References UK clinical guidance from the NHS, the British HIV Association (BHIVA), and the British Association for Sexual Health and HIV (BASHH). Last updated: April 2026.
Herpes (HSV) can cause painful blisters on the lips or genitals, but many people carry the virus with no symptoms or very mild symptoms they don’t recognise. The only reliable way to know is to have an active lesion swabbed or, in some cases, a blood antibody test. Testing while you have symptoms gives the most accurate result.
Here’s how to know.
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Classic Herpes Symptoms
- Tingling or burning before blisters appear
- Cluster of small painful blisters on the genitals, mouth or lips
- Blisters burst into shallow ulcers
- Ulcers crust over and heal within 7-14 days
- Swollen lymph nodes nearby
- Flu-like symptoms during first outbreak (fever, headache, aches)
First Outbreak vs Recurrences
| Feature | First Outbreak | Recurrence |
|---|---|---|
| Severity | Usually worst | Usually milder |
| Number of blisters | Multiple | Fewer |
| Flu-like symptoms | Common | Rare |
| Duration | Up to 3 weeks | 5-10 days |
| Location | Site of exposure | Usually same spot each time |
Atypical Symptoms
Many people have mild or atypical symptoms that don’t match the classic picture:
- Small cracks or fissures in the skin
- Non-specific itching or discomfort
- Mild stinging when urinating
- Tiny pimples rather than obvious blisters
- Occasional outbreaks that are easy to dismiss
These can be easily missed or attributed to other causes.
How Herpes Is Diagnosed
Swab test (gold standard)
- A swab taken from an active blister or ulcer
- Tested with PCR/NAAT
- Highly accurate when fresh
- Can identify HSV-1 vs HSV-2
Blood antibody test
- Detects past exposure to HSV-1 or HSV-2
- Not routinely offered in the UK
- Can give false positives
- Doesn’t tell you where the infection is or whether you’ll have symptoms
What to Do If You Suspect Herpes
- Contact a sexual health clinic promptly
- Go while you still have a visible lesion — testing is most accurate then
- Avoid sex until you’ve been assessed
- Consider avoiding oral sex if you have a cold sore (can spread to partners)
Treatment
- Antiviral medication — aciclovir, valaciclovir or famciclovir
- Episodic treatment — taken during outbreaks to shorten them
- Suppressive treatment — daily low-dose antiviral to reduce recurrence and transmission
- Pain relief — paracetamol; salt water baths can soothe
Living With Herpes
Most people with herpes live normal lives. Outbreaks often become less frequent and less severe over time. With communication, condoms and sometimes suppressive therapy, transmission to partners can be significantly reduced.
Read more: What is herpes? | What looks like herpes | Home herpes tests
Frequently Asked Questions
Can I have herpes without symptoms?
Yes. Many people carry HSV with no or very mild symptoms and don’t know they have it.
How soon after exposure do symptoms appear?
First outbreak usually occurs 2-12 days after exposure, though it can be longer or not happen at all.
Is herpes curable?
No, but it’s manageable. Antiviral treatment controls outbreaks and reduces transmission.
Related reading
- Can You Get Herpes From a Toilet Seat?
- Can You Get Herpes From Kissing?
- Cold Sores vs Syphilis Sores: How to Tell the Difference
- Lab Test for Syphilis and Herpes
- Blood Test for Syphilis, Hepatitis B and Hepatitis C
Sources
- NHS — Sexual health conditions
- BASHH — UK clinical guidelines for STI management
- British HIV Association (BHIVA) — HIV treatment guidelines
- Terrence Higgins Trust — sexual health information
- UK Health Security Agency — STI surveillance data
Steve Page is a recognised expert on Sexually Transmitted Diseases (STDs) and STD treatments, having published numerous articles in peer-reviewed journals and presented his research at conferences around the world. He has an in-depth understanding of the latest medical research on STDs, and is an advocate for the development of new treatments and protocols to improve the health of those affected. In addition to his research, he has dedicated his career to understanding the causes and symptoms of STDs, as well as how to best treat those impacted.
