How Common Is Genital Herpes?

Genital herpes affects a significant portion of the population worldwide. According to estimates from the Centers for Disease Control and Prevention, there were approximately 572,000 new genital herpes infections in the United States during 2018 among people aged 14 to 49 years old^[1]. The total number of people living with genital herpes in the United States is estimated at up to 50 million, with about 600,000 new infections occurring each year^[4].

On a global scale, the numbers are even more striking. Worldwide, an estimated 520 million people aged 15 to 49 years have infection with herpes simplex virus type 2 (HSV-2), which is the main cause of genital herpes. This represents about 13 percent of the world’s population in that age range^[8]. Additionally, approximately 3.8 billion people under age 50 globally have HSV-1 infection, which traditionally causes oral herpes but can also lead to genital herpes^[8].

One important aspect of these statistics is that the majority of people with genital herpes are unaware they have the infection. Studies suggest that as many as 90 percent of people infected with HSV-2 don’t know they carry the virus^[5]. This happens because many infected individuals either have no symptoms at all or experience symptoms so mild that they mistake them for other common skin conditions, such as pimples or ingrown hairs^[1].

The infection affects both men and women, though certain demographic patterns exist. In Australia, around one in every eight sexually active adults has genital herpes^[7]. The widespread nature of this infection means that anyone who is sexually active can potentially contract genital herpes, regardless of age, gender, or background.

What Causes Genital Herpes?

Genital herpes is caused by the herpes simplex virus, of which there are two types: herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2)^[1]. Both of these viruses belong to a larger family of viruses known as herpesviruses. They are enveloped DNA viruses, meaning they have a protective outer layer and carry their genetic information in the form of DNA. These viruses are sensitive to disinfectants and environmental factors, which means they don’t survive well outside the human body^[12].

Historically, HSV-1 has been associated with oral herpes, which causes cold sores or fever blisters around the mouth, while HSV-2 has been linked primarily to genital herpes. However, this distinction has become less clear in recent years. Both types of the virus can infect either the mouth or the genital area^[1]. In fact, an increasing number of genital herpes cases are now caused by HSV-1, particularly among young adults and certain populations. One study found that among college students with genital herpes, almost 80 percent had HSV-1, likely due to high rates of oral sex in this age group^[19].

Once a person becomes infected with either type of herpes simplex virus, the virus establishes a permanent presence in the body. This is due to a unique characteristic called latency. After the initial infection, the virus travels along nerve pathways and hides in clusters of nerve cells called ganglia. For genital herpes, the virus retreats to the sacral ganglion at the base of the spine, where it remains inactive or “asleep” for periods of time^[5].

The virus can reactivate at various points throughout a person’s life, traveling back along the nerves to the skin surface where it may cause symptoms again. This reactivation can happen even when there are no visible symptoms, which is why the virus can be transmitted even when a person feels perfectly healthy and shows no signs of infection^[5].

How Does Genital Herpes Spread?

Genital herpes spreads through direct skin-to-skin contact with someone who has the infection. The virus is most easily transmitted when it comes into contact with a tiny break in the skin or with the delicate mucous membrane tissue found in areas like the mouth and genitals. Most skin on the body is too thick for the virus to penetrate^[5].

The primary way genital herpes is transmitted is through sexual contact. This includes vaginal sex, anal sex, and oral sex with someone who has the infection^[1]. When a person with oral herpes performs oral sex on a partner, it’s possible for the virus to spread from the mouth to the partner’s genitals, causing genital herpes. Similarly, if someone with genital herpes engages in sexual activity, their partner can contract the infection in the genital area.

One of the most concerning aspects of herpes transmission is that the virus can spread even when there are no visible sores or blisters present. A person can get genital herpes from a sexual partner who doesn’t have a visible sore and who may not even know they have the infection^[1]. This happens during periods called asymptomatic shedding or asymptomatic reactivation, when the virus is active on the surface of the skin but causes no noticeable symptoms. There are several days throughout the year when this viral shedding occurs^[5].

The infection can be transmitted through contact with several sources: a herpes sore itself, saliva from a partner with oral herpes, genital fluids from a partner with genital herpes, skin in the oral area of someone with oral herpes, or skin in the genital area of someone with genital herpes^[1]. The virus is very easy to pass on from the first tingling or itching of a new outbreak, before any blisters appear, all the way through until the sores have fully healed^[6].

Mothers can also pass the infection to their babies during childbirth^[3]. This is one reason why it’s particularly important for pregnant women to inform their healthcare providers if they or their partners have genital herpes.

