Most people infected with herpes don’t even know it. They don’t know because the infection often has no symptoms, very mild symptoms, or symptoms that mimic other health or skin problems. But the infection can cause small, painful sores to form on the genitals, thighs, or buttocks. If sores do arise, they typically go away within two to three weeks, but the virus stays in the body for life. “Lots and lots of people live normal, healthy lives with herpes, with some small degree of attention to protecting their partners during outbreaks,” says I. Cori Baill, MD, an obstetrician-gynecologist and an associate professor at the University of Central Florida College of Medicine in Orlando, Florida. Genital herpes can be treated, but it can’t be cured. Fortunately, there are many steps you can take to prevent giving it to other people. You should be examined by your doctor if you notice possible herpes symptoms or if your partner has an STD or symptoms of an STD. Look out for symptoms such as unusual sores, burning when urinating, or, for women, bleeding between periods. Genital herpes sores sometimes cause severe pain and are more likely to do so in people with suppressed immune systems. If you touch your sores or the fluids from the sores, you may transfer herpes to another part of your body, such as your eyes. (2) If you do touch the sores or fluids, immediately wash your hands well to help prevent the spread of your infection. Some people have only one herpes outbreak. Others have many outbreaks. Repeat outbreaks are usually shorter and less severe than the first one. Although the infection stays in the body for life, the number of outbreaks tends to decrease over a period of years. Both men and women can get genital herpes. The disease can be transmitted in nonsexual ways (say, if you touch a cold sore and then your genitals or anus) and also through vaginal, anal, or oral sex. Symptoms of genital herpes tend to be worse in women. These typically include blisters that become painful sores. Some infected women also experience an unusual vaginal discharge. Women most frequently experience blistering sores on these parts of the body:
VaginaVulva (the outer part of the genitals, including the vaginal lips and clitoris)ButtocksAnusThighs
In most women, genital herpes doesn’t cause serious health problems. Learn More About Signs and Symptoms of Genital Herpes Usually, HSV-1 causes oral herpes, which becomes visible in the form of cold sores, or fever blisters, on the face, close to the mouth. Most people contract an oral herpes infection during their childhood or young adult years from nonsexual contact with the saliva of an infected person. HSV-1 mainly spreads through direct contact with cold sores or saliva. Having oral herpes, or cold sores, does not mean that you have genital herpes. But if you have oral herpes, you can spread it from your mouth to another person’s genitals if you perform oral sex on them. Most cases of genital herpes are caused by HSV-2. Since sexual contact is the major means by which genital herpes is transmitted, the illness does not usually arise before adolescence. When a child develops genital herpes, healthcare providers must consider the possibility of abuse. This is true whenever a person contracts a sexually transmitted disease prior to the teen years. People at heightened risk for HSV-2 infection include those who have multiple sexual partners, women, people with low incomes, and those infected with human immunodeficiency virus (HIV). In fact, among people who tested positive for HIV, one study found that the prevalence of HSV-2 infections ranged from 70 to more than 90 percent. (3) You can get genital herpes by having vaginal, anal, or oral sex with somebody who is infected with either HSV-1 or HSV-2. You can also contract the disease through contact with either one of the two herpes viruses in:
A herpes sore on any part of the bodySaliva, if your partner has oral herpes, or genital fluids, if your partner has genital herpesSkin around the mouth if your partner has an oral herpes infection, or the skin in the genital region of a partner who has genital herpes
You can catch genital herpes from a partner who has no visible sores, or from a partner who doesn’t know that they have the infection. But a person is most infectious during their first outbreak of herpes, when they have sores, and during later outbreaks that produce sores. As mentioned above, you can also get genital herpes if a partner with oral herpes performs oral sex on you. You can give yourself genital herpes too, by touching a cold sore and then touching your genitals or anus. Learn More About the Causes of Genital Herpes and Common Risk Factors Alternatively, a doctor may draw a fluid sample from one of your sores for testing or test your blood for herpes or herpes antibodies. (4) Remember that while testing can help determine if you have a herpes infection, no test can tell you who gave you the infection. “Like any other sexually transmitted disease, the more partners you have and the more partners they have had, the more likely you are to contract genital herpes,” says Dr. Baill. “You sleep with everybody your partners have ever slept with.”
