What Is Genital Herpes?

Genital herpes is a common and highly contagious sexually transmitted infection (STI) caused by the herpes simplex virus (HSV). It spreads through sexual contact, including vaginal, anal, and oral sex. People with genital herpes can spread the virus even if they don't have any visible symptoms.

Genital herpes is characterized by painful blisters or sores on or around the genital area, anus, thighs, or mouth. Flu-like symptoms, such as fever, body aches, and swollen glands, often occur during an initial outbreak.

Over 13% of people worldwide live with genital herpes. It's the most common ulcerative (characterized by genital sores) STI in industrialized countries like the United States, northern Europe, Japan, Canada, Australia, and New Zealand. In the United States, approximately 1 in 5 women and 1 in 10 men between the ages of 14-49 have genital herpes. There is no cure, but treatment can reduce the frequency and severity of outbreaks.

Genital Herpes Symptoms 

Symptoms of genital herpes vary from person to person. Some people have no symptoms. Other people may have mild symptoms and mistake them for something else, such as the flu, insect bites, or ingrown hairs.

When symptoms occur with blisters, it is called an "outbreak." The first outbreak usually starts between 2-12 days after exposure. You may initially have flu-like symptoms such as: 

• Fever
• Body aches
• Swollen glands
• Itching or burning sensation in your genital or anal area 
• Unusual penile or vaginal discharge 
• Fatigue 

Within a day or two, you may notice red, swollen bumps around your genitals, anus, thighs, or mouth. These bumps form fluid-filled blisters that eventually break open, leaving crusted and painful sores (ulcers).

You may also have the following symptoms:

• Discomfort or pain when urinating 
• Bleeding between periods (if you menstruate)
• Swollen genitals 

The sores scab over and heal without scarring within 2-4 weeks. However, the virus stays dormant (inactive) in your body for the rest of your life and can cause recurrent outbreaks. Repeated outbreaks are common in the first year after the initial infection. Early signs of a recurrent outbreak include itchiness, burning, or tingling in your genital area.

During the initial outbreak, symptoms can be severe and last up to six weeks. Most repeat outbreaks are less severe, and many people experience them less frequently over time.

Causes

Genital herpes is caused by the herpes simplex virus (HSV). There are two types of HSV:

• HSV-1: HSV-1 is known as oral herpes. Cold sores (fever blisters) typically appear on your face, particularly around your mouth, but they can appear anywhere on your skin. HSV-1 is transmitted through contact with saliva, cold sore fluid, or skin around the mouth. It's most contagious during an outbreak.
• HSV-2: HSV-2 is the most common cause of genital herpes. It's transmitted through contact with anal or genital surfaces, sores, or bodily fluids of someone who has the virus. Blisters typically appear in your genital area but can appear anywhere on your skin. HSV-2 can spread even when the person with herpes does not have active symptoms. 

After the initial outbreak, HSV settles in nerves at the base of the spine and remains dormant in the nerve cells. Triggers like illness, stress, surgery, sunlight exposure, and menstruation can “reactivate” the virus and lead to an outbreak.

Sexual activity is the most common way to contract genital herpes, but the virus can also spread through:

• Skin-to-skin contact 
• Touching open sores and then touching another body part
• Childbirth (from pregnant person to infant) 
• Sharing sex toys, utensils, towels, and other personal items 

Risk Factors

Anyone can be affected by genital herpes, but certain factors increase your risk of contracting it. Common risk factors include:

• Having unprotected sex (for example, not using condoms, dental dams, or gloves)
• Having multiple or anonymous partners 
• A history of having another sexually transmitted infection (STI)  
• Being immunocompromised (having a weakened immune system)

People with a vagina have a higher risk of contracting genital herpes because small tears in vaginal tissue can make it easier for the virus to spread.

Testing and Diagnosis

You may need to get tested for herpes simplex virus if:

• You have symptoms of genital herpes
• Your sexual partner has genital herpes
• You're pregnant and you or your sexual partner has symptoms

Genital herpes is diagnosed based on your symptoms, medical history, physical exam, and lab test results. During a physical exam, healthcare providers look for signs of herpes, such as blisters or sores on your genitals and rectum (lowest part of your large intestine, near the anus).

A healthcare provider may perform a swab test if you have an active outbreak. This involves taking a sample of the fluid, crust, or skin surrounding a lesion (blister or sore) and sending it to the lab for analysis.

Swab tests used to diagnose genital herpes include:

• Viral culture: A healthcare provider uses a swab to gently collect fluid from a herpes blister or sore. The sample is sent to a lab to test for the herpes virus and confirm the type (HSV-1 or HSV-2) and diagnosis.
• Nucleic acid amplification test (NAAT): This test detects viral DNA to confirm the diagnosis and determine HSV type.

Viral culture tests are usually less sensitive than NAAT and may produce false negative results—especially when lesions begin to crust and heal or the test is performed during a recurrence. A false negative means the test did not detect the virus even though it's present.

