Herpes Ulcers

Herpes Ulcers

Signs and Symptoms of Herpes Infection

Most individuals who are infected with HSV 1 or 2 have minimal or no symptoms with the virus as the virus is dormant in their body. Others present with active infection 2 to 7 days after exposure, which is characterised by blisters around the genitalia and/or rectum. Other symptoms include:

  • Itching or tingling sensation around the genital areas;
  • Pain when passing urine (usually over the open sores), most commonly in women
  • Headaches/backaches/myalgia
  • Flu-like symptoms and swollen lymph nodes or fever

The blisters often break, leaving tender ulcers/sores that take as long as a month to heal. After the blisters heal, the infection is by no means cured and can recur again, weeks or months later.

However, subsequent outbreaks are often less severe than the initial episode. Over time, the number of outbreaks get less often.

The herpes virus however, stays in the body indefinitely and while medications can be used to control outbreaks, there is no definitive cure for the infection.

How can I get the disease?

Genital herpes is acquired through skin contact with infected partners usually during sexual intercourse. It is most infectious when lesions appear on the skin during an outbreak. Even when there are no visible symptoms, there is still a risk that the virus is being transmitted through physical contact.

How can Herpes infection be detected?

Signs and symptoms of a herpes infection vary greatly. In most cases of active infection, a visual inspection is usually sufficient. However, to confirm the infection, the following needs to be done:

  • A clinical examination will be done on the genital area
  • A sample will be taken from the sores using a swab or cotton bud
  • Women may need to be examined internally (pelvin exam)
  • A urine sample may or may not be taken
Click here for more info on Screening for Genital Herpes

If symptoms have already disappeared, or if the patient is asymptomatic, a blood test will need to be taken to look for the virus. This blood test looks for antibodies to the HSV 1 or 2 virus which usually will appear 3 months after infection. However, results from such blood tests are not clear cut and cannot differentiate between active infection or a previous infection which is currently inactive.

Can Herpes be treated?

There is no treatment that can cure HSV 1 or HSV 2 infection. However, the severity of the outbreak can be controlled using antiviral medications. In addition, medications can be given to control the symptoms e.g. pain etc.

In some patients, they may experience recurrences of the infection. If the recurrences are very frequent, antiviral medications to suppress the virus may need to be taken for a prolonged period of time.

How can Herpes be Prevented?

Any skin contact can potentially transmit the infection even if there is no obvious signs and symptoms of active infection. However, if sexual intercourse is avoided if there are active sores/ulcers, transmission of infection can be avoided. Unfortunately, barrier methods of contraception, e.g. condoms, only offer limited protection against herpes virus.

Update 25th July 2014 – Condoms only protect against Herpes 30% of the time.

The best method of prevention is to treat the outbreak of herpes promptly and early so it does not transmit from partner to partner. In addition, certain patients may want to consider suppressive therapy even if they have got no symptoms to reduce transmission to their partners.

Complications of Herpes Infections

Individuals who are stressed can be afflicted with more episodes of herpes infection including patients with a suppressed immunity e.g. concurrent HIV infection. Due to the lesions that the infection causes, herpes increases the likelihood of HIV transmission by more than 3 times as it facilitates the entry of the HIV virus.

Click here for New Information on Herpes

Herpes also post a special risk for women who are pregnant. Although herpes does not affect the
women’s fertility, it increases the risk of miscarriage especially in the first 3 months of pregnancy.
The baby also has a risk of being infected. If the mother is infected in the later stages of her
pregnancy, there is a risk of premature delivery.

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  1. Over-analyzer

    Hi Doc,

    Is it possible to get a cold sore at my eyebrow after 2 years without any symptoms or sores happening around at my mouth or genital area? I do not know if its a cold sore or not, as i scratched till it bleed and its recovering now with mupirocin ointment given by GP.

    Furthermore, i had an eye infection at the same time with the suspected sore. But it healed once a GP gave me xepanicol antibiotic eye drops.

    Taking into consideration i have no sexual activity for the past 2 years.

    • Dr. Julian Ng


      It is not possible to determine if it is really a sore without seeing it in person. However, given the fact that it is recovering from the mupirocin ointment, it sounds more likely it is a bacterial superficial wound rather than a sore caused by HSV. If you like, you can visit us for further evaluation.

      • Over Analyzer

        Thank you Doc, it puts my mind at ease.

        As the wound wasnt painful even though i accidently rubbed off the dried blood.

