According to the Centers for Disease Control and Prevention, 1 in every 6 people aged 14 to 49 have herpes, and most people don't know they are infected since symptoms can be mild and infrequent. Herpes is a sexually transmitted disease caused by two types of viruses: herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2). For the most part, HSV-1 causes blisters on or around the mouth and HSV-2 causes blisters in the genital area, however, both virus types can affect both areas. Herpes is spread through skin-to-skin contact, such as kissing and sexual contact. When the virus is dormant, the infected person is not contagious. Once the virus becomes active, however, the disease progresses through the following four stages during which the infected person is contagious.
First Stage of Herpes: Viral Shedding
A few days before the onset of an outbreak, some people experience mild symptoms of itching, tingling, burning, and sometimes swelling and redness in the area where the lesions subsequently appear. The infected person is contagious during this stage because the virus is shedding from the skin. Since there are little to no symptoms during this stage, the infected person may not realize they are contagious and therefore not take precautions or abstain from skin-to-skin contact. Because of this, herpes is frequently transmitted to others during this initial stage of viral shedding.
Second Stage of Herpes: Bumps and Blisters
Sometimes there is only viral shedding and the virus becomes dormant again. Other times, the disease progresses to the second stage and the infected person has an "outbreak" of visible bumps and blisters, either around the mouth (which is referred to as a cold sore or fever blister) or in the genital area. These skin lesions usually begin as painful, small red bumps or tiny, fluid-filled blisters on a red base. According to the American Social Health Association, when this outbreak is in the genital area it is frequently mistaken for pimples, ingrown hairs, jock itch, insect bites or yeast infections, which explains why as many as 90 percent of people with herpes are unaware they are infected. The infected person is the most contagious during this stage because high concentrations of the virus reside in the fluid within the blisters. The first outbreak is the most severe and clustered bumps and blisters may be accompanied by flu-like symptoms. In subsequent episodes, there are usually fewer lesions, notes Dr. Lawrence Corey, Chair of Virology at the University of Washington College of Medicine.
Third Stage of Herpes: Crusts and Ulcers
About two to three days after bumps and blisters appear, they give way to crusts and ulcers. Crusts, as the name implies, are crusty, yellowish, granular scabs. They are more commonly seen on skin lesions, such as the border of the lip and groin. When lesions are on a mucous membrane, they do not crust effectively, resulting in ulcers--shallow, pink, well-demarcated "craters" where the surface layer of tissue is clearly absent. Crusts and ulcers are often itchy and painful. Viral shedding may continue during this time, making the infected person still contagious.
Fourth Stage of Herpes: Healing
Healing occurs as crusts and ulcers are gradually replaced by new tissue. As with other kinds of skin problems, healing occurs from the outside to the inside, with measurable decreases in diameter and depth. In a primary outbreak, the process may take as long as six weeks. In recurrent outbreaks, lesions usually resolve within a week. It is believed that antibodies present in recurrent outbreaks play some role in speeding the healing process, explains Dr. Corey. Herpes lesions usually heal without scarring, however, if there is a secondary bacterial infection scarring may occur. Although there is no cure for herpes and the infection can stay in the body for life, the number of outbreaks tends to decrease over a period of years and there are medicines that can prevent or shorten outbreaks, according to the Centers for Disease Control.