A blood test is used to diagnose genital herpes if you are asymptomatic (have no symptoms). A blood sample is taken and sent to the lab, where it is analyzed to look for herpes antibodies called HSV IgG. The presence of antibodies indicates your body has fought a herpes infection in the past.

It can take time for antibodies to reach detectable levels in the blood after infection, so you may want to wait about four months after exposure before getting a blood test.

Genital Herpes Treatment

There is no cure for genital herpes, but antiviral medications can effectively manage symptoms and reduce the length and severity of outbreaks. They can also reduce the frequency of recurrent outbreaks and lower your risk of transmitting it to others.

Genital herpes outbreaks are treated with prescription antiviral medications such as:

• Zovirax (acyclovir)
• Valtrex (valacyclovir)
• Famvir (famciclovir)

The length of treatment and dose of antiviral drugs depends on whether you have your first outbreak or a recurrence. Over-the-counter (OTC) pain relievers like Advil (ibuprofen) and Tylenol (acetaminophen) can help reduce pain and discomfort.

Initial Outbreak

Initial outbreaks of genital herpes are treated with one antiviral medication taken orally (by mouth) for 7-10 days. The medication will not prevent the virus from settling in nerve cells, but it may reduce discomfort and promote healing. 

Recurrent Outbreaks

One of two antiviral drug regimens may be recommended for recurrent outbreaks: episodic or suppressive.

• Episodic therapy: You might use this type of therapy if you have fewer than six outbreaks yearly. Antivirals are taken at the first sign of symptoms, such as pain or tingling at the site of your first outbreak. When taken within 72 hours of the onset of symptoms, antiviral drugs can help reduce the outbreak's severity and decrease the duration by a day or two. Episodic therapy does not reduce the risk of future outbreaks.
• Suppressive therapy: Suppressive therapy is often recommended to people who have six or more recurrences a year, have a weakened immune system, have a sexual partner who does not have herpes, or take immune-suppressing medications. Taking antiviral medication daily reduces the frequency and duration of recurrent outbreaks and lowers the risk of passing the virus to others. Studies show that suppressive therapy reduces the frequency of recurrences by up to 80%.

If you have genital herpes, a healthcare provider will work with you to develop a treatment plan tailored to your needs and circumstances. 

Prevention

The most effective way to prevent genital herpes is to abstain from sexual activity or only engage in sexual activity with a monogamous partner who does not have the virus. Many people are unaware they have genital herpes, but you can take preventive steps to reduce your risk of contracting or spreading the infection.

Preventive strategies include:

• Practice safer sex: Use condoms and dental dams during sexual activity. The virus can spread without active blisters or sores, but using protection reduces the risk.
  
• Practice abstinence during outbreaks: Avoid close contact (including kissing and sex) with your sexual partner if either of you has an outbreak of oral or genital herpes.
  
• Do not share personal items: Do not share items such as towels, toothbrushes, utensils, or drinks. 
• Get tested: If you are sexually active, get tested regularly for sexually transmitted infections, including genital herpes. 

Triggers for herpes outbreaks include fatigue, stress, extreme temperatures, and overexposure to sunlight. You can reduce the frequency of recurrences by:

• Taking antiviral medications 
• Prioritizing sleep 
• Eating nutritious foods to strengthen your immune system
• Trying stress reduction techniques like exercise or meditation 
• Dressing for the season

Complications

People with genital herpes may be at increased risk for developing other health conditions, including:

• Human immunodeficiency virus (HIV): Blisters and sores on genitalia can make it easier for bodily fluids to enter the body, increasing the risk of HIV.
• Bacterial infections: Genital herpes is associated with an increased risk of developing bacterial infections such as bacterial vaginosis (a common vaginal infection related to an overgrowth of bacteria that’s naturally found in your vagina) and urinary tract infections, or UTIs (bacterial infections that affect part of the urinary system). 
• Viral meningitis: In rare cases, genital herpes can cause inflammation of the lining of the brain and spinal cord. This can lead to meningitis, an infection of the membranes surrounding your brain and spinal cord.
• Pregnancy complications: Pregnant people with genital herpes may be at increased risk of preterm delivery. They can also transmit the virus to the infant during childbirth.
• Depression and anxiety: Living with a chronic condition can affect your mental health. Many people with genital herpes experience symptoms of depression and anxiety.

Living With Genital Herpes  

Living with genital herpes can be distressing, especially in the first weeks and months after diagnosis. Many people report feeling embarrassment, shame, anger, and depression due to the stigma associated with genital herpes.

It can help to know you’re not alone. Nearly half a billion people worldwide live with genital herpes. People with herpes have meaningful relationships and live full lives.

Taking antiviral medications to prevent or treat outbreaks, practicing safer sex, and being open and honest with sexual partners about the virus are important aspects of living with genital herpes. You might consider joining a support group for people with genital herpes if you’re struggling with the emotional impact of your diagnosis or need support. Support groups can provide a safe and non-judgmental space to share your concerns and connect with other people who understand what you’re going through.

Always reach out to your healthcare provider with concerns. They can provide you with additional resources based on your needs.