The Herpes Simplex Virus (HSV) is a highly common viral infection, divided into two main types: HSV-1 (often associated with oral herpes or cold sores) and HSV-2 (the primary cause of genital herpes). Both types can cause infection in either location. Worldwide, billions of people carry HSV-1, and hundreds of millions carry HSV-2. Despite the periodic appearance and disappearance of physical symptoms, the simple answer to whether herpes goes away is no; once infected, the virus remains in the body indefinitely. The virus is not curable, but it is manageable.
Persistence and Viral Latency
The reason herpes does not go away is rooted in its unique biological mechanism called viral latency. Following the initial infection, the virus travels from the site of infection along the sensory nerves to the nerve cell bodies. It establishes a lifelong presence within these nerve cell clusters, known as sensory ganglia. For oral infections, the virus often retreats to the trigeminal ganglion, while genital infections reside in the sacral ganglia.
In this latent state, the viral DNA remains within the neuron’s nucleus, but the virus is inactive and silent, producing almost no new viral particles. This latency allows the virus to hide effectively from the host’s immune system, which is unable to completely clear the infection.
Various triggers can cause the virus to reactivate, moving it back into an active phase. Common triggers include physical or emotional stress, illness, fever, hormonal changes like menstruation, or exposure to sunlight. When reactivated, the virus travels back down the nerve pathway to the skin’s surface, causing the physical symptoms of an outbreak. Even when no physical symptoms are present, the virus can still become active on the skin (asymptomatic shedding), which can lead to transmission.
The Duration of Active Outbreaks
While the virus itself is permanent, the visible symptoms, or active outbreaks, are temporary and follow a predictable timeline of progression and healing. The duration of an outbreak varies depending on whether it is the first infection or a recurrence. The initial outbreak is typically the most severe and the longest-lasting, sometimes persisting for two to four weeks.
Recurrent outbreaks are often milder and heal more quickly as the immune system learns to respond. The process begins with a prodrome phase, where the infected area experiences tingling, itching, or burning before any lesions appear. This sensory warning is followed by the formation of small, fluid-filled blisters.
These blisters eventually rupture, leaving behind open, painful sores or ulcers. Over a few days, these sores crust over and form scabs. Most recurrent outbreaks resolve and heal completely without scarring within seven to fourteen days.
Treatment Options for Management
Although the herpes infection is lifelong, medical treatments are available to manage the symptoms and reduce the frequency of outbreaks. These treatments involve prescription antiviral medications that interfere with the virus’s ability to replicate. The management strategy is divided into two approaches: episodic therapy and suppressive therapy.
Episodic Therapy
This is a short course of antiviral medication taken only when an outbreak occurs. The goal is to reduce the severity and shorten the duration of the physical symptoms, often by one or two days. For best results, the medication must be started promptly at the first sign of the prodrome phase, such as tingling or itching.
Suppressive Therapy
This involves taking an antiviral medication daily over a long period. This approach is recommended for individuals who experience frequent or severe outbreaks. Daily suppressive therapy can reduce the number of recurrences by 70% to 80% and lower the risk of transmitting the virus to a partner. Suppressive therapy has a greater impact on reducing the overall disease burden compared to episodic treatment.