Who Is at Risk for Genital Herpes?

Anyone who is sexually active can contract genital herpes^[1]. The infection doesn’t discriminate based on the number of sexual partners someone has had, though having multiple partners does increase exposure risk. Even people in long-term monogamous relationships can contract genital herpes if one partner was infected before the relationship began and didn’t know it.

Several factors can increase a person’s risk of contracting or experiencing outbreaks of genital herpes. Physical and emotional stress can trigger the virus to reactivate. When the body is under stress, the immune system may become weakened, giving the virus an opportunity to become active again^[14]. Similarly, fatigue and lack of adequate sleep can compromise immune function, making outbreaks more likely^[14].

In women, menstruation can be a trigger for herpes outbreaks^[14]. Hormonal changes during the menstrual cycle may affect the body’s ability to keep the virus suppressed. Genital irritation or injury to the affected area can also prompt a recurrence^[14].

Having genital herpes also increases the risk of contracting other sexually transmitted infections. Herpes infection can cause sores or breaks in the skin or lining of the mouth, vagina, and rectum. These breaks in the protective barrier of the skin provide an entry point for the human immunodeficiency virus (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 specifically targets these immune cells to gain entry into the body. Studies have shown that herpes infection can increase the risk for acquiring HIV by two to three times^[10].

For people who have both HIV and genital herpes, there is an increased chance of spreading HIV to a partner during sexual activity^[1]. This makes managing genital herpes particularly important for people living with HIV or at risk for HIV infection.

What Are the Symptoms of Genital Herpes?

The symptoms of genital herpes can vary greatly from person to person. Most people infected with the herpes simplex virus have no symptoms at all, or they have symptoms so mild that they go unnoticed^[1]. When symptoms do appear, they can be mistaken for other common conditions, which is one reason many people don’t realize they have herpes.

For those who do experience symptoms, the first outbreak is typically the most severe. Initial symptoms usually appear anywhere from 2 to 20 days after exposure to the virus, though it can sometimes take months or even years for symptoms to appear^[4][6]. During this first outbreak, symptoms may last up to four weeks.

The hallmark symptom of genital herpes is the appearance of blisters or sores. These typically begin as small, blister-like bumps that appear in clusters on or around the genitals, rectum, anus, buttocks, or inner thighs^[4]. Before the blisters appear, many people experience a tingling, itching, or burning sensation in the area where the sores will develop. This warning sensation usually occurs 24 to 48 hours before the blisters become visible^[4].

Once the blisters appear, they eventually break open and ooze fluid or bleed, leaving behind painful red, open sores or ulcers^[2]. These ulcers then form scabs as they heal. The entire process, from initial blister to healed scab, can take a week or more. During the first outbreak, people may also experience pain when urinating, especially if urine comes into contact with the sores^[2].

The first episode often includes additional symptoms that go beyond the local sores. Many people experience flu-like symptoms during their initial outbreak, including fever, body aches, headaches, chills, and fatigue^[4]. Lymph nodes in the groin area may become swollen and tender^[2]. Women may notice unusual vaginal discharge, while anyone can experience discharge from the urethra, which is the tube that carries urine out of the body^[4].

After the first outbreak, the virus retreats to nerve cells where it remains dormant. However, it can reactivate periodically, causing recurrent outbreaks. These recurring episodes are usually much milder than the initial outbreak and don’t last as long^[1]. The blisters are typically fewer in number, and the flu-like symptoms rarely occur during recurrences. Some people may have only one or two outbreaks during their lifetime, while others might experience four or five outbreaks per year^[4].

The pattern and frequency of outbreaks vary widely among individuals. Some people carry the virus but never have any symptoms at all. Others have only a single outbreak and never experience another one. Still others have regular outbreaks that occur as frequently as every one to four weeks^[14]. Generally, repeat outbreaks are more common in people infected with HSV-2 than in those with HSV-1^[10]. Over time, outbreaks tend to become less frequent, less severe, and shorter in duration. The number of outbreaks may decrease naturally as years pass^[1].

Can Genital Herpes Be Prevented?

The only way to completely avoid sexually transmitted infections, including genital herpes, is to not have vaginal, anal, or oral sex^[1]. However, for people who are sexually active, there are several strategies that can significantly lower the risk of getting or spreading genital herpes.

Being in a long-term, mutually monogamous relationship with a partner who has been tested and does not have herpes is one effective way to reduce risk^[1]. However, it’s important to remember that herpes tests aren’t part of standard sexually transmitted infection screenings, so partners who want to know their herpes status need to specifically request testing.

