How Common Is Genital Herpes?

Genital herpes affects a significant portion of the global population. In 2018, health authorities estimated there were approximately 572,000 new genital herpes infections in the United States among people aged 14 to 49 years^[1]. In the U.S. alone, up to 50 million people are living with genital herpes, with nearly 600,000 people newly infected each year^[11]. The numbers tell an important story about how widespread this infection truly is.

Globally, the scale is even more substantial. An estimated 520 million people aged 15 to 49 worldwide have herpes simplex virus type 2 (HSV-2), which is the main cause of genital herpes^[6]. This means that about 13% of people in this age group carry the virus. Looking at it another way, roughly 491 million people between ages 15 and 49 have HSV-2 infection, the most common cause of genital herpes^[11]. About 12% of persons aged 14 to 49 in the United States have genital HSV-2 infection^[9].

The infection can affect anyone who is sexually active. More than 50 percent of the adult population in the United States has oral herpes, commonly called cold sores or fever blisters^[4]. Among Americans aged 14 to 49 years, about 53.9 percent are infected with HSV-1 and 15.7 percent with HSV-2^[17]. Around 1 in every 8 sexually active Australian adults have genital herpes^[18].

What Causes Genital Herpes?

Genital herpes is caused by two types of viruses from the herpes simplex family. These are known as herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2)^[1]. Both types belong to the same viral family and both can cause infections in the genital area, though they behave somewhat differently once inside the body.

Historically, HSV-2 has been the primary cause of genital herpes infections. However, an increasing proportion of genital herpes cases are now attributed to HSV-1, especially among young women and men who have sex with men^[9]. Recent research shows that almost 80 percent of college students with genital herpes have HSV-1, probably due to high rates of oral sex in this group^[17]. This shift reflects changing sexual behaviors and the fact that oral herpes can spread to the genitals through oral-genital contact.

HSV-1 often causes oral herpes, which results in cold sores or fever blisters on or around the mouth. Most people with oral herpes get it during childhood or young adulthood from non-sexual contact with saliva^[1]. When someone with oral herpes caused by HSV-1 performs oral sex, the virus can spread from the mouth to a partner’s genitals, causing genital herpes^[1]. This connection between oral and genital herpes is an important aspect of how the infection spreads.

Once the virus enters the body, it behaves in a unique way that distinguishes it from many other infections. The virus creates a small but permanent colony inside the body through a process called latency^[4]. After initial infection and symptoms, the virus retreats along nerve pathways to hide 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^[4]. There it remains inactive for indefinite periods. The virus can “wake up” from this dormant state and travel back along the nerves to the skin, potentially causing new outbreaks.

Who Is at Risk for Genital Herpes?

Anyone who is sexually active can get genital herpes^[1]. The infection spreads through direct skin-to-skin contact during sexual activity, which means that all forms of intimate contact carry some risk. People who are sexually active are the primary group at risk for this infection.

Several factors increase the likelihood of contracting genital herpes. Having multiple sexual partners increases exposure to the virus. People who begin sexual activity at a younger age have more years of potential exposure. Since the virus can spread even when no visible sores are present, having sex with someone who doesn’t know they’re infected is a common scenario for transmission.

There is also an important connection between genital herpes and HIV infection. Herpes infection can cause sores or breaks in the skin or lining of the mouth, vagina, and rectum, which provides a way for HIV to enter the body^[1]. Even without visible sores, herpes increases the number of immune cells in the lining of the genitals, and HIV targets these immune cells for entry into the body. Having both HIV and genital herpes increases the chance of spreading HIV to an HIV-negative partner during oral, vaginal, or anal sex^[1]. Infection with HSV-2 increases the risk of acquiring and transmitting HIV infection^[6]. HSV-2 genital herpes infection increases the risk for acquiring HIV twofold to threefold^[9].

People with weakened immune systems face additional risks. Those who are immunocompromised may experience more severe symptoms and complications from herpes infections. The virus can affect other parts of the body beyond the typical genital area when the immune system isn’t functioning at full strength.

Symptoms of Genital Herpes

Most people infected with the herpes simplex virus don’t know they have it because they have no symptoms or only very mild symptoms^[6]. When symptoms do appear, they often start about 2 to 12 days after exposure to the virus^[2]. The experience varies greatly from person to person, and what one individual notices might be completely different from another’s experience.

During the first outbreak, symptoms are usually at their worst. People may experience pain or itching around the genitals, small bumps or blisters around the genitals, rectum or mouth, and painful ulcers that form when blisters rupture and ooze or bleed^[2]. The affected area can include the vulva, vagina, cervix, penis, testicles, anus, rectum, buttocks, or groin and inner thigh area^[11].

What genital herpes looks like changes as the outbreak progresses. The infection typically begins as small, blister-like bumps that tend to appear in a cluster^[11]. Many people feel itchiness or tingling in the area 24 to 48 hours before a sore appears. The blisters then take on a sore or ulcer-like appearance before eventually opening and oozing. A scab appears as the ulcer heals, and once the ulcers fully heal, the scabs fall off and that outbreak is complete.

The first outbreak often comes with additional symptoms that affect the whole body. These flu-like symptoms can include fever, headache, body aches, and swollen lymph nodes in the groin^[2]. Some people also experience painful urination and unusual vaginal discharge or discharge from the urethra^[11]. Symptoms during the first outbreak may last up to four weeks^[11].

