peeing less than usual or having dark, strong-smelling pee.
  • Diarrhea: Drink lots of fluids, such as water or squash, to avoid dehydration. Signs of dehydration include peeing less than usual or having dark, strong-smelling pee. Do not take any other medicines to treat diarrhea without speaking to a pharmacist or doctor.
  • Skin Becomes Sensitive To Sunlight: Stay out of bright sun and use a high factor sun cream (SPF 30 or above) even on cloudy days. You can also use sun hats and covers. Do not use a sun lamp or sun beds.
  • Kidney Issues: you may have read that antivirals are bad for your kidneys however this is only partially true and not true for everyone. The people that usually experience these side effects have pre existing kidney issues that are amplified by the antivirals. As stated above, taking antivirals with plenty of water will help your kidneys with filtration and help prevent kidney issues. It is important to talk to your doctor about your medical history and continually follow up to make sure nothing changes.

Speak to a doctor or pharmacist if the side effects do not go away or are really affecting you.

Source: https://www.nhs.uk/medicines/aciclovir/side-effects-of-aciclovir/ 

Antiviral Resistance:

On some of the subreddits you may read about people being concerned with antiviral resistance.

Antiviral resistance refers to a virus's ability to evolve and become less susceptible to the effects of antiviral drugs. This occurs through genetic mutations that alter the virus's structure or function, reducing the drug's ability to inhibit viral replication.

Developing antiviral resistance is rare in immunocompetent individuals, the prevalence of resistance is typically below 1%, with some studies reporting it as low as 0.3%. However, in immunocompromised patients, particularly those with weakened immune systems like stem cell transplant recipients, resistance rates can be significantly higher, potentially reaching 4-7% or even higher in some cases.

Reasons for Resistance:

Thymidine Kinase (TK) Mutations:
In most cases (around 95%), resistance to acyclovir (ACV) arises from mutations in the viral TK gene, which is crucial for activating the drug. These mutations can lead to a loss of TK activity or altered substrate specificity.

DNA Polymerase Mutations: Less frequently, mutations can occur in the viral DNA polymerase gene, which is the target of many antiviral drugs. These mutations can also confer resistance to multiple antiviral agents.

If your doctor suspects that you are resistant to antivirals they may try increasing the antiviral dosage or switching to a different antiviral medication. In some cases, they might also consider using alternative therapies like foscarnet, cidofovir, or imiquimod potentially in topical or intravenous forms.

Sources:

Where Antivirals CHEAP (With or Without Insurance):

*Unfortunately I only have information on the United States if you have any info on other countries please feel free to message me on Reddit: Mylovelyladylumps69 or Instagram: Bubblieinblu*

