Genital herpes

Overview

Genital herpes is caused by HSV-1 or HSV-2. It spreads through skin-to-skin contact during vaginal, anal, or oral sex. It can spread even when there are no sores.

After the first infection, the virus stays in the body. Sores can come back from time to time, called outbreaks. Outbreaks usually become milder and less frequent over time.

Symptoms

Many people never notice symptoms, or mistake them for a pimple or ingrown hair.

• Painful genital sores or blisters that break open
• Blisters on or around the genitals, rectum, or mouth
• Tingling or itching before sores appear

Less common

• Fever and body aches with the first outbreak
• Swollen glands in the groin
• Burning when urinating
• Headache

How it usually goes

• First outbreak: Often the worst; sores can take 2 to 4 weeks to heal.
• Later outbreaks: Usually milder and shorter, often with tingling first.
• Over years: Outbreaks usually become less frequent.

Look up a symptom: Blisters · Body aches · Burning when urinating · Fever · Genital itching · Genital sores or blisters · Painful sore on the genitals with a painful groin lump · Painful, swollen lymph nodes in the groin after sex, or a groin node that drains · Recent sex without a condom, or a partner with an STI · Rectal pain, discharge, or bleeding after anal sex · Swollen glands

When to get medical care

Causes

Genital herpes is caused by herpes simplex virus type 1 or type 2. HSV-1 also causes cold sores and can spread to the genitals through oral sex.

It spreads through contact with a sore, the skin, or fluids of someone who has it, even if they have no symptoms.

Does it spread or run in families?

• Yes, it can spread from person to person.
• How it spreads: touch or sex.
• Condoms lower the risk. Sex partners should be tested and treated too.

Who is more likely to get it

• More than one partner
• A partner with herpes
• Not using condoms
• A weak immune system (more severe outbreaks)

Possible complications

• HIV: Herpes sores raise the risk of getting or spreading HIV
• Cold sores: Caused by the same virus family

Diagnosis

A healthcare professional can often tell by looking at the sores.

Questions you may be asked

• When the sores started and what they look like
• Fever, body aches, or swollen glands
• Past sores in the same area
• Recent partners

The exam

They'll look at the sores and nearby lymph nodes.

Tests

Tests can confirm it:

• Swab of a sore: Best done on a fresh sore, before it crusts over.
• Blood test: Can show past infection, but can give wrong results; not usually done without symptoms.

Treatment

Antiviral medicine can't cure herpes, but it helps sores heal faster and prevents outbreaks.

Self-care

• Keep sores clean and dry
• Don't touch the sores. Wash your hands if you do, to avoid spreading it to your eyes or others
• Wear loose cotton underwear
• Take pain relievers and try a warm bath for comfort
• Avoid sex from the first tingling until sores are fully healed
• Tell your partners so you can decide together how to lower the risk

Medicines

Antivirals need a prescription. Creams don't help much.

Everyone with a first outbreak should get antiviral medicine, even if it seems mild.

If you have frequent outbreaks, daily medicine (suppressive therapy) can cut outbreaks by most and lower the chance of spreading herpes to a partner.

How it compares

Prevention

You can lower the risk:

• Use condoms every time; they help but don't cover all skin
• Avoid sex during outbreaks or when you feel tingling
• Daily antiviral medicine lowers the chance of spreading it
• Talk with partners about herpes before sex

Which doctor treats this

• Start with your primary care provider (family doctor or internist).
• They may send you to a sexual health clinic, an OB-GYN, or a urologist; your local health department can test for free or low cost.

Living with it

• Keep a simple diary of symptoms, triggers, and medicines to bring to visits.
• Bring a list of your medicines and questions to each visit.
• Stay active in ways that feel good to you.
• Get enough sleep and manage stress.
• Long-term illness can affect mood. Tell your doctor if you feel down or anxious.

Back to school, work, or sports

• You can go to school and work as usual.
• Don't have sex until you and your partners finish treatment and your doctor says it's OK.

Children, pregnancy, and older adults

• Pregnancy: Herpes can pass to the baby during birth and be very serious. Tell your healthcare professional; medicine late in pregnancy or a C-section may be advised.
• Newborns: Call right away if a newborn has blisters, fever, or seems sick.
• Weak immune system: Outbreaks can be longer and more severe.

Pregnancy and breastfeeding

• If you're pregnant or planning to be, tell your prenatal provider about this condition.
• Some infections can pass to the baby during pregnancy or birth. Tell your provider if you've been exposed.
• Don't start or stop any medicine on your own. Some are safe in pregnancy and some need to be changed.
• Ask before taking any pain reliever. The FDA advises avoiding ibuprofen and naproxen after 20 weeks unless your doctor says to.
• Breastfeeding: Most medicines are fine, but ask. The NIH LactMed database lists what's known about each one.

For caregivers

• Go to visits when you can and take notes.
• Keep a list of medicines, allergies, and doctors in one place.
• Learn the warning signs that need fast care.
• Take breaks and ask for help. Caregivers need care too.

Outlook

Herpes is lifelong but manageable. Outbreaks usually get milder over time, and medicine helps control them and protect partners.

Myths and facts

Getting ready for your visit

Go while sores are fresh, if you can.

What to bring

• When sores started and how often they come back
• Recent partners
• Whether you're pregnant

Questions to ask

• Should I take daily medicine?
• How do I lower the chance of spreading it?
• What should I tell my partner?
• What if I get pregnant?

Research studies

Research studies test new ways to find and treat health problems. Some are looking for volunteers. Talk with your doctor before joining one.

Search ClinicalTrials.gov for studies on Genital herpes