The frequency and severity of recurrent outbreaks vary greatly between people. Some individuals' outbreaks can be quite debilitating, with large, painful lesions persisting for several weeks, while others experience only minor itching or burning for a few days. Some evidence indicates genetics play a role in the frequency of cold sore outbreaks. An area of human chromosome 21 that includes six genes has been linked to frequent oral herpes outbreaks. An immunity to the virus is built over time. Most infected individuals experience fewer outbreaks and outbreak symptoms often become less severe. After several years, some people become perpetually asymptomatic and no longer experience outbreaks, though they may still be contagious to others. Immunocompromised individuals may experience longer, more frequent, and more severe episodes. Antiviral medication has been proven to shorten the frequency and duration of outbreaks.[79] Outbreaks may occur at the original site of the infection or in proximity to nerve endings that reach out from the infected ganglia. In the case of a genital infection, sores can appear at the original site of infection or near the base of the spine, the buttocks, or the back of the thighs. HSV-2-infected individuals are at higher risk for acquiring HIV when practicing unprotected sex with HIV-positive persons, in particular during an outbreak with active lesions.[80]
Human herpes virus 5 (HHV5) is the official name of cytomegalovirus (CMV). CMV is also a cause of mononucleosis. In people with healthy immune systems, the virus may not even cause any symptoms. It can be sexually transmitted, can cause problems to newborns, and can cause hepatitis. CMV can be transmitted through sexual contact, breast-feeding, blood transfusions, and organ transplants. CMV infection is one of the most difficult complications of AIDS. It may lead to diarrhea, severe vision problems including blindness, infections of the stomach and intestines, and even death. For a virus that barely causes a problem in most people with healthy immune systems, it can be amazingly nasty in people with damaged immune systems, such as people with AIDS.

Oral herpes is also known commonly as cold sores and fever blisters but is different entity from oral canker sores although canker sores may sometimes be associated with HSV infection. Canker sores occur solely inside the mouth. Oral herpes occurs inside and around the mouth. Most of the time HSV-1 causes mouth symptoms and in a minority of cases it may also be responsible for genital symptoms. The opposite is true for HSV-2 – it causes genital symptoms in the majority of cases while only a few cases of HSV-2 infection will result in mouth symptoms. HSV-1 infection may be seen in all ages, including children, but when genital herpes is seen in children, sexual abuse needs to be a consideration.
'Using condoms or dams can help to protect against STIs, but herpes can also be passed on by skin-to-skin contact with the affected area, so it’s strongly recommended that you don’t have sex during this time,' she adds. 'This includes direct genital contact or skin-to-skin contact with the affected area, and doesn’t have to be penetrative sex,' says O’Sullivan.
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