  2. Hi doc, can i check if herpes (mouth) will likely flare up / recur after an operation to remove a sebaceous cyst? Also, are you able to share / write an update article (when you have time) on the potential complications of herpes that comes with aging? I have read of complications affecting the brain (herpes encephalitis) but there doesnt seem to be much literature on it from Singapore. Hope to understand more! Thank you!

    • Dr. Julian Ng


      Oral herpes can flare up when your immune system is down like during times of stress. Thus, it is not unusual for people to have flares during periods of stress. Herpes encephalitis is uncommon and is not only cause by Herpes type 1 can other be caused by other viruses. There is no way to predicts anyone will or will not get this uncommon condition. it may also be that you could get the uncommon condition even when you have never been infected with it before. Thus I would not be too concerned about this uncommon condition unless you have symptoms suggestive of it and in such a case, you should seek medical evaluation with a doctor.

  3. Hi doctors,5 months ago i had a sexual encounter with the prostitute using condom. I donot know it is safe or not because my penis is not erected time to time.
    After 2 weeks i fell dizziness,strong headache,fatigue, dry eyes, nausea, itchy mouth and too much white tongue, mouth ulcers, severe sore throat. After 2 months i have swollen gland below the jaw. I donot have fever and rash but all symptoms of hiv. I think i have hiv and get tested 5 times ypto now. All came negative. I did test and hsv 1 comes positive around 5.85. I test positive for prevotella, streptococcus grpup B and corynebacterium. Can hsv1 cause this symptoms?? I test negative for chalmydia, gonorrhoa, syphillis, urethritis, hpv, candia albicans.
    Its frustrating. Is it possible that i am affected by novel pathogen??? Before,i am very healthy person.
    Thank you

    • I would consider your HIV testing conclusive. If you are still concerned about your symptoms, it is best to get them assessed at a doctor. We cannot make any diagnosis over the internet.

  4. I had oral with double protected with combo 109 non reactive vdrl native hcv nagtive
    Hsabg nagtive 47days hiv 1 rna pcr non reactive
    115 days hsv1iggab/2 postive
    Hsv igm nagtive 1/2
    Chalimidiya 1/2 nagtive
    Iam worry this result it any hiv pls

  5. Hi Doctor,
    I did the Herpes test after 4 weeks,7weeks, 3months from my initial exposure, the result all came out negative, do you think I need to retest again?

  6. Hi Dr,
    I would like to get your professional advice. It’s herpes oral can spreading by carried children or hugging with touching side face to side face(but no touching lip area)? It’s whole body skin to skin contact with kids will spreading the viral to them? If we are infected parent, what behavior need to adjusted to avoid spreading to kids?

    • It is infective from the area of infection. If you have sores over the lips, they will spread from the lips. If you have sores over your fingers, it can spread from there. Please visit us for a proper consult and assessment if you are concerned.

  7. Doctor.. can i tell me about to my result?
    My result
    HSV 1 igg ab *>3.5
    HSV 2 igg ab <0.2

    • Your HSV-1 IgG is positive, and HSV-2 IgG is negative. If you wish to have a consult regarding your tests, it is best to visit us for a proper evaluation.

  8. I had last exposure 6 month ago I test almost 7 times hiv two times 4th generation hiv test last one is 6 month after I get tested with 4th generation hiv test is it conclusive I also test for all std and I got hsv1 positive 52.90 does hsv1 does effect my hiv test at 6 month of exposure I got negative hiv result at 6 month

  9. Doctor

    Please advice. I am tested IGG Hsv 1 positive with a reading of 2.4
    I read in your blog somewhere about a reading of above 3.5 to consider as true positive.
    How should I treat the reading? Should I ignore or do a retest.
    I am seeking a second opinion.


    • I would recommend you to repeat tests in 3 months to see if this is either a false positive or an early infection.

  10. Hi Dr,I have tested HSV 1 positive in my blood teat after my last exposure.Currentlt I got two cold sore on my neck is it possible due to hsv infection.

  11. May I know if the test done at days 58 of last exposure The result shown HSV-1 Igg antibodies Reactive but for HIV ab/ag is Non Reactive.In your opinion did I need to retest HIV due to HSV infection.

  12. Gerald

    Hi doctor
    I took a hsv 1 &2 igg test on 4th week exposure it came both <0.2 and on the 13th week I took another test which back hsv1 0.11 and hsv2 0.5 is this result mean I'm clear from it ? Why does the ratio diff after 2 month.

    • HSV serology may take up to 3 months or sometimes even longer to become positive. Please speak to your doctor for further assessment.

      • Gerald

        Thanks doctor Johnathan for your advice but I took the test on 3rd month should I take again ?

