Genital Herpes Simplex
Genital herpes is a common sexually transmitted infection that affects millions of people worldwide, yet most who have it don’t even know they’re infected because they have no symptoms or only very mild ones.
Table of contents
- What is Genital Herpes?
- How Common is Genital Herpes?
- Symptoms and Outbreaks
- What Causes Genital Herpes?
- How Genital Herpes Spreads
- The Link Between Genital Herpes and HIV
- Diagnosis and Testing
- Treatment Options
- How to Prevent Genital Herpes
- Living with Genital Herpes
- Genital Herpes and Pregnancy
What is Genital Herpes?
Genital herpes is a sexually transmitted infection (or STI, also called a sexually transmitted disease or STD) that causes painful sores or blisters on your genitals. The infection is caused by two types of viruses called herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2).[1] Both types can cause genital herpes, although HSV-2 causes it much more frequently.[11]
The sores can affect your vulva, vagina, cervix, penis, testicles, anus, rectum, buttocks, or the groin and inner thigh area.[11] While HSV-1 often causes oral herpes (cold sores or fever blisters on or around the mouth), it can also spread from the mouth to the genitals through oral sex and become genital herpes.[1]
Once you’re infected, the virus stays in your body for life. It’s usually dormant (asleep) but may wake up and cause outbreaks.[3] There’s no cure for genital herpes, but treatments can help manage outbreaks and lower the chances of spreading the virus to others.[1]
- Vulva
- Vagina
- Cervix
- Penis
- Testicles
- Anus
- Rectum
- Buttocks
- Groin
- Inner thigh
How Common is Genital Herpes?
Genital herpes is very common in the United States. In 2018, the Centers for Disease Control (CDC) estimates show there were 572,000 new genital herpes infections in the U.S. among people aged 14 to 49.[1] The CDC estimates that about 12% (one in eight) persons ages 14-49 in the United States has genital HSV-2 infection.[4]
However, as many as 90 percent of people with the virus are unaware that they have it.[4] This is because most people with genital herpes have no symptoms or have very mild symptoms that they don’t recognize as herpes.[1]
Globally, about 491 million people aged 15–49 have HSV-2, the most common cause of genital herpes.[11] More than 50 percent of the adult population in the United States has oral herpes.[4]
Symptoms and Outbreaks
Most people with genital herpes have no symptoms or have very mild symptoms. Mild symptoms may go unnoticed or be mistaken for other skin conditions like a pimple or ingrown hair. Because of this, most people do not know they have a herpes infection.[1]
First Outbreak
When symptoms do occur, they’re usually worse during the first outbreak. Symptoms typically appear within 2 to 20 days after infection and may last up to four weeks.[11] The first outbreak may include:[1][2]
- Small blisters that burst to leave red, open sores around your genitals, anus, thighs or bottom
- Pain, itching, or tingling around the genitals
- Painful urination (a burning feeling when you pee)
- Unusual vaginal discharge or discharge from the urethra (the tube that carries urine out of your body)
- Flu-like symptoms such as fever, headache, body aches, or swollen glands
The blisters break and leave painful sores that may take a week or more to heal. Scabs eventually form as the ulcers heal.[1]
Recurrent Outbreaks
People who experience an initial outbreak of herpes can have repeated outbreaks, especially if they have HSV-2. However, repeat outbreaks are usually shorter and less severe than the first outbreak.[1] Recurring symptoms are usually milder than the first outbreak and don’t last as long.[11]
Some people may only have one or two outbreaks during their lifetime. Others may have as many as four or five outbreaks a year.[11] Although genital herpes is a lifelong infection, the number of outbreaks may decrease over time.[1] Over time, outbreaks tend to happen less often and be less severe. Some people never have outbreaks.[7]
What Causes Genital Herpes?