Prices are subject change these prices were captured in 2026

  1. WISP: with WISP you do not need a prescription from a doctor (you can have a “First Herpes Outbreak Consult for $65); they can prescribe medication online after consulting an online doctor on their website. If you have a prescription you can order your medication either for discrete delivery to your home or for same-day pick up at a local pharmacy. You can also opt in for a subscription or a one time order (the subscription is usually cheaper in the long run).  https://hellowisp.com/shop/genital-herpes 
  • Vacylovir: Starting at $25 a month for outbreak treatment  $12.50 a month for preventative treatment pick-up at pharmacy $25.50 per month for preventative treatment delivery. There are further options of a one time purchase, or different amounts and dosage all are affordable with or without insurance.
  • Acyclovir: Starting at $22 a month for outbreak treatment $10 a month for preventative treatment pick-up at pharmacy $19 per month for preventative treatment delivery. There are further options of a one time purchase, or different amounts and dosage all are affordable with or without insurance.
  1. Cost Plus Drugs: this is the new website from Mark Cuban.You need a previous prescription from a doctor but the cost of antivirals are WAY less. Acyclovir 800 mg 90 count bottle is $13.99 the lesser dosage or amount is less money. Valacyclovir 1000 mg 90 count bottle is $35.13 same as acyclovir less dosage or amount will be less money. There is around a $5 shipping fee but both brands seem to save a bunch of money. The people in my support group who have used the site say it takes around 5 days to arrive in discrete packaging and was 1/3 rd the price of costco pharmacy. https://costplusdrugs.com/medications/ 
  2. Lemonaid Health: this is an online prescription filling service that you need a diagnosis to use. Free shipping to your house in discreet packaging. $50 for 3 months of antivirals. They also offer a yearly prescription. All major brands are offered. https://www.lemonaidhealth.com/ 
  3. Nurx: 90 day supply, but pills start out at 1000mg for $75. Answer a few health questions to get started and pay $20 for your medical consultation. This price includes unlimited messaging with our medical team for a year.Your prescription will be delivered fast and for free in discreet, unbranded packaging. Refills are automatic for one year.
  1. Roman Health: This site you also need a previous herpes s diagnosis from a doctor. The antivirals are $86 for 90 days. Share your symptoms and medical history in the free online visit. A US-licensed healthcare provider will review your information and will typically get back to you within 24 hours. Free deliveries in discreet packaging to your door. https://ro.co/roman/ 
  2. GoodRX Care: this website is a great alternative if you do not have health insurance. It is a telehealth doctor that can prescribe basic medications. $9.99/ month will get you a gold membership which makes doctor visits. The first time you visit will cost you around $28.99 for the initial consultation and the gold membership.  Without the membership it is $59 to chat with a doctor and you pay full price for the prescription. It is still cheaper than an in person visit to a doctor if you do not have health insurance.  
  1. Costco: You do need a previous prescription from a doctor and it does seem that they only have Acyclovir. According to their website it is $33.99 for a 800 mg 90 count bottle in tablet form and $36.99 for a home delivery. They have cheaper options for lower dosages and less pill counts. You do need a Costco membership. They also give options for other pharmacies like Wegmans ($44.99), Health Mart Atlas ($45.79) and ACME ($45.79) https://www.costco.com/cmpps?drugIdentifierParam=27023555756&drugNameParam=Acyclovir 
  2. Amazon: Amazon also has a pharmacy section where you do not need a previous prescription from a doctor. You also do not need insurance.

Where To Get Antivirals As A Minor:

If you are underaged or on your parents health insurance and worried that they will find out or ask questions but want to be prescribed the proper medication there are ways to get antivials without telling them check out the Guide Specifically For Minors With Herpes: https://docs.google.com/document/d/1cw3muEEh8PDMD58-SBcJGmLNLI-UonCkTftacv_ZsJ0/edit?usp=sharing 

Outbreak Prevention For Fitness:

If you are having an outbreak it may be uncomfortable or painful to do some workouts during the outbreak so you may want to take a rest day or do upper body exercises that do not cause friction on the lower half. All protein powders tend to contain large amounts of arginine which may be a trigger for a herpes outbreak so taking lysine supplements can help combat the large amounts of arginine consumption as well as taking antivirals. Drastic lifestyle changes could potentially trigger an outbreak (and could also cause other issues) so it is important to consult a doctor or professional trainer before making major changes in fitness or diet or to start slowly on your own. However in most cases if the change is a healthier switch it will not trigger a herpes outbreak.

Source:

Protein Powders That Are High in Lysine

While all protein powders contain arginine not everyone will automatically get an outbreak because of protein powder, each person is different and you need to find what works for you. Some protein powders also contain Lysine which is what combats arginine. You can also take lysine supplements, and antivirals to help combat the arginine.

