Genital Herpes

Genital herpes is a common sexually transmitted infection that affects millions of people worldwide. While there is no cure, the virus can be managed with medication, and many people with herpes live normal, healthy lives with fulfilling relationships.

Table of contents

• What is genital herpes?
• Signs and symptoms
• What causes genital herpes and how it spreads
• How genital herpes is diagnosed
• 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 (also called an STI or STD) caused by two types of viruses called herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2). Both types can cause genital herpes, although HSV-2 is responsible for most cases^[1].

Genital herpes is very common. In 2018, health officials estimated there were 572,000 new genital herpes infections in the United States among people aged 14 to 49^[1]. The Centers for Disease Control estimates that up to 50 million people in the U.S. have genital herpes, with almost 600,000 people newly infected each year^[4]. Globally, about 491 million people between ages 15 and 49 have HSV-2, the most common cause of genital herpes^[8].

• Vulva (external genitals including vaginal lips)
• Vagina
• Cervix
• Penis
• Testicles
• Anus
• Rectum
• Buttocks
• Groin or inner thigh area

While HSV-1 often causes oral herpes (which results in cold sores or fever blisters on or around the mouth), it can also cause genital herpes. Most people with oral herpes get it during childhood or young adulthood from non-sexual contact with saliva^[1]. Recent research shows that almost 80 percent of college students with genital herpes have HSV-1, probably due to high rates of oral sex^[19].

Once the virus enters your body, it stays there for life. The virus hides within nerve cells, where it can remain inactive or “asleep” for long periods. It can “wake up” and cause symptoms at any time, though many people never have symptoms or have very mild symptoms^[14].

Signs and symptoms

Most people with genital herpes have no symptoms or have very mild symptoms that may 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]. Some estimates suggest that as many as 90 percent of people with HSV-2 are unaware that they have the virus^[5].

When symptoms do occur, they usually appear 2 to 12 days after exposure to the virus^[2]. However, symptoms might not appear for weeks or even years after infection^[6].

First outbreak

The first outbreak is usually the most severe. Symptoms typically last up to four weeks and may include^[4]:

• Flu-like symptoms, including fever, chills, fatigue, body aches, headaches, and swollen lymph nodes (small glands that are part of your immune system)
• Pain, itching, burning, or tingling around the genitals
• Small bumps or blisters around the genitals, rectum, anus, or mouth
• Painful sores that form when blisters break open and ooze or bleed
• Scabs that form as the sores heal
• Painful urination
• Unusual vaginal discharge or discharge from the urethra (the tube that carries urine out of your body)

The sores usually appear as one or more blisters on or around the genitals, rectum, or mouth. This is known as having an “outbreak.” The blisters break and leave painful sores that may take a week or more to heal^[1].

Recurrent outbreaks

After the first outbreak, the virus remains in the body and can cause repeated 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].

Although genital herpes is a lifelong infection, the number of outbreaks may decrease over time. 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^[4]. Over time, outbreaks tend to happen less often and be less severe. Some people never have outbreaks^[6].

You may feel itchiness or tingling in the area 24 to 48 hours before a sore appears^[4]. This early warning sign is called prodrome.

What causes genital herpes and how it spreads

Genital herpes is caused by the herpes simplex virus. The virus spreads through direct skin-to-skin contact with an infected area. This happens when a contagious area comes into contact with a tiny break in the skin or mucous membrane tissue (the soft, moist tissue that lines certain body openings), usually on the mouth or genitals^[5].

You can get genital herpes by having vaginal, anal, or oral sex with someone who has the infection. 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]. 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 fully healed. You may also be able to pass on the virus even if you do not have any symptoms^[6].

Throughout the year, there are several days (called asymptomatic 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^[5].

It is also possible to get genital herpes if you receive oral sex from a partner with oral herpes. Oral herpes caused by HSV-1 can spread from the mouth to the genitals through oral sex^[1].

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^[5].

Certain factors can trigger the virus to “wake up” and cause a new outbreak, including^[14]:

• Fatigue
• Physical or emotional stress
• Illness
• Menstruation
• Injury
• Genital irritation

How genital herpes is diagnosed

Your healthcare provider can usually diagnose genital herpes based on a physical exam and a history of your sexual activity^[9]. To confirm a diagnosis, your provider will likely take a sample from an active sore using a small cotton swab. One or more lab 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^[9].

The best way to determine if someone is infected with HSV-1 or HSV-2 is to perform a laboratory analysis on a sample from a fresh herpes sore. 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^[6].