Genital herpes is caused by two types of herpes simplex virus: HSV-1 and HSV-2.[1] Most cases of recurrent genital herpes are caused by HSV-2.[9] However, an increasing proportion of genital herpes infections have been attributed to HSV-1, which is especially prominent among young women and men who have sex with men.[9]
Once the herpes simplex virus gains entry into the body, it begins making copies of itself and spreading. The virus then retreats along the nerve pathways, hiding in a nerve root called a ganglion. In cases of genital herpes, HSV retreats to the sacral ganglion, located at the base of the spine. In the ganglion, the virus remains inactive (latent) for an indefinite period of time.[4]
The virus can become active again and travel back to the skin, causing outbreaks. Various biological events can trigger this reactivation, though it doesn’t always cause visible symptoms.[4]
How Genital Herpes Spreads
Genital herpes spreads through direct skin-to-skin contact during sexual activity. This happens when a contagious area comes into contact with a tiny break in the skin or mucous membrane tissue, usually on the mouth or genitals.[4] You can get genital herpes by having vaginal, anal, or oral sex with someone who has the infection.[1]
You can get herpes if you have contact with:[1]
- A herpes sore
- Saliva from a partner with an oral herpes infection
- Genital fluids from a partner with a genital herpes infection
- Skin in the oral area of a partner with oral herpes
- Skin in the genital area of a partner with genital herpes
You can also get genital herpes from a sex partner who does not have a visible sore or is unaware of their infection.[1] The virus can spread even when sores are not present.[2] There are several days throughout the year (called asymptomatic reactivation, asymptomatic shedding, or subclinical shedding) when the virus may be on the surface of the skin, but there are no symptoms. Herpes can be passed through sexual contact during this time.[4]
It is also possible to get genital herpes if you receive oral sex from a partner with oral herpes.[1] If a person with oral herpes performs oral sex, it is possible to pass along the infection to the partner’s genitals.[4]
You will not get herpes from toilet seats, bedding, or swimming pools. You also will not get it from touching objects, such as silverware, soap, or towels.[1] There are no documented cases of a person getting genital herpes from an inanimate object such as a toilet seat, bathtub, or towel. Herpes is a very fragile virus and does not live long on surfaces.[4]
The Link Between Genital Herpes and HIV
Herpes infection can cause sores or breaks in the skin or lining of the mouth, vagina, and rectum. This provides a way for HIV to enter the body. Even without visible sores, herpes increases the number of immune cells in the lining of the genitals. HIV targets immune cells for entry into the body.[1]
Having both HIV and genital herpes increases the chance of spreading HIV to a HIV-negative partner during oral, vaginal, or anal sex.[1] Genital herpes can also increase the risk of acquiring HIV twofold to threefold.[9] Therefore, all persons with genital herpes should be tested for HIV.[9]
Diagnosis and Testing
Your health care provider can usually make a diagnosis of genital herpes based on a physical exam and a history of your sexual activity.[8] If genital lesions are present, clinical diagnosis of genital herpes should be confirmed by type-specific testing from the lesion.[9]
To confirm a diagnosis, your provider will likely take a sample from an active sore using a small cotton swab. One or more tests of these samples are used to see if you have herpes simplex virus infection and show whether the infection is HSV-1 or HSV-2.[8] The test cannot be done if you do not have visible blisters or sores, and it cannot tell you how long you’ve had herpes or who you got it from.[7]
Less often, a lab test of your blood may be used for confirming a diagnosis or ruling out other infections. Type-specific blood tests can be used to diagnose HSV infection in the absence of genital lesions.[9] A blood test can show if you have herpes and, if so, whether it’s HSV-1 or HSV-2. However, a blood test cannot tell you what part of your body the virus will affect.[17]
Your care provider will likely recommend that you get tested for other STIs. Your partner should also be tested for genital herpes and other STIs.[8]
Treatment Options
There’s no cure for genital herpes. Treatment with prescription antiviral pills may be used for the following purposes:[8]
- Help sores heal during a first outbreak
- Lower the frequency of recurrent outbreaks
- Lessen the severity and duration of symptoms in recurrent outbreaks
- Reduce the chance of passing the herpes virus to a partner
Medications
There are three antiviral medications that are FDA-approved for the treatment of genital herpes:[12]
- Acyclovir: The oldest antiviral medication for herpes, available since 1982. It has been shown to be safe in persons who have used it continuously for as long as 10 years.
- Valacyclovir: A newer drug that uses acyclovir as its active ingredient. This medication delivers acyclovir more efficiently so that the body absorbs much of the drug, which has the advantage of taking the medication fewer times during the day.
- Famciclovir: Uses penciclovir as its active ingredient to stop HSV from replicating. Like valacyclovir, it is well absorbed, persists for a longer time in the body, and can be taken less frequently than acyclovir.
