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Last updated October 11, 2019. 8 minute read

Genital herpes: signs, symptoms, treatment, and more

Genital herpes is one of the most common sexually transmitted infections (STIs), affecting more than 500 million people worldwide. Genital herpes is caused by a viral infection, primarily by herpes simplex virus 2 (HSV-2), but can also be caused by herpes simplex virus 1 (HSV-1), the virus that also causes cold sores (oral herpes). These viruses are part of the herpes virus family.

Dr Jefferson Chen Md Written by Dr. Jefferson Chen, MD
Reviewed by Dr. Mike Bohl, MD, MPH

If you or your partner have been diagnosed with genital herpes, you probably have a lot of questions about what to expect and how it will impact your life. First, know that you’re not alone. Genital herpes is one of the most common sexually transmitted infections (STIs), affecting more than 500 million people worldwide (Jaishankar, 2016). Genital herpes is caused by a viral infection, primarily by herpes simplex virus 2 (HSV-2), but can also be caused by herpes simplex virus 1 (HSV-1), the virus that also causes cold sores (oral herpes). These viruses are part of the herpes virus family. The symptoms of genital herpes can vary significantly from person to person. Some people infected with genital herpes can have mild symptoms or no symptoms at all. Others experience severe, painful ulcers on their genitals, itching or burning with urination, fever, headache, flu-like symptoms, and swollen, painful lymph nodes. Unfortunately, once you’re infected with genital herpes, there’s no cure. However, some medications effectively treat outbreaks and prevent them from coming back.

Vitals

  • Genital herpes is one of the most common sexually transmitted infections (STIs).
  • Genital herpes is caused by two viruses in the herpesvirus family: HSV-1 and HSV-2.
  • Symptoms of genital herpes vary from person to person. The most common symptoms include small pimples or blisters on the genitals that turn into painful ulcers or open sores.
  • There’s no cure for genital herpes, but it can be effectively treated with antiviral medication.

How many people have genital herpes?

Genital herpes is widespread. The Centers for Disease Control and Prevention (CDC) estimates that 12% of 14-49-year-olds in the United States are infected with HSV-2, the virus that commonly causes genital herpes (CDC, 2017). The good news is that HSV-2 infections are becoming less common. The CDC reported that the rate of infection with HSV-2 dropped from 18% in 1999-2000 to 12% in 2015-2016.

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Who is at the highest risk of getting genital herpes?

Unfortunately, ladies, women may be at higher risk of getting genital herpes. The CDC estimates that 15.9% of women aged 14-49 years old are infected with HSV-2 compared with only 8.2% of men (CDC, 2017). This is most likely because it is easier to transmit herpes virus infections from men to women during penile-vaginal sex than the other way around. Additionally, studies have shown that HSV infections are more common among non-Hispanic blacks (34.6%) than among non-Hispanic whites (8.1%) (Bernstein, 2013).

How is genital herpes transmitted?

Let’s talk about how genital herpes is spread from person to person. Herpes infections are commonly transmitted during oral sex, anal sex, or vaginal sex. The highest chance of transmitting a herpes infection is during an outbreak, but even when there are no ulcers, genital sores, or rashes, there’s still a chance of spreading the virus. And unlike what you may have heard from your friends, there’s no chance of getting genital herpes from a toilet seat.

So how can you prevent genital herpes? Studies have shown that condom use can reduce the risk of transmitting HSV-2 by 30% (Martin, 2009). Additionally, if you know you have genital herpes and don’t want to spread it to your sexual partner, taking an antiviral medication such as valacyclovir (brand name Valtrex), can prevent herpes outbreaks and decrease the risk of giving genital herpes to someone else. If you do have an outbreak, it’s important to abstain from having sex until the outbreak has gone away.

Because there’s no foolproof way to guarantee that genital herpes can be prevented (other than complete abstinence from sexual contact), it’s vital to communicate with your partner before a sexual encounter. It might be embarrassing or uncomfortable, but it’s an important conversation to have.

How is genital herpes diagnosed?

The diagnosis of genital herpes starts with the physical exam that your healthcare provider performs. To help your healthcare provider confirm the diagnosis, there are several laboratory tests available that your healthcare provider can use. These tests are especially important when the diagnosis is not clear from your symptoms. 

The standard test is called a viral culture. This test is used when there is an active lesion (ulcer or blister) on your genitals. To send this test, your healthcare provider sends a sample from your lesions to the lab, where they will attempt to grow or isolate the virus. This can take up to a week to come back with a result. A positive result on the viral culture almost always means that you have genital herpes. However, it only catches around 50% of genital herpes cases (Schomogyi, 1998) and the probability of getting a false negative increases once your lesions start to heal.