People who experience an initial outbreak can have repeated outbreaks, especially if they have HSV-2^[1]. However, recurring symptoms are usually milder than the first outbreak, and symptoms don’t last as long with later outbreaks^[11]. Repeat outbreaks are generally shorter and less severe than the first outbreak. Some people may only have one or two outbreaks during their lifetime, while 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, and some people never have outbreaks^[7].

How Genital Herpes Spreads

Genital herpes spreads through direct skin-to-skin contact during sexual activity^[11]. This transmission happens when someone has the herpes virus present on their skin and another person makes direct contact with that area. You can get genital herpes by having vaginal, anal, or oral sex with someone who has the infection^[1].

The virus can spread through contact with several sources. A person can get herpes from contact with 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, or skin in the genital area of a partner with genital herpes^[1]. The key factor is that wherever active virus is present on the skin or mucous membranes, transmission can occur through intimate contact.

One of the most challenging aspects of preventing herpes transmission is that you can 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^[5]. You may be able to pass on the virus even if you do not have any symptoms^[7]. There are several days throughout the year when the virus may be on the surface of the skin, but there are no symptoms—a phenomenon called asymptomatic shedding or subclinical shedding^[4]. Genital herpes is very easy to pass on from the first tingling or itching of a new outbreak (before any blisters appear) to when sores have completely healed^[7].

It’s 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]. This is why some cases of genital herpes are due to HSV-1^[1].

Importantly, 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]. Herpes is a very fragile virus and does not live long on surfaces^[4]. There are no documented cases of a person getting genital herpes from an inanimate object such as a toilet seat, bathtub, or towel.

Preventing Genital Herpes

The only way to completely avoid sexually transmitted infections is to not have vaginal, anal, or oral sex^[1]. For people who are sexually active, several strategies can lower the chances of getting genital herpes, though none provides complete protection except abstinence.

Being in a long-term mutually monogamous relationship with a partner who does not have herpes reduces risk significantly^[1]. However, this requires that both partners know their herpes status, which can be determined through testing. Using condoms the right way every time you have sex is another important preventive measure. 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].

For people who already have herpes, preventing transmission to partners involves additional steps. People with genital herpes should avoid vaginal, anal, or oral sex until the sores have completely healed^[7]. Taking antiviral medication can also help. Medicines can reduce symptoms and lower the risk of passing the virus to others^[5]. For individuals who have frequent recurrences, studies have shown that suppressive therapy—taking antiviral medication daily—can reduce the number of outbreaks by at least 75% while the medication is being taken^[12].

Communication with sexual partners is essential. Always tell partners if you have herpes so you can help prevent it from spreading^[14]. Discussing genital herpes with a partner may not feel comfortable at first, but most people find that their partners are both supportive and understanding^[16]. Having educational materials on hand for your partner to read and being prepared to answer their questions can make the conversation easier^[16].

How the Virus Affects the Body

Understanding what happens inside the body when herpes simplex virus enters helps explain why the infection behaves the way it does. The virus enters the body through mucous membranes or small breaks in the skin during contact with an infected area. Mucous membranes are the moist tissues that line certain body openings, including the mouth and genitals^[3]. Most skin on the body is too thick for the virus to penetrate, which is why transmission requires contact with these more vulnerable areas^[4].

Once inside, the virus begins making copies of itself through a process called replication. This multiplication of viral particles can lead to a range of signs and symptoms, from subtle indicators that go unrecognized to more obvious illness^[4]. The body’s immune system responds by mobilizing its defenses to limit the virus’s spread. This immune response helps control the infection but cannot eliminate it completely.

After the initial infection period, the virus employs a survival strategy unique to the herpesvirus family. To avoid the immune system, HSV retreats along nerve pathways to hide in nerve roots. Once there, the virus remains inactive or dormant for indefinite periods^[3]. This dormant state is why the virus stays in the body for life—it has found a protected hiding place where the immune system cannot reach it.

The virus doesn’t always stay asleep. Various biological events can cause it to become active again and begin traveling the nerve pathways back to the skin^[4]. When it reaches the skin surface, it can cause signs and symptoms again, though it doesn’t always produce visible outbreaks. Sometimes the virus becomes active and appears on the skin surface without causing any noticeable symptoms—the asymptomatic shedding mentioned earlier. During these times, the virus can still spread to others even though the infected person has no idea it’s active.

Recurrences and subclinical shedding are much more frequent for HSV-2 genital herpes infection than for HSV-1 genital herpes^[9]. This difference is important because it affects both prognosis and counseling—knowing which type of virus you have helps predict how often outbreaks might occur. The frequency of viral reactivation varies considerably from person to person. Some individuals experience frequent outbreaks while others rarely have symptoms after the initial infection.

The physical changes during an outbreak follow a predictable pattern. The virus causes inflammation and damage to skin cells, leading to the formation of fluid-filled blisters. These blisters contain high concentrations of viral particles. When the blisters break open, they become painful ulcers that gradually heal. The healing process involves the formation of new skin cells and eventually scabs that protect the area while complete healing occurs underneath.

The immune system plays a complex role throughout infection. While it can’t eliminate the virus, it helps control outbreaks and reduce their severity over time. This is why many people notice that outbreaks become less frequent and less severe as years pass—the immune system becomes better at keeping the virus suppressed. However, factors that weaken the immune system, such as stress, illness, or fatigue, can trigger the virus to reactivate more easily.