Commonly prescribed medicines used for genital herpes include acyclovir (Zovirax), famciclovir, and valacyclovir (Valtrex).[8]
Treatment During First Outbreak
For adults and adolescents with a first clinical episode of genital HSV infection, treatment is recommended. Standard doses include:[10]
- Aciclovir 400 mg orally three times daily for 10 days (standard dose)
- Aciclovir 200 mg orally five times daily for 10 days
- Valaciclovir 500 mg orally twice daily for 10 days
- Famciclovir 250 mg orally three times daily for 10 days
If you’ve had symptoms for more than 5 days before you go to a sexual health clinic, you can still get tested to find out the cause.[7] You may also be prescribed cream for the pain.[7]
Treatment Types
There are two kinds of treatment approaches:[12]
Episodic therapy: A person begins taking medication at the first sign of an outbreak (or ideally at first signs of prodrome) and continues taking medication for several days, in order to speed healing or even prevent an outbreak from fully occurring. Antiviral medicine may help shorten an outbreak by 1 or 2 days if you start taking it as soon as symptoms appear.[7]
Suppressive therapy: People with genital herpes who want to eliminate (suppress) outbreaks can take antiviral medication daily to hold HSV in check so that it’s less likely to flare up and cause symptoms. For individuals who have frequent recurrences (six or more per year), studies have shown that suppressive therapy can reduce the number of outbreaks by at least 75% while the medication is being taken.[12] Some people who have more than 6 outbreaks in a year may benefit from taking antiviral medicine for 6 to 12 months.[7]
Long-term use of the antiviral drugs is considered safe.[8] Your health care provider will talk to you about the right treatment for you. Treatment depends on the severity of disease, the type of HSV, your sexual activity and other medical factors.[8]
Self-Care During Outbreaks
There are things you can do if you’ve been diagnosed with genital herpes and you’re having an outbreak:[7]
- Keep the area clean using plain or salt water to prevent blisters becoming infected
- Apply an ice pack wrapped in a flannel to soothe pain
- Apply petroleum jelly (such as Vaseline) or painkilling cream (such as 5% lidocaine) to reduce pain when you pee
- Wash your hands before and after applying cream or jelly
- Pee while pouring water over your genitals to ease the pain
- Do not wear tight clothing that may irritate blisters or sores
- Do not put ice directly on the skin
- Do not touch your blisters or sores unless you’re applying cream
- Do not have vaginal, anal or oral sex until the sores have gone away
How to Prevent Genital Herpes
The only way to completely avoid STIs is to not have vaginal, anal, or oral sex. If you are sexually active, you can do the following things to lower your chances of getting genital herpes:[1]
- Being in a long-term mutually monogamous relationship with a partner who does not have herpes
- Using condoms the right way every time you have sex
Always using latex condoms can reduce the risk of transmitting the herpes virus by approximately 50%.[16] Condoms can help prevent the spread of a genital herpes infection.[2] If you or your partner is allergic to latex, you can use polyurethane condoms.[5]
If you have genital herpes, there are ways to help prevent spreading it to others:[7]
- Genital herpes is very easy to pass on (contagious) from the first tingling or itching of a new outbreak (before any blisters appear) to when sores have fully healed
- You may also be able to pass on the virus even if you do not have any symptoms
- Taking antiviral medication can reduce the risk of passing the virus to a partner
- Avoid sexual contact during outbreaks
Living with Genital Herpes
Finding out you have herpes can be tough, but it’s not the end of the world. Millions of people living with herpes have great lives and relationships.[14] It’s normal to have lots of different feelings after you find out that you have herpes. You might feel mad, embarrassed, ashamed, or upset at first. But you’ll probably feel a lot better as time goes by, and you see that having herpes doesn’t have to be a big deal.[14]
People with herpes have relationships and live totally normal lives. There are treatments for herpes, and there’s a lot you can do to make sure you don’t give herpes to anyone you have sex with. Millions and millions of people have herpes — you’re definitely not alone. Most people get at least one STD in their lifetime, and having herpes or another STD is nothing to feel ashamed of or embarrassed about.[14]
Herpes isn’t deadly and it usually doesn’t cause any serious health problems. While herpes outbreaks can be annoying and painful, the first flare-up is usually the worst. For many people, outbreaks happen less over time and may eventually stop completely.[14]
Talking to Partners
It’s super important to always tell partners if you have herpes, so you can help prevent it from spreading.[14] Many people do not feel comfortable talking about sexuality and sexual health issues. However, for most people, this is a minor skin infection. People fear the possibility of rejection but in reality this rarely happens.[16]
Most people find that their partners are both supportive and understanding.[16] If you are able to discuss the situation openly and honestly, you can find imaginative ways to be ‘safely’ sexually intimate.[16]
The best thing to do when you find out you have herpes is follow your doctor’s directions for treating it. If you’re having a hard time dealing with the news, talking with a close friend or a support group for people living with herpes may make you feel better.[14]
Genital Herpes and Pregnancy
If you are pregnant, it is important to tell your doctor if you or your partner have genital herpes, so the risk to your baby can be reduced.[18] Mothers can also infect their babies during childbirth.[5] The virus can be more serious in newborn babies or in people with weak immune systems.[5]