Examples of protein powders that contain lysine:

  • Pea Protein: A vegan protein powder that is derived from yellow split peas and is not only rich in lysine but also packed with other essential amino acids. It is easily digestible and has a smooth texture, making it a versatile ingredient for various recipes. The main complaint is that the taste is not great. There are many different brands available so trial and error may be your best bet.
  • Gold Standard Whey Protein Whey Protein: this is used by members of the support group that I am in. It contains high levels of lysine and it tastes smooth and great according to members.    https://a.co/d/02wFwyq 
  • Rival Nutrition Clean Gainer: is a high carb protein that works for members of the support group I’m in. https://www.rivalnutrition.com/clean-gainer/ 
  • OxyWhey Lean Wellness Protein: is a lean wellness protein that is consistently praised for its excellent taste and variety of flavors. It also contains 5 times more lysine than arginine. You will get around 2500 mg of lysine vs the 500 mg of arginine per serving. (Chocolate flavor can contain slightly more arginine) https://a.co/d/3ThRRi0 
  • Levels Nutrition Grass Fed Whey Protein: is a high quality protein that is high in lysine. Specifically the unflavored version contains 2210 mg of lysine vs 680 mg of arginine per serving. Check the flavors for variation. The peanut butter and chocolate flavors may have higher amounts of arginine.  https://a.co/d/cJR0Pel 
  • Wild Whey Protein: low carb protein option specifically 10.489 g of lysine to 2.84 of arginine per 100 g. It is sourced from 100% grass-fed cows, is gluten free and no added sugar and is biologically active. https://a.co/d/9Mw51TH 
  • Equate Whey Protein: this is a popular protein powder that contains 870 mg of arginine to 2,760 mg of lysine. People on Reddit recommend it. https://a.co/d/8tZc2YH 
  • Natreve Mooless Animal-Free Whey Protein: animal and cruelty free but is not dairy free. It contains 7.41 g of lysine vs 1.48 g of arginine per 100 g. https://a.co/d/5oMyz8y 
  • Pure Label Nutrition Vanilla Whey Isolate: high quality protein powder that is rich in lysine. It contains 2348 mg of lysine and 435 mg of arginine per serving. It is sourced from 100% grass-fed cows. https://a.co/d/95VEh9O 

Source: https://herpesfoodguide.com/articles/high-lysine-low-arginine-protein-powder/ 

Other Symptoms Or Illnesses Associated With Herpes

The list is in alphabetic order not in order of commonality. Most things on this list are NOT actually associated with herpes but sometimes google will connect them because of certain overlapping / similar symptoms or you may see questions being asked about them on Reddit or other forums. You may also notice certain symptoms and assume that they are herpes related and be concerned.  

Acne:

Herpes does not cause acne. Herpes is a viral infection, while acne is a skin condition caused by clogged pores. However stress can cause acne and if you are someone who stresses about herpes then it can be an indirect cause. Stress can trigger or worsen it by increasing hormones like cortisol and androgens, which stimulate oil production and inflammation. These hormonal changes, along with increased inflammation and inflammation, create an environment in which pores become clogged with excess oil and dead skin cells, leading to pimples and more severe flare-ups. Also if you take antivirals without hydrating properly it can cause dry skin. Dry skin can contribute or worsen acne because it can also be a trigger for excessive oil production, leading to clogged pores and can also cause dead skin cells to accumulate and block follicles. Dryness can also compromise the skin's protective barrier, increasing inflammation and allowing acne-causing bacteria to enter more easily.

Sources:

Alzheimer's or Dementia:

While there are some studies that suggest a potential link between herpes simplex virus (HSV) infections and an increased risk of dementia or Alzheimer's disease and some researchers hypothesize that HSV-1 could cause excess inflammation in the brain, potentially triggering or worsening Alzheimer's, at this time there is no concrete evidence and it is only a theory. It is important to note that these studies do not prove a direct cause-and-effect relationship and are only looking into the correlation (a connection or link between them) between the two. At this time no one knows for sure what causes either of these diseases. It is also important to note that 50-80% of the population has HSV-1 and 1 in 5 adults have HSV-2. If it really did cause an increased risk then the majority of the population would develop Alzheimer’s or dementia as they get older and that is currently not true.  Basically this is an ongoing theory that currently holds very little weight so do not freak out if you read somewhere that people with herpes will get dementia or Alzheimer's as there are MANY UNKNOWN factors that can cause you to get these diseases as you age.

