Three types of herpesvirus (viral family herpesviridae) cause sores, also described as blisters. These blisters, which are fluid-filled, break and then form a crust. Before these blisters form, symptoms known as prodrome occur; one type of herpes prodrome is distinctly painful, while the other two can cause burning or similarly uncomfortable sensations.
Oral herpes is caused by infection with the virus HSV-1, also known as HHV-1; it is sometimes also caused by HSV-2, the virus generally responsible for genital herpes. Oral herpes prodrome leads to a sensation in the area that will be affected by the cold sore. This feeling can be burning, itching or painful. Additionally, the Mayo Clinic reports that cold sores may themselves be painful. A typical outbreak of oral herpes lasts a week or slightly more.
Genital herpes is generally caused by HSV-2 (HHV-2), but may also be triggered by HSV-1. It, too, leads to prodromatic symptoms that can include, according to the Mayo Clinic, pain or itching in the affected area. Sores develop later and may also lead to pain and itching.
Shingles (herpes zoster) is a recurrence of the varicella-zoster virus (VZV, also known as HHV-3). This virus causes chickenpox during initial outbreak and causes shingles when it recurs, which is years or decades after infection with chickenpox.
Herpes zoster prodrome is painful and occurs along the line of the nerve in which the virus has again become active. This is generally along the buttocks or trunk of the body and occurs on only one side of the body. This pain continues as the red rash and blisters develop; for some people, the pain can be excruciating and can sometimes last even after the rash clears up.
The main line of treatment for all three of these herpetic conditions is a course of antiviral drugs. These drugs include acyclovir, valacyclovir and famciclovir. A physician may recommend other, topical treatments for the management of oral herpes, although it is not recommended that topical treatments be used for genital herpes.
In addition to antiviral drugs, shingles is managed with corticosteroids to reduce swelling as well as the possibility of complications. Pain relievers and topical agents like calamine lotion and capsaicin cream along with lidocaine patches are also employed to manage shingles pain.
Efficacy of Treatment
Antiviral treatment for herpetic conditions is most effective when it is begun during prodrome. People who have chronic outbreaks of oral or especially genital herpes may be put on daily suppressive therapy; this course of treatment involves taking antiviral drugs on a daily basis to reduce the number and severity of outbreaks.