A newer test is called a polymerase chain reaction (PCR) and detects the DNA of the viruses that cause genital herpes. To send this test, your healthcare provider needs to collect a sample from your lesions and sends the swab to the lab where the genetic material is amplified and analyzed. Compared with the viral culture, the PCR test is usually faster and can detect more cases, even in people without symptoms (Gupta, 2004). Unfortunately, the PCR test can be more expensive than the viral culture. 

Finally, there are blood tests that look for antibodies your immune system produces against the viruses. These are called serological tests, and they are highly accurate (Workowski, 2015). They are able to differentiate between the different viruses that cause herpes. If you’ve had a negative viral culture or PCR, but your healthcare provider still thinks you may have been infected with genital herpes, s/he may send this test to be sure. Unfortunately, if you’ve been infected recently with genital herpes, this test may not pick it up as it can take several weeks before the test can detect it.

What is the “lifecycle” of genital herpes?

The “lifecycle” of genital herpes is what healthcare providers call the different phases of infection. The first time you experience symptoms is called the initial episode or first outbreak. This typically occurs a few weeks after you become infected. Symptoms during the initial episode tend to be more severe than in later outbreaks and can include blisters in the genital area that turn into painful ulcers. These symptoms can last for two to three weeks before they go away. 

After your symptoms resolve, you enter the latent phase of the infection. The virus travels to a bundle of nerves called the sacral ganglia. It’s from these nerves that recurrences of genital herpes will come from. You won’t experience any symptoms during this stage. Keep in mind that even without symptoms, you can spread genital herpes to another person. 

When your symptoms come back, it’s called a recurrent episode. The virus that’s been hanging around in your sacral ganglia travels back down your nerves and causes another outbreak. Before any major symptoms occur, you may experience what’s called a prodrome, during which you might feel mild itchiness, tingling, or pain in your genitals or the surrounding area. Note: This would be a great time to take antiviral medication to prevent a full-fledged outbreak if you have it available. After the prodrome, the genital herpes symptoms you experienced during your initial episode come back, and you’ll have painful ulcers once again. When the recurrent episode ends, your infection goes back into the latent phase. You’ll continue to cycle between these two throughout your life. 

Recurrent episodes can happen multiple times a year. In one study, nearly 9 in 10 patients with newly diagnosed HSV-2 had at least one recurrent episode within 391 days, 4 in 10 had at least six episodes, and 2 in 10 had more than ten episodes (Benedetti, 1994). After the first year, the frequency and severity of episodes should go down.

What causes a genital herpes outbreak?

People with genital herpes can often identify “triggers” that spark an outbreak. The science behind what causes recurrences is incompletely understood, but researchers think that the nerve cells that house the virus are stimulated in some way, which triggers the replication of HSV (Berger, 2008). Some find that stress, other illnesses, decreased immunity, sunlight, and fatigue can trigger recurrent herpes outbreaks. In women, menstrual periods may also play a role in triggering outbreaks.

What does genital herpes look like?

Genital herpes typically looks like small pimples or blisters that will turn into painful ulcers or open sores. Over time, they will crust over and then form a scab. For women, these blisters are frequently found in the vagina and on the vulva. For men, the penis and scrotum are commonly affected. And for both men and women, the anus, buttocks, and thighs are areas that often have blisters. 

Not all genital ulcers are herpes. Other diseases that cause genital ulcers include syphilis, chancroid, drug reactions, and Behçet’s syndrome. If you’re worried about genital herpes, seek out a healthcare provider.

Can you only get genital herpes on your genitals?

HSV-1 and HSV-2, the viruses that cause genital herpes, can infect other parts of your body outside of your genitals. A rare but serious infection can occur when these viruses affect your brain or the lining surrounding it. This can cause headaches, confusion, nausea, fever, seizures, drowsiness, and, in severe cases, death. Other areas that HSV can infect include the nerves that control urination—which can cause urinary retention (inability to urinate) and leg weakness—and the rectum (the part of your digestive tract that connects your colon to your anus)—which can cause pain and diarrhea.

How is genital herpes treated?

Although there is no cure for genital herpes, there are excellent treatments available. There are three antiviral medicines commonly used to treat genital herpes—acyclovir, famciclovir, and valacyclovir. These medications are taken by mouth. These can be used on an ongoing basis to prevent or suppress outbreaks (also known as suppressive therapy), or they can be used to abort or shorten an episode when taken at the first sign or symptom of an outbreak.

Some antiviral medications are also available in a topical form but are not nearly as effective as the oral medications (Corey, 1983). Additionally, studies have shown that using topical antivirals with oral antivirals at the same time isn’t any better than just taking oral antivirals (Kinghorn, 1986).