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Bell’s Palsy:

Bell's palsy is a condition causing facial muscle weakness or paralysis on one side of the face. It typically resolves on its own in a few weeks and in some cases months. It results from damage or swelling of the facial nerve. While the exact cause is often unknown (idiopathic), it's believed to be linked to viral infections that cause nerve inflammation. Herpes, usually oral herpes, is a common cause of Bell’s Palsy as it is a virus that causes nerve inflammation however it is not the only virus that can cause it. Other possible triggers include Lyme disease, untreated sinus infections, shingles, epstein-barr virus, cytomegalovirus, HIV, and middle ear infections.

It is important to note that most people with herpes will not ever develop Bell’s Palsy. Only 1 in 60 people will experience Bell’s Palsy during their lifetime. The annual incidence, or new cases per year, is estimated to be between 15 and 40 per 100,000 individuals according to the National Institutes of Health (NIH). This translates to about 0.015% to 0.04% of the population per year. So the rates are very low considering 50-80% of the population has herpes in some form.

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Bacterial Vaginosis (BV), or Yeast Infections:

Though HSV itself does not cause BV or yeast infections (or vise versa) individuals with a vagina can see a correlation between herpes outbreaks and BV/ Yeast infections, especially during the primary (1st) outbreak.

BV/Yeast infections are separate infections that are not caused by HSV though they can have overlapping symptoms that some doctors may initially misdiagnose you with. BV/Yeast infections can have symptoms such as itching, burning, discomfort, irregular discharge which can also be symptoms of herpes. Herpes outbreak sores usually appear after the other symptoms so if you go to your doctor too soon after some or all of these symptoms appear you may get a misdiagnosis.

A herpes outbreak may trigger a BV or yeast infection for a few reasons:

  1. Your immune system: When your immune system is busy fighting HSV. This temporary stress on local immunity in the genital area can make it easier for Candida (yeast) or BV-related bacteria to overgrow.
  2. Changes in the Vaginal Microbiome: HSV lesions and inflammation can alter the vaginal pH and microbiome balance. BV happens when healthy lactobacilli decline and anaerobic bacteria take over.Outbreak-related inflammation may tip this balance.
  3. Stress & Hormonal Shifts: Stress is a common trigger for herpes outbreaks. Stress also affects hormone levels and the vaginal ecosystem, which can predispose someone to yeast infections or BV.
  4. Medication Side Effects: Sometimes people are prescribed antivirals along with antibiotics if doctors are unsure what’s going on. Antibiotics (for suspected BV or other infections) can wipe out protective vaginal bacteria, making yeast infections more likely.

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Canker Sores:

Canker sores are not herpes related whatsoever. Canker sores are small, shallow lesions that develop on the soft tissue in your mouth, or at the base of your gums. Unlike cold sores, canker sores don’t occur on the surface of your lips and aren’t contagious. You can get them  from being sick, a minor injury to your mouth from dental work, overzealous brushing, sports mishaps or an accidental cheek bite, toothpastes and mouth rinses containing sodium lauryl sulfate, food sensitivities, spicy or acidic foods, a diet lacking in vitamin B-12, zinc, folate (folic acid) or iron, an allergic response to certain bacteria in your mouth, hormonal shifts during menstruation or emotional stress.  

Source:

Cervical Cancer:

Herpes is not associated with cervical cancer at all. Cervical cancer is linked to HPV (human papillomavirus) which is a different virus from herpes entirely. Some people get the two confused or think that they are interchangeable as their acronyms are similar.

Source:

Dry Skin:

Herpes can cause dry skin, specifically in the affected area. While herpes is typically known for causing blisters and sores, these lesions can dry out and scab over during the healing process, leading to temporary dryness. Antivirals also can cause dry skin which is why doctors will tell you to drink plenty of water when taking them.

