All herpes viruses manifest with an active period lasting from 2 to 21 days. Afterwards, the virus goes dormant and the patient has a period of time free from symptoms. Although transmission of the virus is most common during active periods, “shedding” of the virus occurs even during dormancy.

Diagnosis is usually based on the appearance of the outbreak. Treatment is with an antiviral medication such as acyclovir. Treatment suppresses recurrence of symptoms, but does not destroy the virus. 

Herpes labialis, oral herpes, is a recurrent infection of the mouth usually caused by HSV-1. It is known as “cold sores” or “fever blisters.” The first outbreak usually occurs 1 to 3 weeks after infection. 

Symptoms include: 
Tingling or burning sensation before blisters appear.
Small, painful blisters that break open, ooze or merge to form a larger blister.
A red rash on the lips, mouth or gums.

Genital Herpes is an STD usually caused by HSV-2. Transmission of either herpes type can be passed by oral sex to the mouth or genitals of an uninfected partner. After infection, the first outbreak occurs within 2 to 15 days. The lesions can take 2-3 weeks to heal, even with treatment. In women, genital herpes is sometimes confused with trichomoniasis, a sexually transmitted parasitic infection.

Symptoms include:
Tingling sensation on the surface of the skin.
Red, irritated skin.
Small, painful, fluid-filled blisters on the vulva and cervix in women or penis and scrotum in men, the upper thighs, and the membranes of the urethra and anus.

Neonatal Herpes is one of the most serious herpes infections. It is passed mother-to-child, usually during vaginal birth. Infection is most likely when the mother has her first outbreak during the third trimester of pregnancy. Neonatal herpes is classified according to the three forms the disease takes:

Skin, Eye Mouth herpes (SEM) or “localized” herpes. The symptoms are external blisters, but no internal lesions. The blisters can form where there was skin damage, and in the corners of the eyes and roof of the mouth.

Disseminated Herpes (DIS) affects the internal organs. The liver is particularly vulnerable.

Central Nervous Herpes (CNS herpes) infects the brain and spinal cord, leading to encephalitis and brain damage. 

Acyclovir is used to treat neonatal herpes, though early detection of DIS and CNS herpes is difficult due to the lack of external lesions. Sadly, there is a death rate of 25% for infants infected with herpes in utero or at birth. 

Prevention is vital, as no form of herpes is curable. Condoms offer some protection, but transmission can occur from contact between areas that are not covered by the condom.