Prognosis of Genital Herpes
Genital herpes can be treated and managed. Baill stresses that for most people who have healthy immune systems, the high-risk times for giving a sex partner genital herpes are during the first outbreak and during later outbreaks of sores. “Without such an outbreak, the viral load is usually not sufficient to infect a normal, healthy partner,” she says. “Antiviral medication can be effective at controlling the frequency and the severity of genital herpes outbreaks,” Baill says. For some people, though, even the times when no symptoms are present can be risky ones for transmission. “If you have genital herpes and your partner is taking biologic drugs for rheumatoid arthritis or MS [multiple sclerosis] or psoriasis, you may need to be extra careful,” says Baill. “It may take a lower viral load to infect people taking those medications.” In these situations, she says, you may want to take antiviral drugs in an ongoing way to keep your viral load low and protect your partner. After the initial outbreak, outbreaks tend to last for less time and have less severe symptoms. Research has indicated that the number of symptomatic outbreaks may decrease over time. (7)
Medication Options
Antiviral drugs are the primary way that genital herpes is treated. These medications can reduce the pain of genital sores during the initial outbreak, provide relief during later outbreaks, and make it less likely that you’ll infect any sexual partners with the virus. (8) Three antiviral drugs are used for treating genital herpes:
Zovirax (acyclovir)Famvir (famciclovir)Valtrex (valacyclovir)
“The three drugs are all basically the same medication. Their efficacy [effectiveness] is the same,” says Baill. The difference, she explains, is how often a person takes them. According to the CDC, the recommendation for a first episode of genital herpes is to follow one of these dosing options:
Acyclovir 400 milligram (mg) orally three times a day for 7 to 10 daysAcyclovir 200 mg orally five times a day for 7 to 10 daysValacyclovir 1 gram orally twice a day for 7 to 10 daysFamciclovir 250 mg orally three times a day for 7 to 10 days
The therapy can be extended if healing is not complete after 10 days. Some people also take antiviral medication during recurring episodes of herpes symptoms, and some take a daily antiviral to reduce symptom outbreaks and lower the likelihood of giving the infection to a sexual partner. Learn More About Treatment for Genital Herpes: Medication and More
Alternative and Complementary Therapies
Although it’s not known for certain what triggers herpes outbreaks, they are often associated with fatigue, stress, and illness. (5) Mind-body interventions that reduce stress, such as meditation and yoga, may therefore be helpful in reducing outbreaks. Getting adequate sleep and following a nutritious diet are also important for maintaining a healthy immune system and helpful for managing life stresses. Certain supplements and herbal remedies have been tried for preventing herpes outbreaks or easing the symptoms of an outbreak. To date, however, there’s insufficient data to conclude that any of them is safe and effective for this use. (9) If you wish to try a complementary therapy for genital herpes, speak to your doctor first to make sure the product you want to try won’t interfere with any medications or other therapies you’re currently using. Learn More About Alternative and Complementary Therapies for Genital Herpes
Prevention of Genital Herpes
You can give a partner genital herpes with any kind of skin-to-skin sexual contact. It can spread during vaginal, oral, and anal sex. Practicing safe sex can reduce the risk of transmitting the virus. This includes being monogamous, or having only one sexual partner, and using condoms or dental dams during sexual encounters. Herpes can spread from areas of the body not covered by condoms, though. The virus can live on your thighs and buttocks, for instance. Nonetheless, even though condoms can’t work all the time, regular use of condoms can reduce the risk of transmission. For greatest protection, use condoms and dental dams consistently, not just during outbreaks. Other steps to lower the risk that you will spread herpes to another person include the following:
Learn what it feels like for you when an outbreak is starting, and stop having sex as soon as you sense that feeling.Avoid sex completely during active outbreaks. Condoms can’t completely cover infectious areas and cannot be counted on during such times.Wait for all sores to scab over and heal before having sex again.Avoid touching your herpes sores, because you can spread the germs around your body that way. If you touch a sore, wash your hands right away.Don’t kiss anyone — especially pregnant women, babies, or children — or have sex when you have a cold sore.Tell a prospective sex partner about having herpes before you have sex with them, even though it may be hard.Ask your doctor about taking antiviral drugs to control herpes.