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Herpes Simplex Encephalitis (HSE): 

Most people with herpes will not end up with Herpes Encephalitis (HSE) and most cases are not in people with recent cold sores, even though over 60% of adults have HSV-1. So it’s rare despite HSV being extremely common. This is because after the initial HSV infection (usually oral or genital), the virus goes latent in nerve ganglia (trigeminal for HSV-1, sacral for HSV-2) .In most people, it stays dormant or causes only mild recurrences (cold sores, etc.). Herpes encephalitis happens when HSV reactivates and travels into the brain (especially the temporal lobe), which is very rare. Most people have a healthy immune system that keeps the virus in check. Specific immune responses (like interferons and T-cells) can prevent HSV from spreading beyond its usual areas (like skin or mucosa). If the immune system is weakened or fails to contain the reactivation, the virus may invade the central nervous system (CNS). Some people also have genetic mutations that make them more vulnerable to severe HSV complications, like HSE. For example, mutations in the TLR3 pathway (toll-like receptor 3), which play a role in detecting viruses, have been linked to increased susceptibility to HSE in children and adults.

HSV is neurotropic, meaning it prefers nerve tissue. But being neurotropic doesn’t guarantee it will invade the brain,  it usually only travels to ganglia, not into the CNS. It takes a rare breakdown in immune containment or viral control for HSV to cross the blood-brain barrier or travel along nerves into brain tissue.

Herpes encephalitis is a serious brain inflammation (encephalitis) caused by the herpes simplex virus, most commonly HSV-1. Herpes simplex encephalitis (HSE) is relatively rare, but it is the most common cause of fatal sporadic encephalitis in the United States. The annual incidence is estimated to be between 1 in 250,000 and 1 in 500,000 people. While most adults who contract HSE are older than 50, it can occur in all age groups, with one-third of cases in children and adolescents.It can be sporadic, often fatal, infection characterized by rapid onset of fever, headache, seizures, and neurological deficits.

Early diagnosis and treatment of herpes infections, as well as limiting contact with infected individuals, can help prevent the spread of the virus. Signs to look out for are fever, headache, confusion and seizures. Rarer signs can include changes in consciousness, personality changes, sensitivity to light, memory loss, speech difficulties, motor problems, vision changes and even in some cases hallucinations. Always talk to your doctor if you develop any new symptoms as they can test for HSE with:

  • Spinal Tab (lumbar puncture) to collect cerebrospinal fluid to detect infection. It is an extremely accurate test with a 95% sensitivity when done correctly.
  • Brain Scan (MRI): looking for temporal lobe inflammation, swelling, hemorrhaging or necrosis.
  • Electroencephalogram (EEG): measures the brain’s electrical activity, this is a less specific test but it may show periodic lateralized epileptiform discharges (PLEDs) and can support a diagnosis when paired with clinical symptoms or a different test.
  • Genetic Testing: This is done in rare cases done only in children or adults with recurrent HSV encephalitis or a family history. It will look for genes like the TLR3, TRIF, TBK1 or the IRF3.

Sources

HIV:   

Herpes does not transform into HIV; they are 2 different viruses. However you may read that people with herpes have an increased chance of getting HIV however your chance is only increased if you are having sex with someone who has HIV AND you are currently having an outbreak. If you aren’t having an outbreak the risk is the same as anyone else.

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HPV:

Though the acronyms look similar, HPV and HSV are different viruses and are unrelated to each other. HPV is Human Papillomavirus. There are many different strains of this virus (over 200) and it can in some cases cause genital warts, and some strains can lead to cervical cancer. It is also transmitted through skin-to-skin contact and there are no tests for it in males currently; in females this is tested through an annual pap-smear. Most people with HPV are asymptomatic and in most cases HPV will clear up on its own.

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Migraines or Headaches:

This is a rarer side effect of herpes and only usually a symptom of oral herpes as oral herpes lays dormant in the nerves at the base of the neck. Migraines or headaches can be, for some individuals, a prodrome symptom (warning symptom) for an upcoming outbreak. Most people will not experience HSV induced headaches and not every headache / migraine means that you will have an outbreak.

The more likely causes of headaches / migraines are stress, lack of sleep, dehydration, hormonal cycles, weather changes, certain foods or alcohol. When diagnosed with herpes many individuals begin to stress or lose sleep over their diagnosis which is a more likely cause of the headaches. Also if you take antivirals without properly hydrating it can cause dehydration which is also a more likely cause of headaches or migraines than herpes.