  13. sir I have herpes infection in my penish inside 20days befor I get the result I am positive I already take medicine 2week but still now same situation pain what can I do now please if anyone reply?

  14. Hi Dr Tan,

    I tested HSV 1 igg 1.5 and HSV 2 igg 1.05 since 2004. no symptoms until today. My question are:

    1) Report reference: Positive >1.0, mean i have the virus?

    2) Can HSV cause Hematospermia?

    Please advice. Thanks

    • Your HSV results are likely a false positive or were a very early infection as antibodies were still rising. If you are worried, speak to your doctor and get a repeat test. HSV should not cause hematospermia.

  15. Hi Doc,

    Is it possible to purchase a acyclovir cream itself from one of the clinics in town? Or do I have to be consulted again?

    I was consulted by a doctor about genital herpes prior at one of the clinics.

    Please advise.


  16. Hai doc..i did recieve handjob with a massage boy..m i at risk for contracting herpes?

  17. Hi Dr,
    I suspected that i had contracted HSV since late 2013 as I have been having “on and off” lesions on my genitals roughly 3 – 4 times a year. But during those time period (2013 – 2016) i have gotten myself blood tested IgG and IgM 6 times (latest test was August 2016) and have never tested positive for HSV 1 nor 2. However i was tested positive on Chlamydia (Blood tested as well). I learned from your comments that blood test is basically useless to find out about my current status.

    My questions would be:
    1. If i dont have any lesions at the moment, what is the best way to get tested for HSV? Is it possible that Blood test for HSV doesnt turn positive after 3 years of having HSV ??

    2. Is there any other STD that have the characteristics of “on and off” lesions regularly throughout the year??

    3. If i would like to get tested at one of your clinic, how long does it take for the result to come out? (I dont live in singapore so I need to estimate my length of stay if im going to get tested at your clinic).

    Thank you

    • I have not seen you so cannot give you any specific advice. From what you have told me, I think the best thing to do is to wait for the lesions to appear then swab it for various tests (not just HSV). Depending on the appearance of the lesion, you may also need a skin biopsy. Results can take 1 to 2 weeks.

      • Dr, is there any other STD which symptoms mimic HSV? A regularly “on and off” lesions throughout the year??
        It was not a once off lesions …

  18. Hi Dr

    I just been exposed to herpes from my girlfriend she told me that her first episode was 16 years ago can i believe her? Now i am worry and i want to known if there is any antiviral drug that i can take after exposure to reduce or eliminate the chances of getting infected. I am referring like those morning after medication or hiv medication you can take to eliminate chances upon recent exposure. Thank you.

    • drtan

      Why can you not believe her? It is definitely possible for someone for have Herpes for 16 years. In fact, people have it all their lives. There is an anti-viral pill that can be used almost like a morning after pill for Herpes. However, it is an off-label use. You should see a doctor to talk about it first. You can visit us at any of our clinics. Click HERE for location info.

      • Hi Dr

        Thank you for the reply.
        Yes I believe people can have the herpes virus for life time but i am wondering does it stay rested for 16 years and not appear only recently her 2nd episode she said… thanks.

  19. Mr. Ed

    Hi Dr,

    I went for a HSV2 test (as I experienced burning sensation in my penis while urinating & a tingling pain). My HSV2 rest was igb >12.

    My question is, do you reckon since the antibody amount is high I have been infected with HSV2 for long time and the symptoms only showing now ?

    – Ed

    • You cannot draw any kind of conclusion from the result of the antibody test except for 1: You carry HSV 2. 2. You probably caught it more than 4 months ago. You CANNOT conclude that your current symptoms are due to HSV 2. For that, you should get a swab test.

  20. Margaret J

    Dear Doctors

    I’m having herpes below my lips, in one years 2 to 3 times I will having it. And I notice when I stress, tired or no enough sleep is easy for them to come out. Can I have any injection to prevent them coming out?

    • drtan

      Unfortunately, there are no injections to prevent herpes. There is however medicines that can be taken to suppress any outbreaks. Come speak to us to learn more. Click HERE for location info.

  21. James17

    Hi doctor,

    I had a high risk encounter about a week back and I’m contemplating taking a 4th gen hiv test and herpes pcr test. There has been no symptoms whatsoever, but for peace of mind I would like to take the tests. Would a 14 day period post exposure be sufficient for anything to show up on the tests?

    Looking forward to hear from you, many thanks.

    • If you have been infected, 4th generation HIV combo test most likely would show up as positive. It is a little too early to test for Herpes.