Other sexually transmitted infections Having genital sores can increase the likelihood that you contract or spread other sexually transmitted infections, including AIDS.Newborn infection If a baby is exposed to the herpesvirus via the infected mother, it can result in brain damage, blindness, or even death for the newborn.Bladder issues Sometimes the sores associated with genital herpes can cause inflammation around the tube (called the urethra) that delivers urine outside your body from your bladder. The swelling can close the urethra for several days; if this occurs, a catheter must be inserted to drain the bladder.Meningitis Although rare, herpes simplex infection can lead to inflammation of the membranes and cerebrospinal fluid surrounding your brain and spinal cord.Rectal inflammation Also called proctitis, genital herpes can cause inflammation of the lining of the rectum, especially in people who have anal sex.Eye infection Called herpes keratitis, a herpes simplex infection of the eye can cause pain, redness, blurred vision, tearing, and sensitivity to light. Untreated, it can lead to severe damage to the eye. (2)Skin infection In addition to causing sores around the mouth and nose, HSV-1 can also cause sores on other areas of the skin, such as the sides of the neck, sides of face, and forearms. Called herpes gladiatorum, this presentation of HSV-1 is often seen in athletes who participate high-contact sports such as rugby, wrestling, and boxing. The skin lesions typically appear 4 to 11 days after exposure. (11)
Genital Herpes and Pregnancy
Pregnant women who get genital herpes during pregnancy, or who had genital herpes before becoming pregnant, can spread the infection to their babies during delivery. If it’s not treated, it can be deadly to the baby. The risk of giving herpes to your baby during delivery is low, however. Most women who have genital herpes give birth to uninfected babies. (12) Still, it’s important to avoid getting herpes while pregnant. And if you’re pregnant and already have genital herpes, you should have regular prenatal visits. If you don’t have your own doctor, find a Planned Parenthood clinic, a community health center, or another clinic that provides prenatal care. Tell your doctor if you have ever had symptoms of, or have been diagnosed with, genital herpes. Also tell your doctor if you have ever been exposed to genital herpes. Some research suggests that genital herpes infection may increase the risk of miscarriage or heighten the risk that you will give birth too early. (13,14) If you are pregnant and have genital herpes, your doctor may prescribe herpes medicine late in your pregnancy. This medicine may reduce your risk of having signs or symptoms of herpes when you give birth. At the time of delivery, your doctor should carefully examine you for herpes sores. If you do have herpes symptoms at delivery, the doctor may do a cesarean section (C-section).
The Emotional Side of Herpes
Many people feel embarrassed and ashamed upon learning that they have genital herpes, or they’re worried about getting it from a sexual partner or prospective sexual partner. If either case describes you, take the time to educate yourself about the causes and symptoms of herpes, treatments, and steps you can take to stop the spread of herpes, such as using condoms. It’s important to recognize and deal with feelings, worries, and fears you may have. Talking to your doctor or another healthcare provider can help you normalize your experience and move forward. If you are in a committed relationship, it may be helpful for you to make an appointment to see a healthcare provider with your partner. Engaging in open conversations with your provider and any sexual partners may help to put your mind at ease. You will find out about the right precautions to take in light of your own personal situation. According to data from the National Health and Nutrition Examination Survey (NHANES), the prevalence of HSV-2 was 11.9 percent during 2015 and 2016, a decline of 5.9 percentage points from the years 1999 and 2000. (16) HSV-2 is more common in women than in men. It’s suspected that women are more likely to contract the HSV-2 infection because genital infection is more easily transmitted from men to women than from women to men during penile-vaginal sex. (7)
Black Americans and Genital Herpes
The NHANES survey found that the age-adjusted prevalence for the HSV-2, the virus that causes most genital herpes, was 34.6 for Black Americans, compared with 8.1 percent for white Americans. (16) Black Americans are also less likely to be diagnosed with genital herpes, even after accounting for socio-demographic factors such as education and income or health insurance. Lack of diagnosis likely contributes to ongoing transmission of the virus at a higher rate than for white or Hispanic Americans. (19)
Mexican Americans and Genital Herpes
There was no significant difference in the age-adjusted rates for HSV-2 between Mexican and white Americans; the age-adjusted prevalence was 9.4 percent and 8.1 percent, respectively. (16)
Varicella zoster virus, or human herpesvirus 3, the cause of chicken poxEpstein-Barr virus, or human herpesvirus 4, the cause of infectious mononucleosis and other diseasesCytomegalovirus, or human herpesvirus 5, which in most people causes no symptoms but can cause CMV mononucleosis and hepatitis, among other diseasesHuman herpesvirus 6, a cause of Roseola infantum and middle ear infectionsHuman herpesvirus 7, a cause of Roseola infantumKaposi sarcoma associated herpesvirus, or herpesvirus 8, a contributing cause of Kaposi sarcoma and AIDS-related non-Hodgkin lymphoma
The STI Project: STD Support Groups This organization lists support groups for people living with herpes and HPV in the United States, Canada, and Australia. Some groups meet in person, while others provide hotline support or online forums. DatingWithHerpes.org This group intends to give accurate and current information, support, and advice to people with genital herpes and their partners, friends, and families. The group offers tips on navigating dating life and how to have honest conversations about genital herpes. American Sexual Health Association (ASHA) This website offers straight information about genital herpes and lists a selection of herpes support groups around the United States and Canada. ClinicalTrials.gov Stay up-to-date on the latest research in genital herpes treatments, vaccines, and more. Learn More About Sexuality and STD Resources Additional reporting by Becky Upham.