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Post Herpetic Neuralgia:

Herpetic neuralgia is a chronic pain condition that can occur after a herpes zoster infection. This is usually associated with Shingles and not HSV-1 or HSV-2 however in rare cases it can occur especially in people over 60, or immunocompromised people. Genital herpes infection can cause inflammation of the nerves in the genital area. This inflammation can damage the nerves, leading to chronic pain. If you are experiencing intense nerve pain, or consistent nerve pain for longer than a week or recurring nerve pain without an outbreak occurring, talk to your doctor.

This pain can include:

  • Burning Pain (usually in the genital area).
  • Stabbing Pain (usually in the genital area).
  • Shooting Pain (usually in the genital area).
  • Sensitivity to touch or temperature.
  • Numbness
  • Tingling Sensation
  • Itchiness in the skin.

Treatment for Herpetic Neuralgia can include:

  • Daily Antivirals
  • Pain relievers such as gabapentin, or pregabalin
  • Nerve blockers including injections of numbing agents into the affected nerves to provide temporary pain relief
  • Lifestyle changes such as stress management, exercise, good sleep and hygiene can help improve overall well-being and reduce pain.

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Viral Meningitis:

Though HSV can cause viral meningitis (more commonly HSV-2 but can also be caused by HSV-1), it does not happen often. HSV is associated with Aseptic Meningitis and Mollaret’s Meningitis. Mollaret’s Meningitis in general is rare with only a reported annual incidence of 1.2 cases per 1,000,000 adults and there are multiple causes for it, not just herpes. Aseptic Meningitis is more common with children and for adults the prevalence is 7.6 per 100,000 adults in the United States and there are also other causes of Aseptic meningitis other than herpes. This means that though there is a chance of getting meningitis because of herpes it is unlikely. Individuals most at risk are:

  • Immunocompromised individuals
  • Individuals with HIV
  • Individuals with cancer or undergoing chemotherapy
  • Individuals taking immunosuppressive drugs
  • Babies or young children under the age of 5

Sources:

Sources To Look At:

Herpes Cure / Vaccine/ Research:

You may be wondering if herpes is so old why isn't there a cure or a vaccine to prevent contracting it. There are a few reasons why viruses in general are hard to “cure”:

  1. Being herpes hides in your own cells which means in order to kill the virus would mean that you would have to harm your own cells which can make inventing a cure for herpes much more difficult.
  2. Being herpes has a latent or dormant stage that means that the herpes virus goes through times where it doesn’t produce viral proteins and can avoid detection by your immune cells. This makes herpes invisible to the immune system and resistant to most drugs. (Antiviral drugs only target active replication and not when herpes is dormant.)
  3. Herpes hides in long-lived nerve cells which do not turn over and are hard to reach by medication, also making it difficult to target the dormant virus.  

There is also a social aspect to medicine and research. Most scientists like to focus their time, effort, and money on viruses and diseases that are deadly or cause bodily harm. Though there are some people with extreme herpes outbreaks most people with herpes are asymptomatic or have mild symptoms, making many scientists feel that a cure isn’t necessarily needed when there are so many other illnesses that deserve more immediate attention. There is also the issue that many doctors and scientists who understand herpes from a scientific angle not a social angle feel that herpes is not that big of a deal. It to them is just a virus that occasionally causes a mild skin rash that is so common there is no real urgency to cure it.

The STI stigma also plays a role in this. Scientists need funding for their research and there are still many people that feel that individuals who get STIs “deserve” it for being promiscuous or not practicing safe sex practices so they do not want to pour money into that type of cure. (Most people with herpes know that this is far from true and that you can get an STI from things that are out of our control, lying partners, lack of knowledge, assault, etc.)