If you don’t have active sores, your healthcare provider may use a blood test that can detect antibodies to herpes viruses. 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^[19].

If you want to be tested for herpes, ask your healthcare provider. A standard screening for sexually transmitted diseases may not include herpes unless you specifically ask^[19].

Treatment options

There is no cure for genital herpes. The virus stays in your body for life. However, medicines can help lessen symptoms, decrease outbreaks, and lower the risk of passing the virus to others^[1].

Three antiviral medications are FDA-approved for the treatment of genital herpes^[13]:

• 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 reproducing. Like valacyclovir, it is well absorbed and can be taken less frequently than acyclovir

Treatment during the first outbreak

If you start treatment within 5 days of symptoms appearing, antiviral medicine can help stop the symptoms from getting worse. You may also be prescribed cream for the pain^[6].

Treatment for recurrent outbreaks

There are two ways to use antiviral medication for recurrent outbreaks^[14]:

Episodic therapy: You take medication for about 7 to 10 days only when symptoms occur. This typically shortens the time it takes for symptoms to clear up. 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^[13].

Suppressive therapy: You take medication daily to prevent outbreaks from developing. People with genital herpes who want to eliminate 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^[13]. Some people who have more than 6 outbreaks in a year may benefit from taking antiviral medicine for 6 to 12 months^[6].

Generally, there are very few if any side effects from antiviral medicines. If they occur, side effects may include fatigue, headache, nausea and vomiting, rash, seizures, and tremor^[14].

Self-care during outbreaks

There are things you can do if you’re having an outbreak^[6]:

• Keep the area clean using plain or salt water to prevent blisters from 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 urinate
• Wash your hands before and after applying cream or jelly
• Urinate while pouring water over your genitals to ease the pain
• Take acetaminophen, ibuprofen, or aspirin to relieve pain^[14]
• Wash sores gently with soap and water, then pat dry
• Do not bandage sores—air speeds healing
• Wear loose-fitting cotton underwear

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, and do not have vaginal, anal, or oral sex until the sores have gone away^[6].

How to prevent genital herpes

The only way to completely avoid sexually transmitted infections is to not have vaginal, anal, or oral sex^[1].

If you are sexually active, you can lower your chances of getting genital herpes by^[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

Correct usage of latex condoms can reduce, but not eliminate, the risk of catching or spreading herpes. If you or your partner is allergic to latex, you can use polyurethane condoms^[3].

If you have genital herpes, there are ways to protect others^[14]:

• Let any sexual partner know that you have herpes before having sex. Allow them to decide what to do
• Use latex or polyurethane condoms, and avoid sex during symptomatic outbreaks
• Do not have vaginal, anal, or oral sex when you have sores on or near the genitals, anus, or mouth
• Do not kiss or have oral sex when you have a sore on the lips or inside the mouth
• Do not share your towels, toothbrush, or lipstick
• Wash your hands well with soap and water after touching a sore
• Consider using daily antiviral medicine to limit viral shedding and reduce the risk of passing the virus to your partner

Taking medication can also help lower the risk of spreading the infection^[1]. One study found that women on suppressive acyclovir had a 94% reduction in subclinical shedding while taking daily therapy^[13].

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^[16]. 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^[16].

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. It doesn’t mean you’re “dirty” or a bad person—it means you’re a normal human who got a really common infection. The reality is that herpes can happen to anybody who has ever been kissed on the lips or had sex—that’s a LOT of people^[16].

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^[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^[16]. There are a lot of online support groups for people who have herpes, and the American Sexual Health Association has a list of support groups that meet in person^[16].

Some people feel like their love lives are over when they find out they have herpes, but it’s just not true. People with herpes have romantic and sexual relationships with each other, or with partners who don’t have herpes^[16]. Talking about STDs isn’t the most fun conversation you’ll ever have, but it’s super important to always tell partners if you have herpes, so you can help prevent it from spreading^[16].

Taking steps to keep yourself healthy can also minimize the risk for future outbreaks. Things you can do include^[14]:

• Get plenty of sleep to help keep your immune system strong
• Eat healthy foods—good nutrition also helps your immune system stay strong
• Keep stress low, as constant stress can weaken your immune system
• Protect yourself from the sun, wind, and extreme cold and heat

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^[7]. Mothers can infect their babies during childbirth^[3]. The virus can be more serious in newborn babies^[3].

Infection with HSV-2 increases the risk of acquiring and transmitting HIV infection^[8]. 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. Having both HIV and genital herpes increases the chance of spreading HIV to an HIV-negative partner during oral, vaginal, or anal sex^[1].