  22. Doctor,
    Would it be wise for me to undergo a HSV test? As far as I am concerned, I do not have any symptoms but worried that I may have it from sharing utensils/cigarretes with people who have the virus. Is it a common virus in Singapore and is it possible to not show up or stay dormant? Thanks doctor.

    • HSV is extremely common. There is a good chance that you are already carrying it. Most people who have it do not show any symptoms. If you do not have any symptoms, there is really no point to test. If you test positive, there is nothing you can do about it anyway and you’ll probably suffer a lot of unnecessary worry and anxiety from the result. Best to let sleeping dogs lie.

  23. hi,

    can i check if herpes can be detected through normal blood test and urine test (i.e normal medical check up and not STD screening)?

  24. Xyhwang

    Hi Doctor. When does the first outbreak usually occur after we are contracted by the virus? It has been a week since I last kissed my bf.!I have chapped lips, dry mouth (every morning), a little white bumps on my upper lip line (size still stays the same) . Could this happen to be oral herpes? I have been really stressed and losing sleep because of this.

    • Dr Justin Sim

      Herpes is different for everyone – some get symptoms immediately after infection, while some never get symptoms. The best thing to do is get it checked by a doctor, I can’t confirm Herpes by just a description alone.

    • You don’t need to that worry. Herpes will not kill you. Almost 75% of human have the virus. If you search the famous people with herpes maybe you’ll be surprised.

  25. Hi doctor. I had test Hsv 1 igg was 1.43 & Hsv 1.02.
    Having a fever and whole body weakness.
    My doctor give me APO 800.
    Do I need eat every day or just stop if no outbreak?
    What is the side effect of this antiviral?

    • I’m sorry we cannot give medical advice over the internet. I suggest you ask your doctor who prescribed this medication to you for more information.

  26. worriedg

    Hi doctor.. previously I had itch below and scratching it resulted in rashes or something… and went to see doc and he suspected I have herpes..I did full std test all my results neg.. but hsv type 2 igg was 0.89.. the doc warn me it was a bit on the high positive side.. I was worried and so like after 8 months I went to do another herpes hsv 2 test.. and the result is 1.54 which means positive from the result >1.09 positive . so the results are a confirmation? because I am worried and would this affect me having a kid

  27. worried

    My girlfriend has a cold sore on her lower lips but in the country where we live does not have the luxury of testing for herpes. The cold sore started 5 days ago and is slowly getting better. Now she is saying a kind of sore throat is developing. Can I say it is due to herpes simplex? We had unprotected sex 3months ago after my unfaithful affair with another girl but with protected sex.she has not been complaining of other symptoms until she started having the cold sore. Did I infected my girlfriend with herpes? I tested 98days post exposure prophylaxis with alere determine hiv and was negative.3 days on PEP I have unprotected sex with my steady girlfriend and I am scared that I have infected her.can you help assess my risk and for giving my friend a sexual ly transmitted disease

  28. chris

    Hi doc,
    Last april 9 I have unprotected sex with unknown person and it came up in april 12 sunday 4 days after infection I have this blisters. And 1 week from that I go to specialist they suspect herpes 2 so 1 week i dont have any medication at all. It is really painful it is located in anus. Then doctor gave me acyclovir and some cream that is good and tested my blood negative of hiv and other related diseases. And this is my 33 day of having herpes. Last day i have a fever is it 2nd reoccurence? Or other symptoms? Im really worried and already stress im having sleepless nights. Im having a fever and bad headache and lower back pain my lips chapped. Is it from genetal herpes?

    • drtan

      I don’t understand your question. You caught Herpes. That is very common and you have already seen your doctor to get treatment. You had a HIV test at just 4 days post exposure which is completely useless as that is within the eclipse period. So what is your question?

  29. Good Afternoon Dr, Hope all is well with you.

    I had taken a Full std Panel and all results had came out favourably. However my HSV 1 result was Equivocal and was requested to take a sample in a months Time.

    I need some advise of what this actually means, if my memory serves me right, i had never had any sores on my lips..

    Your advise is deeply appreciated

  30. Dear Doctor,

    I went to test std in gribbles. my result is herpes simplex type 1 igg 1.3, herpes simplex type 2 is >10, chlamydia is 2.4. i went to see doctor he mentioned this is old infection. but will be forever in my body? how do i eliminate it forever?

    • Dr Justin Sim

      Herpes is not curable and will remain in your system – you can treat flare ups as they occur. Chlamydia is curable so please go and see your doctor again and ask them to explain the results clearly to you.


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