Recurrences
Recurrences of herpes can break out weeks, months or years after the primary attack, or never. Recurrences are rare after HSV type 1 genital infection. Your resistance to illness (immune function) is important. Recurrence is more likely when a person is ‘run down’ or if triggered by a local injury. People who get oral herpes know that it is likely to break out if they have another illness (hence the name ‘cold sores’ and ‘fever blisters’) or if they get sunburn or any other injury on the mouth.
Recurrences turn up near the spot where the primary infection occurred. They’re usually smaller, less painful and clear up more quickly than the first attack.
Most people notice prickling or itching in the area a day or so before a recurrence breaks out. This is a good warning to stop sexual contact for the time being, because the infection can be passed on from the first suggestion of symptoms until the ulcer has completely healed. Occasionally a recurrence can be so tiny and painless that it isn’t noticed, though a sexual partner may be infected. Most recurrences don’t need any treatment, but salt-water bathing and local anaesthetic jelly can be used if needed.
Why does herpes recur?
During the primary attack, some viruses get into the nerve that supplies the infected area and travel along the nerve to its root beside the spinal cord. Here it lives, mostly in a dormant state, for the rest of your life. The virus may occasionally become activated in the nerve root for reasons that we don’t understand well but think are connected with immune function. The activated virus starts to multiply and migrates down the nerve to cause a recurrence.
People who get recurrences of genital herpes often know what is likely to lead to an outbreak. Some women find that a recurrence might follow an episode of sex when they’re too dry, or follow friction from tight clothes or sanitary pads. Being otherwise unwell, overtired, emotionally upset, jet lagged or ‘hung over’ can also trigger recurrences. Worrying about having herpes and the possibility of infecting your partner might even increase the risk. Sometimes recurrences turn up for no apparent reason when everything seems to be going well. However, most people with herpes feel that they can reduce the number of recurrences by avoiding whatever is likely to bring them on.
Should antiviral drugs be used for recurrences?
They usually aren’t recommended for mild, infrequent outbreaks. If attacks occur more than 10 times a year or are becoming more severe, a course of antivirals will almost eliminate recurrences while the drug is being taken. For most people herpes will settle back into its old pattern when the antiviral is stopped, so preventative treatment may require taking an antiviral
continuously for months or years. There is a fear that HSV strains resistant to antivirals may develop. So far people have used them for up to ten years without problems and with no evidence of resistant strains developing.
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