Pritelivir

Type: Treatment

Status:  Phase 3 of the trial

Pritelivir is an experimental antiviral drug that acts as a helicase-primase inhibitor for herpes simplex virus Clinical trials have shown it can be more effective than standard drugs like valacyclovir in reducing viral shedding and lesions. While it has shown promise for immunocompromised individuals and those with treatment-resistant herpes, it is not yet an approved medication and is still in clinical development. AiCuris Anti-infective Cures AG is in Phase 3 of the trial. This pivotal trial demonstrated pritelivir's superiority in healing lesions compared to standard treatments, with results announced in late 2025.

Fred Hutchinson 

Type: Potential Cure

Status:  preclinical (lab and animal studies)

The Fred Hutchinson Cancer Center (Fred Hutch) has made significant strides in developing a potential cure for herpes, focusing on gene therapy. Research efforts, led by Keith Jerome and Martine Aubert, have shown promising results in laboratory studies, particularly using gene-editing techniques to eliminate or significantly reduce the latent herpes virus in nerve cells. These advancements are a step towards a cure that could not only eliminate the virus but also reduce viral shedding, potentially lowering transmission rates. Currently they are still in the preclinical stage so there is still a way to go before there will be a true cure for herpes.

BioNTech

Type: preventative/therapeutic vaccine

Status:  Phase 1 of the trial

Conducting Phase 1 trials for BNT163, an mRNA vaccine designed to prevent HSV-2 infections. The vaccine encodes three HSV-2 glycoproteins aimed at blocking viral entry and counteracting immunosuppressive properties. Expanded to evaluate safety and immune responses, including in people with recurrent genital herpes. Recruitment is complete, the study is still happening data is still being collected through 2026.

Rational Vaccines

Type: Live-Attenuated Vaccine Concepts

Status:  Early/observational studies

Developing RVx201, a live-attenuated therapeutic vaccine for HSV-2 for recurrent genital HSV-2 aiming to reduce outbreaks and shedding.. The company has received an Innovation Passport under the UK's Innovative Licensing and Access Pathway (ILAP), facilitating accelerated development and regulatory support.

Assembly Biosciences

Type: Antiviral (non-vaccine)

Status:  Phase 1a/1b Completed

Assembly Biosciences – ABI-5366 (Helicase-Primase Inhibitor) is in trials for an Antiviral (non-vaccine) small molecule targeting viral replication in recurrent genital herpes.The goal is to reduce HSV-2 viral shedding and outbreaks with possibly weekly/monthly dosing.

Moderna

Type: mRNA-1608 (Therapeutic Vaccine)

Status:  Discontinued

Developing mRNA-1608, an mRNA-based vaccine targeting HSV-2 aiming to reduce outbreaks and shedding. This vaccine is currently in Phase 1/2 clinical trials, assessing safety and immune response in adults with recurrent genital herpes. The study is expected to conclude in June 2025, however recent industry reporting indicates Moderna discontinued advancing this candidate to Phase 3 despite completing early trials.

Herpes Cure Advocacy

Herpes Cure Advocacy (HCA), is a grassroots membership-based, international non-profit 501c3 advocacy organization with a mission of cure, treatment and prevention for Herpes Simplex Virus types 1 + 2. Our vision is a world free of Herpes Simplex Virus (HSV-1 and HSV-2). Founded in 2021, Herpes Cure Advocacy was born out of collaborative efforts with patient advocates worldwide. By channeling grassroots efforts in multiple patient advocate communities globally, HCA harnesses the power of patients themselves to create change.

This group gives updates and stays on top of all cure and vaccine stages, phases, trials etc. If you are looking to follow along closely with updates this is where you should go. There is also a subReddit HerpesCureResearch that also gives updates.

If you have any further questions, if any of the source links no longer work or if you found a different method or treatment that works for you reach out to the creator of this document on Reddit: Mylovelyladylumps69, IG: Bubblieinblu,  Tiktok: Bubblieinblu, or Discord: Bubblieinblu / The Herpes Questions Discord Chat. HOWEVER I will NOT look at any scam websites that claim that they “cured” herpes. I will also  NOT look at images of a herpes outbreak and diagnose you / tell you if it is herpes.

This document was last updated on Jan 23 2026.