Using condoms correctly and consistently during every sexual encounter can reduce the risk of transmitting or acquiring genital herpes. Latex condoms, when used properly every time, provide significant protection^[1]. For people who are allergic to latex, polyurethane condoms offer an alternative^[3]. However, it’s important to understand that condoms cannot eliminate the risk entirely. The virus can infect areas of the genitals that aren’t covered by a condom, so transmission can still occur even with consistent condom use^[2].

For people who already have genital herpes, there are important steps they can take to prevent spreading the infection to partners. The most crucial step is to avoid all sexual activity when symptoms are present. People should not have vaginal, anal, or oral sex when they have sores on or near the genitals, anus, or mouth^[14]. Sexual activity should be avoided from the first sign of tingling or itching (which often occurs before blisters appear) until all sores have completely healed^[6].

Even when no symptoms are present, the virus can still be transmitted through asymptomatic shedding. For this reason, many healthcare providers recommend that people with genital herpes consider taking daily antiviral medication. This approach, called suppressive therapy, can limit viral shedding and reduce the risk of passing the virus to a partner^[14]. Studies have shown significant reductions in viral shedding among people taking daily antiviral medication^[13].

Preventing outbreaks through healthy lifestyle choices can also help reduce transmission risk. Getting adequate sleep helps keep the immune system strong, making it less likely that the virus will reactivate^[14]. Eating nutritious foods supports overall immune function. Managing stress through relaxation techniques, exercise, or counseling can help prevent stress-related outbreaks^[14]. Protecting skin from extreme weather conditions—sun, wind, cold, and heat—is also important, as environmental stress can trigger outbreaks^[14].

How the Virus Affects the Body

Understanding how the herpes simplex virus behaves in the body helps explain why it’s a lifelong infection and why symptoms can come and go over time. When the virus first enters the body through a break in the skin or mucous membrane, it begins to replicate, or make copies of itself. This replication triggers the immune system to mount a response, which leads to inflammation and the symptoms associated with an outbreak^[5].

During this initial phase, the body’s immune system works to limit the spread of the virus. White blood cells and antibodies are deployed to fight the infection. This immune response is what eventually brings the first outbreak under control. However, the immune system cannot completely eliminate the virus from the body.

To evade the immune system, the herpes simplex virus has developed a clever survival strategy. After the initial infection and the body’s immune response, some viral particles retreat along nerve pathways to reach clusters of nerve cells deep within the body. For genital herpes, this hiding place is typically the sacral ganglion, located at the base of the spine. Once there, the virus enters a dormant or “sleeping” state called latency^[5].

While latent, the virus is essentially inactive. It’s not making new copies of itself or causing symptoms. However, it remains in the nerve cells for the rest of a person’s life. At various times, biological triggers can cause the virus to “wake up” or reactivate. When this happens, the virus travels back along the nerve pathways to the skin surface, where it can cause another outbreak of symptoms^[5].

The reactivation process can occur even when there are no visible symptoms. This is what happens during asymptomatic viral shedding, when the virus is present on the skin surface and can be transmitted to others, but the infected person has no blisters, sores, or other noticeable signs of an outbreak. This phenomenon explains why herpes is so easily spread—the virus can be contagious even when a person feels completely healthy and shows no symptoms.

Various factors influence how often the virus reactivates. A weakened immune system, whether from illness, stress, fatigue, or other factors, gives the virus more opportunity to reactivate. Hormonal changes, physical trauma to the affected area, and environmental stresses can also trigger outbreaks. However, even in people with strong immune systems and healthy lifestyles, the virus can still reactivate periodically. Scientists don’t fully understand all the mechanisms that control viral reactivation, which is why it’s difficult to predict when outbreaks will occur.

Over time, most people find that their outbreaks become less frequent and less severe. This happens because the immune system, having been exposed to the virus repeatedly, becomes better at recognizing it and responding quickly when reactivation occurs. The body develops specific antibodies that target the herpes virus, making it harder for the virus to replicate effectively when it reactivates. This immune “memory” explains why recurrent outbreaks are typically milder and shorter than the initial outbreak.

Despite these natural immune defenses, the virus remains in the body permanently. Current medical treatments can help control symptoms and reduce viral shedding, but they cannot eliminate the virus from nerve cells where it hides during latency. This is why genital herpes is considered a chronic, lifelong infection that requires ongoing management rather than a condition that can be cured.